2000, 05-08 Permit App: 00003533 Pool I 1 PROJECT APPLICATION
'� SPOKANE COUNTY DIVI1SION OF BUILDING&CODE ENFORCEMENT
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.2714 1026 WEST BROADWAY AVENUE
011 SPOKANE,WA 99260
SPOxKi COUIyIY 509-477-3675
Project Description: Slt//!M✓v►
TYPE OF APPLICATION
Ci Building Permit O Change in Use O Grading O Manufactured Home Permit
O Relocation O Sign O Tenant (New/Change) O Other
SPECIFIC SITE INFORMATION
Street Address: /O 7/s2 , c �d/
�
Assessor's Tax Parcel Number(s):
Legal Description:
Department Use Only
Water.District/Purveyor. Sewer District/Purveyor Road width Setbacks
Front: Rear:
School District:. Fire District: Zoning
Left Right:
OWNER/APPLICANT INFORMATION
Indicate who should be contacted regarding this project
Owner: Phone: ❑ Applicant: Phone:
4/9 u
Al / Fax: Fax:
Mailing Address: Mailing Address:
/87/x' � , CfT c%
City,State,Zip City,State,Zip
S, 6,c ✓7(4/) : 77o/,6
Phone
y
❑ Contractor� Phone yDi a�S/ ❑ Architect/Engineer
�i'/yQ(212./ 1-e P LS Fax Fax
Mailing address Mailing address
/v 2/. ? i a5
City,State Zip City,State Zip
/ tag , 99 c)
WA 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 Heat source(electric,gas,etc.)
Manufactured Home Sign
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
11 Concrete ❑ Welding ❑ Bolting ❑ Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes ❑ No What is the current property size?
If yes,identi6 on site plan y 0 rr\' (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 ❑ Yes L1 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?❑ Yes No
❑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?
If yes,identify on site plan If yes,identify on the site plan ❑ Yes ® No
❑Maybe ❑Don't know ❑ Yes QI No
Are there any wetlands,streams or ponds within 200 feet of the Is there evidence of fill or excavation on the property?
property? ❑ Yes l No
If yes,identify on site plan ❑ Yes CCI 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?
❑ Yes f3 No ❑ Yes til 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:
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SPOKANE, WA 99206 l g 7/p ` CJ T
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