2002, 01-14 Permit App: 02000219 Safety Inspect 0a — tel
( 1 PROJECT &PPLICATION WORK SHEET
A SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
SPOx'CoUKTY 509-477-3675
SPECIFIC SITE INFORMATION
Street Address: M' O e�O ���� /day
`[f�
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: ,. _ / ,,Ar .✓./
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) Er Other
Department Use Only
Water District/Purveyor. Sewer District/Purveyor Road width Setbacks
Front Rear
School District Fire District Zoning
Left: Right:
OWNER/APPLICANT INFORMATION
0 Indirale who should be contacted renardinn this juuyed
❑ Owner: -/ �J�/-7r y�'Phhhoone: a� /o55/-(p133 ❑Applicant:
./L ./ gfy ,31 J Phone: zee GG 7 6/r)
ofcu1/IV�ro' /nardi Alatia,: rgeE (�N Co,ti ,:ax: .o --c.----
Mailing Address::� Mailing Address:
if
(a ,. ate,/. city,State,Zip
eX 9c4C 4 g cofae diliet/E (p 338'/ /
❑ Contractor Cohone 4a a6' 1 6/"g'/ CIArchitect-Engineer Phone
FEEmf ,/ (tet%vS T Fax cr 4 7 z, / I'ax
Mailing address Mailing address
814 v,Cro"ix/ Pa
(Sts,State Zip Cin,State''Lip
Cot1uI_ dXISA' /0 i'3r/6
WA State Contractor license# Contact name:
pa6'Ertt C1 /01 /f
PROJECT INFORMATION
Building Information
Building height to peak #of stones Main floor sq. ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2"d floor sq.ft. finished basement sq.ft.
(Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project I leaf source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: What is the square footage of the sign I low high is the sign?
faces
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
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Yes ❑ 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 shoreline? What is the current use of this property?
I f yes,ident/,on site plan ❑ Yes ❑ No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?❑ Yes ❑ No
❑Don't know ❑ Yes ❑ No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
1/yes,
irlentijj,on site plan Ifye,identif t on the site plan ❑ Yes ❑ No
❑Maybe ❑Don't know ❑ Yes ❑ No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
I/yes,ident/'on site plan ❑ Yes ❑ No ❑ Yes ❑ No
Are there slopes greater than 30%on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
( %) ❑ Yes ❑ No ❑ Yes ❑ No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? ❑ Yes ❑ No
❑ Yes 0 N
Is the property inside the ASA? ❑ Yes ❑ No Is public water available to the site? ❑ Yes ❑ No
❑ Yes ❑ No
Is the property inside the PSSA? ❑ Yes ❑ No Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Receiv ed: Staff Representative:
METHOD OF PAYMENT
`i(Wit SUBTO \1,
VISA
0 C vsl I ❑ Cl ll:CK 0 ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
1)\TI(: I?\PlRFS: TOTAL FEE
BANK.\RI)NUMBI':R: MINIMUM PERMIT FEE IS$35.001'1,11 ASE
:aI AKE CHECKS PAS.SIILE 10 SPOIL ANE
AUII 1ORl/,I?D SIGN\I'URI:: COUNTvPtRyIIFCINTER