2003, 03-10 Permit App: 03001498 Foundation, Anchor lOcil PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
--- SPOKANE,WA 99260
1 509-477-3675
SPOKE COINTY
SPECIFIC SITE INFORMATION
Street Address: j 007
E, ? "Li' A6
Assessor's Tax Parcel Number(s):
36.22/J , 36//
Legal Description:
Z»�,pIIQ- /l -yI1s
Project Description: IC.Qi-10't r 6.4e,‘514 het Met li wra...GI -v e_ I'"t ao/i to
J
=$uilding 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
El Indirale who should be covete nhardin;this protea
❑ Owner: Phone: Co— AC: j' e Applicant Phone: hl�i6,—755 7y
PLh1 1/� /L/ rd Fax: /J 7A Ji.'tf4-i rs L . i000la rel SIS e.
Mailing Address: Mailing Address:
ASS E, a.Y Sofri 03O7 lit 5-favrda_d d.*r
City,State,Zip On, ate,Zip
❑ Contractor Phone ,v6,4,,75 7 ❑ Archttecti)'.ronneel, Phone 5
VoilliwesfEa-i. •r : Fax az e. �o1114 Frs1r,v�ef Fax 9z‘ -S97z
Mailin address l Mailing address
03o7 A, 5icci,,01ard 51-. Po, '3o)1 elz.f
City,State Zip i City,State Zip
kte 'A . ggZ9e Verctv�al� f w �- , oto37
/
\\A State 'ontractor license#1 Contact name.
1VogT"N L r (24/4iN F Z0 Li,. F:cL ktor
PROJECT INFORMATION
Building Information
Building height to peak #of stones Main floor sq.ft. Unfinished basement sq.ft.
/ 15 I z_
DimensionsTotal habitable space 2",1 floor sq.ft. Finished basement sq.ft.
27 k 5-6 /57 Z
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of projectI Icat 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 Fire Sprinkler 'fent
Paint booth Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Pirm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Yes ❑ No What is the current property size?
If yes,idei4,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/t on site plan ❑ Yes ❑ No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?❑ Yes ❑ No
CI Don't know ❑ Yes ❑ No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifj'es,identin,on site plan If yes,identify on the site plan ❑ Yes ❑ No
❑Maybe ❑Don't know ❑ Yes ❑ 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,ident 'on site plan ❑ Yes ❑ No ❑ Yes ❑ No
Are there slopes greater than 30°o on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
%) ❑ Yes In No In Yes ❑ No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? ❑ Yes ❑ No
❑ Yes ❑ No
Is the property inside the ASA? ❑ Yes ❑ No Is public water available to the site? ❑ Yes ❑ No
❑ Yes ❑ No
Is the property inside the PSSA? ❑ Yes ❑ No Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Received: Staff Representative:
METHOD OF PAYMENT
MEM
C \Ff SUBTOTAL
❑
CASH ❑ CI HICK ❑ ❑ _ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D:\"1'I{: I(SPIRFS: TOTAL FEE
BANKC:\RD NU MBI MINIMUM PERMIT FEE IS$35.OIPLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AU'll IORI"/.I?D SIGNATURE: coLNTYPEILMITCENrER