2002, 10-21 Permit App: 02009277 Egress Windows lPROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
A
SPOKANE,WA 99260
509-477-3675
SPOx E COUNTY
SPECIFIC SITE INFORMATION
Street Address: i. 1 e/.02. •-• ]z, /-/`//v �,;��
� D A, lam//'. , ”-*Z Cf
Assessor's Tax Parcel Number(s): Z
Legal Description:
Project Description: 1-ii,-. 5 5 /a/ VOLA 5
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ 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
IZI Indicate who should be contacted reZardint this project
tPft Ownec �1 Phone: 9 . 9 �/ ❑ Applicant: Phone:
(1;///7g 1/- G if/(' Q✓✓ J�/ Fas: Fax:
Mailing Address: �/ Mailing Address:
/0 './2 fl &
City,State,Zip City,State,Zip
17�G7/�Q /7 (a 1/,7/1 9f Z(i
❑contractor Phone ❑ Architect/Engineer Phone
Fax Fax
Mailing address Mailing address
City,State Zip City,State Zip
\VA State Contractor license# Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stories 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 I Leat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: What is the square footage of the sign I low high is the sign?
face?
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?
Finn Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
0 Concrete 0 Welding O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
Ifyes,identify 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,identiA,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,identi on site plan Ifyes,identift 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?
Ifyes,iiientift on site plan 0 Yes 0 No 0 Yes 0 No
Arc there slopes greater than 30%on the property?(30 ft rise in 100 ft) Arc critical or hazardous materials used or stored on site?
( /%) O Yes 0 No 0 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
0 Yes D No
Is the property inside the PSSA? 0 Yes 0 No Isthe property located within 1000 feet of a Natural Resource Area?
O Yes 0 No
Date Received: Staff Representative
METHOD OF PAYMENT
,., sus OPAL
VISA
0 CASH 0 CI IFCK ❑ MEM. 0 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
1)A'1'I?: 1?XPIKI?S: TOTAL FEE
BANKCARD NUMBER: MINIMUMPERMIT IS 35.00PLEAS
MAKE CHECKS PAYABLE TO SPOKANE
AU1'I 1()1217.1'..1)SIGNA'T'URE: COUNT'S PERMIT CENTER