2003, 08-08 Permit App: BLD-03-02182 Tear off, Reroof •
10c1 PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
1=r SPOKANE,WA 99260
509-477-3675
SPoKN CoINIY
SPECIFIC SITE INFORMATION
Street Address: -7/11
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: I�1i b' .0 vcz/'
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other ice.. .,/�
Department Use Only
Water District/Purveyor: Sewer District/Purveyor Road width Setbacks
Front: Rear.
School District: Fire Distrct: Zoning
Left: Right
OWNER/APPLICANT INFORMATION l\
El Indicate who should be contacted regarding this project \ }
r1.
❑ Owner: Phone: ❑ Applicant Phone:
Fax: Fax:
Mailing Address: Mailing Address: Z •'
���Cityy,State,Zip City,State,Zip
g Congaa for y Phone 6g7....,..,;68;2_ El Architect/Engineer Phone
<, j�•4r l l� X�yic Fax Fax
Mailing address Mailing address
City,State Zip City,State Zip
f 1
WA State Contactor license# Contact name: („,..,
r f' r ,,t.-')i L '>i).r ,..'-A
PROJECT INFORMATION
Building Information
Building height to peak #of stones Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2^d floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project Heat source(electric,gas,etc.)
Manufactured Home
Width: Length: What is the square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area 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
O Concrete O Welding O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes O No What is the current property size?
Ifyes,ident 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,ident!fy on site plan 0 Yes O No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system? Yes O No
O Don't know O 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,identify on site plan Ifyes,ident on the site plan O Yes O 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,identify 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) Arc critical or hazardous materials used or stored on site?
( /%) O Yes O No 0 Yes O No
DEPARTMENT LY
Ts th prnpert$' n desi a d Sto uta t tl al rea? RTIsUSE rublte sewONer able to the site'
I 1pt iastde thSr Cys O I�Iyt Is plblle water avaalal>le the site? OCet
er
Is tine property inside tl e ISS' CI 'Y'es ° El Is tht proper ineated ithin 1`00(1 fleet o f a Nstued esour Mead
� Yds' {?.Nn_
Date Received: Staff Representative:
METHOD OF PAYMENT
SUBTOTAL
0 CASH 0 CHECK ❑ 1 ❑ " 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES: T 1U
BANKCARD NUMBER: MlNI MpF IT ZS, g
MAt CNECKSI'AYAB'.ET)$#(51eilitilI?
COUNNYPERMiT
AUTHORIZED SIGNATURE: