2002, 02-04 Permit App: 02000689 Reroof lik
l PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
Ilk
SPOKANE,WA 99260
SPO CO Of
509 477-3675 2 '0 &g 0(
SPECIFIC SITE INFORMATION
Street Address: r l �y� q
13 ✓tea( _— . 3 112 ( e a,�eery - / Lc)/51, ?fes'`' !.9a/,G"
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: (Fe_ —lo IQ eir,^/(3 p L vi-,,,
71 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
In Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Purveyor. Sewer District/Purveyor Road width Setbacks
Front Rear.
School District Fire District Zoning
Left: Right.
OWNER/APPLICANT INFORMATION
El Indita[e who should he eon/aeled retarding Mit project
❑Owner: Phone: ❑ Applicant: Phone:
Fax: lax:
Mailing Address: Mailing Address:
City,State,Zip Cm,State,Zip
liAContractor p;�.a. 1 one(VI� gab — i8 ❑ Architect.I nlnneer Phone
'E 1 t � u ,:ax C5,5-) 7i0 ,2/77 I ax
Mailing addresssMailing address
JT7e.L./ k: - '0irb ,;,,t-j
Cite,State Zip Cit,State Zip
O &Stt/d • 9o/,6
A
VA State Contractor license# ( Contact name:
P�2 C tf- °Q9 o MCS_,
PROJECT INFORMATION
Building Information
Building height to peak #(if stones Main floor sq.ft. Unfinished basement sq.ft.
7
Dimensions Total habitable spac2nt floor sq.ft. Finished basement sq.ft.
7 /4 67, /4
Occupancy group Construction type Garage sq. ft. Deck sq.ft.
Cost of project I Teat source(electric,gas,etc.)
3 ,,
Manufactured Home 0" Sign
Width: Length: What is the square footage of the sign flow 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?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
0 Concrete O Welding 0 Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
Ifjer,identifi,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,ident'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?
Ifyes,identj on site plan Ilyes,yes,identii,on the site plan 0 Yes 0 No
0 Maybe 0 Don't know 0 Yes 0 No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
If yes,identifp 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?
( %) O Yes 0 No O Yes 0 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? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No
D 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?
D Yes CI No
Date Received: Staff Represen tarns e:
METHOD OF PAYMENT
11C#VE. SUB1'OT:vl.
VISA
❑ cAsll ❑ clll:ck ❑ , 5 e S ❑ � ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
l:NP1RI(S: TOTAL FEE
R\NkC.\Rl)NUNIR1{R: MINIMUM PERMIT FEE IS$35.ADPLE_\SE
AKE Ct IECKS PAYABLE TO SPOKANE
\UTI IOR1/,l::1)SlGN.A7'URI:: COUNTY PrRvuTCENTER