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2000, 10-30 Permit App: 00009957 Remodel
on - Gini s 7 loci PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE HP SPOKANE,WA 99260 SPoxAN COUINTY 509-477-3675 SPECIFIC SITE INFORMATION Street Address: l/ 3 6 ). , 7 /4..I .- Assessor's Tax Parcel Number(s): Legal Description: Project Description: 4,,,„,-,,,e (tel-�tGr ..„N.„ a ��1 //.1�tGjid�(J4 O Building Permit O Change in Use O Grading O Manufactured Home Permit O Relocation O Sign O Tenant (New/Change) O Other OtIliteV'Tifa �ft� aate,� ., rt 0 ic � VIIK II 3 t '" ,aa" 's' � r �- 4 a 3- , . 43t "€. f 1 a x _ r za y rr- x FIs H $°kS a - �� '"` s is D 6€ W "3 `s ship fsax.x A a 1 =4'„�`.� 5n z�#«#^a#`e er-<i ialg,„k ,,,. . .u..a, � t alto 0444,., m r,W _,... _ .. - . __ z__ OWNER/APPLICANT INFORMATION El Indicate who should be contacted regarding this project O Owner: � t? e l?.._Phone: ❑Applicant: �j Fax: � Phone: Y 'V't .e.-.. - 0Fax: eo R�c `r � �/ MailingAddress: Mailing Address: l/ 0� F VXfilar City,S4,ip : J ^ �4 `. City,State,Zip ❑ Contractor a� ` Phone '— b V O Architect/Engineer Phone �/"Y Fax —vcT / J Fax Mailing address f Mailing address City,State cl,/ City,State Zip 4.1„4,7 4c7)po WA tate Contractorlicense# `� Contact name: Cap,e H. ©D ,7" PROJECT INFORMATION BuildinglD.fOrIIldtlD)rl Building height to peak #of stories Main floor sq.fr. Unfinished basement sq.ft. Dimensions Total habitable space 2na floor sq.ft. Finished basement sq.ft. Occupancy group / Construction type Garage sq.ft. Deck sq.ft. Cost of project ..f!/ �6 Heat source(electric,gas,etc.) f� � :-ffit ,aa P gyp- - �+s , . ice ^ ,'fn w . »aa '« 3 °- .ms' s, : "� -..g o • - ,''.n z s "',� �- "�C S �f,h.nom T a , x--" �+ - e %sy. r •r, -3.,. ..amu- •� .. U:t7.44'-'71°''''' ' rsa - .. - ,� 'S...F. ... ...,r •;:a ?._ s.� _ . � "� .�� ,, w ' Width: Length: What is the square footage of the sign How high is the sign? face? Year: Make: #of signs Area of existing signs itW .,.xis„ .-- .,.x ,.. .,, ..� ,_.w :..,.,..�,. ..i`� .. . ,,�".. ;° �. Previous address Fire Sprinkler Tent Paint booth Fire Alarm Fireworks display Proposed use Value mar Firm Name Phone Plans Examiner Phone Address Inspectors: Inspector Phone O Concrete O Welding O Bolting O Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? O Yes O No What is the current property size? If yes,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? If yes,identify on site plan O Yes O No Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O 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? If yes,identify on site plan If yes,identify on the site plan O Yes O No O Maybe O Don't know O Yes O No Are there any wetlands,streams or ponds within 200 feet of the Is there evidence of fill or excavation on the property? property? O Yes El No If yes,identify on site plan O 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 O No O Yes O No DEPARTMENT USE ONLY Is the propert• iiia esx-A'-d' ced Sto a ua ex s dols Js p tb1k siwe available to th sitFx Y .7-<, Is the property iiiside t&ASA Q YeW rI '� � Is'pubiicwatet•available t thesite4l� .._., • Ties Is the p..;:,... ."..„..,ickrt tl a PSSA - y 7 Yes- D-�` Is the•property locatedLTIVIL witlwi 1000 feet of a I �� - a? Date Received: Staff Representative: METHOD OF PAYMENT 0mm Zeli,,,,,,,z,-.:,,n.:z.; LIC t1 SUBTOTAL ❑ CASH ❑ CHECK 0 ❑ • ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: EXPIRES: T�(,�AI FEB' BANKCARD NUMBER: MINIMU,tMPERMfFF.EE $ b*Its.I MARE CHECKS PtYBFE CSSPORAI*IE AUTHORIZED SIGNATURE: _ •C©UrrrrpEtu t E1R'