2000, 09-25 Permit App: 00008610 TrussesSroigCotign
es(n (to CIO
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
Project Description: RPSrtc%d,tc ( RP vtfcfc/
TYPE OF APPLICATION
,Z Building Permit
O Change in Use
O Grading
0 Manufactured Home Permit
0 Relocation
0 Sign
0 Tenant (New/Change)
0 Other
SPECIFIC SITE INFORMATION
Street Address:
0e7/0
Assessor's Tax Parcel Number(s):
Legal Description:
OWNER/APPLICANT INFORMATION
El Indicate who should be contacted rerardinr this nroiect
0 Owner'.{(1,, �(�I
I�KAAx t. t IX Qi
(�"y��Phone:
0 kbas. t
0 Applicant: / Phone: yq 5. )5y
/2tni / : JN kr Fax:
Mailing Address:
kliktittl
rA4
d.t Q
Mailing Add /
/AC ? I7 s Aflmiiig f ie RC(
City, State, Zip
Total habitable space
1,
2"d floor sq. ft. l
City, State, Zip
Spo/1-0.--.- es(mss g 4 z 2 u
0 Contractor
Construction type
Fho
Fax
0 Architect/Engineer Phone
Fax
Mailing address
i(
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROTECT INFORMATION
"
Building height to peak
# of stories
5': ray /-b
Main floor sq. ft.
90.5—x('00 ,{'-,<
Unfinished basement sq. ft.
Dimensions
'-(ax 21
Total habitable space
1,
2"d floor sq. ft. l
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Co of projectSO
41 / / SvOO .
Heat source (electric, gas, etc.)
c
Width:
Length:
What is the square footage of the sign
race?
How high is the sign?
Year:
Make:
N of signs
Area of existing signs
Previous address
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
Proposed use
Value
Firm Name
Inspectors.
Phone
Plans Examiner
Address
Phone
Inspector
Phone
0 Concrete 0 Welding 0 Bolting 0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
Ifyes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No,
Will the site be served by a septic system? 0 'Yes 0 No
Is any pan of the property within a 100 yr flood plain?
If yes, identify on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
If yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% 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
tYYhep'roptity. iii a .4{cs naafi tor` wa e% �hi.a�tt d
�".. mRK Ss,{ aW �` •t y"�irv'F "4`h+tkti Ya��
a i.," s€
Y'4 .Yh #
s publicseav valla taM}Ceta* 'sitar - .
SUBTOTAL
'e
r
e'
88%
Is risc prol#, luside the' ASA? s 1= x` 4
s is
t k ‘v„dtku°n az° .1 4v a ,. rLt, ,p.tw,f
I Sy "r�
'€s , L ' NP,> ' s, i
xTs tubltcw ei ilableegto rpt
7
x .r,� ,�. , e , s. ie+ rE°
th o etrty��s��de the SA'?
2c, htli p9'r,
`'i ra "''D
C1. No . :*
I'sahe, ,op�" 1b8.ttcd w ihixWt�000 eeet.o
a: a,.�{
i
la
e'•
+.,''
)s"
Date Received:
Staff Representative:
METHOD OF PAYMENT
❑ CASH ❑ CHECK ❑ 111111111111111111 ❑ :.._. <<:.:,;,_ ❑
FAXED PERMITS WILL ONLY BE ArFPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL
8
'MI
,a,„14A
a* .,
MW, C '
HE
cos
88%
88.8 a
n
TSS
FEV )3i.00P