2000, 10-30 Permit App: 00009972 Reroof ---p-
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1 PROJECT APPLICATION WORK SHEET dc
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SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
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SPOKANE,WA 99260
SPOKANE Cot 'y 509-477-3675
SPECIFIC SITE INFORMATION
Street Address: 'G QO2 1, VG.4(y CJ ) v�CzcicJ� / ici , ?Q 6$ 7
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Assessor's Tax Parcel Number(s):
Legal Description: �/
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Project Description: i V .-C% (&si 2 So, 1-e—s
$ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
CI Relocation CI Sign ❑ Tenant (New/Change) ❑ Other
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OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted regarding this project
❑ 0 er: Phone: R93-12•74 CI Applicant:
� Phone:
�j Fax: Fax:
Mailing Address: Mailing Address:
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City,State,Zip City,State,Zip
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CI Contractor l Phone
Cl Architect/Engineer Phone
/1n�/ Fax 4
Fax
Mailing address Mailing address
City,State Zip City,State Zip
WA State Contractor license# Contact name:
PROJECT INFORMATION
Building Information
Building height to peak Hof stories Main floor sq.ft. Unfinished basement sq.ft.
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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 cidHeat source(electric,gas,etc.) r I
-H1—�►rced 41. v.41. v. deet (�
h r ate'
Width: Length: What is the square footage of the sign How high /is the sign?
face?
Year: Make: #of signs Area of existing signs
rpa� ago
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% •a. , s:" .,..x. .,ASIC'. ,,. ,a_. ".==•
Previous address Fire Sprinkler Tent
Paint booth Fire Alarm Fireworks display
Proposed use Value
4:04d„
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11.52161
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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? O Yes 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 shoreline? What is the current use of this property?
If yes,identify on site plan O Yes O No
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 If yes,identify on the site plan O Yes O No
O Maybe O Don't know O Yes O No
Are there any wetlands,streams or ponds within 200 feet of the Is there evidence of fill or excavation on the property?
property? O Yes O No
If yes,identify on site plan O Yes O 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?
( /%) O Yes O No O Yes O No
DEPARTMENT USE ONLY
Is the property uc a desglrate •dtorngi�Cct aAe "R � • Mvi
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Date Received: Staff Representative:
METHOD OF PAYMENT
V.;', f!C r SUBTOTAL
VISA' ,
❑ CASH ❑ CHECK 0 . ❑ 0 --
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
TO�'AJ.BEE
BANKCARD NUMBER: MFI177Mi1MPERtdJ1 t I $3500PIEASE
MAKE CHECKS PA A i'OSPOKANE
AUTHORIZED SIGNATURE: COtiNtXPER?wiiTNtEi�