2002, 05-09 Permit App: 02003550 Reroof I PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
AA:ilk
SPOKANE,WA 99260
11 509-477-3675 02 _ 3 S
Sroi c COUIyTY V0
SPECIFIC SITE INFORMATION
treet Address: E
S
7LiS'` /s''
� . Aum
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: ��koKL 5 �E��C
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Pun eyor. Sewer District/Purveyor Road width Setbacks
Front Rear.
School District Fire District Zoning
Left: Right
OWNER/APPLICANT INFORMATION
,�� 0 Indacale who should be conlacled regarding lb's project
ltl (/h/���•ncrr.r - ! ,4�/C� Phone: �( 7 ❑ Applicant: Phone:
t A dy 6V i 5/ �' `� Fax: Fax:
S ailing Address: Mailing Address:
C, State,Zip Cit,,State,Zip
,5 K WA, i''.3- i
❑ ContractorPhone In Architect/I::nl,�neer Phone
JA- b- lax l'ax
Mailing address Mailing address
City,State Zip Cm,State Zip
WA State Contractor license# Contact name: RECEIVED
MAY 0 9 A.M. dt,n3
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2 I floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
/ Cost of project�j�,� 0 0 I teat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: What is the square footage of the sign Flow high is the sign?
r . fafe?
Year: Make: #of signs Area of existing signs
Relocation Fire Safety
Previous address I'ire 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
0 Concrete O Welding O Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? O Yes O No What is the current property size?
Ifyes,identi,fi 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?
Ifyes,ident4 on site plan O Yes 0 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes O No
O Don't know 0 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?
Ifyes,identiA on site plan Ifyes,ident/,on the site plan Yes O No
0 Maybe O Don't know 0 Yes O No
Arc there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identii5t on siteplan 0 Yes O No 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 in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
OYes 0 N
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes O No
0 Yes 0 No
Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
OYes ONo
Date Received: Stall Representative:
METHOD OF PAYMENT
Ei1COV[ SUBTO"1':v.
VISA •
0 c;ASI I ❑ cI iEcK ❑ 0 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I;SPIRES: TOTAL FEE
BANKCARI)NUNIBI'.R: MINIMUM PERMIT FEE IS 05.00 PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AUTHORIZED SIGNATURE: COUNTY PERMIT CENTER