2001, 05-17 Permit App: 01003712 Reroof1ee R06Project Description:,7s
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SPOKE COUIyTY
Street Address: (I X)7 E VC" //
Assessor's Tax Parcel Number(s): q 57/ , 94,
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Legal Description:
O Building Permit
O Relocation
O Change in Use
0 Sign
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1
0 Grading
0 Tenant (New/Change)
g)
0 Manufactured Home Permit
O Other
i
Owner,
Mailing Address:
OWNER/APPLICANT INFORMATION
IZI Indicate wbo should be contacted regarding this project
Phone, 7 t�yt1 ' Applicant,
4/ ❑
Fax,
City, State, Zip
s t ff i e 6..44 47 C
0 Contractor Phonc
Mailing address
City, State Zip
Fax
Mailing Address:
City, State, Zip
Phone:
Fax
WA State Contractor license #
/Conua name:
0 Architect/Engineer
Phone
Mailing address
Fax
1
City, State Zip
PROJECT INFORMATION
Building height to peakN of stones
Diinensions
)ccupancy group
'ost of project
Total habitable space
fi
Construction type
Main floor sq. ft//� Unfinishedbasement sq_ ft_
Uel
2°d floor sq. ft. LL/ Finished basement sq. ft.
Garage sq_ ft. Deck sq. h.
�!I
Heat source (electric, gas, etc.)
Width:
Year:
Length:
Make:
What is the square footage of the sign
face?
1 of signs
How high is the sign?
Area of existing signs
Firm Name
Phone
Plans Examiner
Phone
Inspectorfi
Address
Inspector
Phone
0 Concrete 0 Welding 0 Bolting 0 Reinforcement
Address
NAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the propeny within 250 feet of a shoreline?
I If yes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
If yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identih on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/ %) O Yes O No
Are critical or hazardous materials used or stored on site?
0 Yes O No
DEPARTMENT USE ONLY
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH 11 CHECK ❑ =NM❑
ifCOVE
•
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANK CARD NUMBER:
4UTHORIZED SIGNATURE:
SUBTOTAL
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