2000, 04-12 Permit App: 00002635 Tear Off, Reroof r
I , I PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
H SPOKANE,WA 99260 („
SPOKANE COUNTY 509-477-3675 �f
Project Description:
TYPE OF APPLICATION
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other
SPECIFIC SITE INFORMATION
Street Address: (....12.0 7 57,,Laer-(a..ta /47:viciccc.) 0_,._
4),--q--
Assessor's Tax Parcel Number(s):
Legal Description:
Department Use Only
Water District/Purveyor: Sewer District/Purveyor Road width Setbacks',
Front: Rear:
School District: Fire District: Zoning
Left: Right:
OWNER/APPLICANT INFORMATION
El Indicate who should be contacted regarding this project
❑ Owner: Phone: '5,-.9
1 (Z3ty.7 ❑ Applicant: Phone:
/
t/l)a(f`/P(A—t- Etj41,1 SOL', Fax: Fax:
Mailing Address: Mailing Address:
L e 5-“,,der l,u-Q
Ctt ate,Z'tCity,State,Zip
/ 04 LI ft-
0 Contr� Phone �' j_55 L 9 ❑Architect/Engineer Phone
/Ca s I Ce-i ti Fax Fax
Mailing address Mailing address
1O0 3 I 3d
City,State Zt City,State Zip
WA Contractor license# Contact name:
oSk --X3fid- 0/ Co3All
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2nd floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project Heat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: What is the square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area of existing signs
Relocation Fire Safety
Previous address Fire Sprinkler Tent
Paint booth_ Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 1Yes O No What is the current property size?
If yes,identify on site plan (square feet or acres)
Is any part of the property within 250 feet of a shore •ne? What is the current up of thi property?
If yes,identify on site plan O Yes No :t?C
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O Yes O No
O Don't know O Yes O No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
If yes,identify on site plan E If yes,identi on the site plan O Yes O No
O Maybe O Don't know O Yes I�10
Are there any wetlands,streams or ponds within 2 0 feet of the Is there evidence of fill or excavation on the property)
property? O Yes No
If yes,identify on site plan ° )O Yes No
Are there slopes greater than 30%on the property. (3 ft rise in 100 ft) Are critical or hazardous materials used or stored on •��
( /%) O Yes t No O Yes
DEPARTMENT USE ONLY
Is the property in a designated Stortnwater Control Area? Is public sewer available to the site? O Yes D No
OYes 0N
Is the property inside the ASA? 0 Yes O No Is public water available to the site? O Yes O No
D Yes O No
Is the property inside the PSSA? O Yes O No Is the property located within 1000 feet of a Natural,Resource
Area? O Yes O No
Date Received: Staff Representative: