2002, 04-08 Permit App: 02002308 ReroofSPOKANE COUNfIY
Street Address
r'
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PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \VEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
5e- 3 01 Ott, 1e_
Assessors Tax Parcel Number(s):
Legal Description:
La., O//rKlL
Project Description:
0- Budding Permit
0 Relocation
Lay 0Vi /&!)4 -ti) col'
O Change in Use
O Grading
O Manufactured Home Permit
0 Sign
O Tenant (New/Change)
O Other
OWNER/APPLICANT INFORMATION
-- .........,...o .rrow,it In =macertgur@ng Ion pryea
Depai_nuent Use Only
Water Distncr/Punnyor.
❑ (1.`Y' e r phone:
5-aM4 s_ 5GG N
nhiling
Sewer District/Purveyor
' Road width_ .
e:Sithi'ks - -
Emile Rear.
.AaR Right
School District
Fire District
Zoning'
OWNER/APPLICANT INFORMATION
-- .........,...o .rrow,it In =macertgur@ng Ion pryea
❑ (1.`Y' e r phone:
5-aM4 s_ 5GG N
nhiling
0 Applicant:
Phone:
AJ
5 £
5a 3Tu7 (i1,,,,�,�
chi, <t
Mailing Address:
ate ,'rir L
City, State, Zip
0G,noarA i �1�/� 0!_i %fPham'
`1R W Eas�o btN (r
Mailing
/V C,
0 Architect/Engineer
gineyr
Phone
Fax
address
,
`^ o i Ai
i/11 is ma sito, cl D /(
City, Stale Zip
Mailing address`G
LI�e�?-Lcice_ t.s,L
\c':1 Stam Cnraa..r
circ, sane tip
m license =
Comanmmc
Sit t.al
L! q
1 /tld
PROJECT INFORMATION
Build Ight w peak
Dimensions
Building Information
# 0 f sr,,rk
Main floor ski.
Unfinished basement sq. fi.
Occupancy grc nip
Cost of rroject
inat habiublc space
rkt floor sq. fi.
Finished basernenr sq. fr.
Cunstructiun type
Garage sy. fi.
Deck sq. ft.
I Icaz source (elect tie, gas, etc.)
Manufactured'Home
Sign '
Width:
Length:
\Vhat is the square footage of the sign
face?
I -low high is the sign?
Year.
Make:
# of signs
Arca of existing Signs
Fireworks display
_
Address
Proposed use
Relocation
Fire Safety
Finn Name
What is the current use of this properrv?
Previous address
Will the sire be .served by a septic system? 0 Yes 0 No
Paint booth
Fire Sprinkler
Tent
_
Fire Alarm
Fireworks display
_
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Finn Name
What is the current use of this properrv?
Phone
Will the sire be .served by a septic system? 0 Yes 0 No
Plans E aminer
Phone
Inspectors:
Is there evidence of fill or excavaripn on the properrv?
0 Ycs 0 No
Arc there slopes greater than 301/4 on the property? (30 ft rise in 100 ft)
( .-%) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
Address
Inspector
Phone
13 Concrete
❑ Welding
❑ Bolting
0 Reinforcement
AJJres:
ADDITIONAL SITE INFORMATION
Arc therc structures on rhe property? 0 Ycs 0 Nu
If yes, identify on the plan
What is the current property size?
(square feet or acres)
Is any parr of the property within 250 feet of a shoreline?
If yet, idennifir on site plan 0 Yes 0 No
What is the current use of this properrv?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Ycs 0 No
Will the sire be .served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
fj•n, identi on site plan
0 Maybe 0 Don't know ❑ Yes 0 No
Are or will there be wells located on the property?
lbw. ide;tify on the rite plan 0 Ycs ❑ No
;\re there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identify on site plan ❑ yes 0 No
Is there evidence of fill or excavaripn on the properrv?
0 Ycs 0 No
Arc there slopes greater than 301/4 on the property? (30 ft rise in 100 ft)
( .-%) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Arca?
❑ Ycs O No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes ❑ No
❑ Ycs 0 No
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSS,\? O,,Yes 0 No
Is the property located within 1000 feet of a Natural Resource Arca?
0 Yes O No
Date Received
Staff It pm.enmInc.
METHOD OF PAYMENT
age
VISA
❑ C.\s11 ❑ ci II CI; ❑ ma= ❑ ❑
:41C111VF
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D.\'I'IX:
EN PI It I
BANIU:AIZD
.\Urn IORIZED SIG N.\'NItI.:
SLIB'f('1'AI.
TOTAL FEE
MINIMUM PERMIT FEE IS JJSOO PIS.\S E
.'Isla'. (:I IECICS PAYABLE '1'0 f.POKAN1
C.l1CNTV PERMIT CP.N I}R