2003, 12-05 Permit App: BLD-03-03204 Finish Basement 6 3 .... 32d ei
iiLl PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
f
SPOKANE,WA 99260
509-477-3675
SPOKANT CoviyTY
SPECIFIC SITE INFORMATION
Street Address:
''35 °14 OF Re- c- R
Assessor's Tax Parcel Number(s): f/ S � I1'qO 4
Legal Description: `� (�
L �_� \ a i
Project Description: ? "0
❑ Building Permit ❑ Change in Use ❑ Gra . g ❑ Man .,•s H�" Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Purveyor: Sewer District/Purveyor Road width Setbacks
Front: Rear. {
n A,
School District: Fire District: toning (�J 4
Left Right: (,....f.
OWNER/APPLICANT INFORMATION
Ei Indirale who should be conladed re aidmt lhirproject S
❑('()wner ('hone: 71 Applicant: Phone:
rKrg.fZ_ I`-' ZiE4>( Fax: Fax:
Mailing Address: I Mailing Address:
SAME sac A k r,t)
City,State,Zip City,State,Zip
Sp°KARif,, Lk)A- qq, 0
ElContractor Phone ❑ Architect/Engineer Phone
Fax Fax
Mailing address Mailing address
City,State tip City,State tip
WA State Contractoelicensc# Contact name
PROJECT INFORMATION
Building Information
Building height to peak #of stones 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 h � I[rat source(electric,gas,etc.)
3
Manufactured Home Sign
Width: length: What is the square footage of the sign 1 low high is the sign?
face
Year: Make: #of signs Arca 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?
Finn Name Phone l'lans I saminer Phone
Inspectors: Address
Inspector Phone
0 Concrete 0 Welding 0 Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
If yes,identity 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,identib,on site plan 0 Yes 0 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes 0 No
0 Don't know 0 Yes 0 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 Ifj,es,identib,on the site plan 0 Yes 0 No
0 Maybe 0 Don't know 0 Yes 0 No
Arc there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
If yes,identify on site plan 0 Yes 0 No 0 Yes 0 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?
( %) 0 Yes 0 No 0 Yes CI No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
0 Yes 0 No
Is the property inside the ASA? CI Yes CI No Is public water available to the site? CI Yes 0 No
0Yes 0 N
Is the property inside the PSSA? CI Yes CI No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received: Staff Representative:
METHOD OF PAYMENT
!COW SUBTOTAL
VISA
❑ CASH ❑ cl!F K ❑ =MO ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D.ATI l'XP1 R NS: TOTAL FEE
BAN K(;\Rl)NUMBI'IR: MINIMUM PERMIT FEE IS$35.00PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AU'l'I IORIZI'ID SIGN COUNTY COUNTV I'I RMITCENTER