2001, 05-21 Permit App: 01003796 Tear Off, Reroof •
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441 1 PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
ill SPOKANE, WA 99260
SPIC A�E COUI�IY 509-477-3675
SPECIFIC SITE INFORMATION
Street Address: 6�S l/ n
Assessor's Tax Parcel Number(s): ! ( (J
Legal Description:
/
Project Description: Q � - 4.41' �n n��a hoyitsz___ _ eco �/
❑ Building Permit O Change in Use ❑ Gradin ��/rnc���
II
g O Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other
"� 9 &' 'F'.4- . ' ° ° -- 'g`-'-: ; '�c{ 75Tri,. . , :i :sem ' _ i
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OWNER/APPLICANT INFORMATION
El Indicate who should be contacted regarding this project
OOnwner: 4 7 ` Phone:,_5-36_)T b 7 Applicant:
Phone:
1/./eJ<I 60ove k Fax: rrrr / \l�V M Fax:
Mailing Address: Mailing Address: //,
603 o5rc 1 /:-/_L A-0 6
City,State,Zip
-ijU1 Q ti e W A 9 9 a 1vZ City,State,Zip
❑ Contractor Phone ❑Architect/Engineer Phone
Fax Fax
Mailing address Mailing address
City, State Zip
State Zip
WA State Contractor license# Contact name-
PROJECT INFORMATION
,, _ .� tea_. ,: __s._„b _
Building height to peak Hof stories Main floor sq.h. nfinished basement sq.h.
Dimensions Total habitable space tad floor sq.ft. Finished basement sq.b-
occupancy group Construction type Garage sq.ft. Deck sq.ft.
ost of project Heat source(electric,gas,etc.)
97/D00
•
i ams "-4- -r�,N- -a'ri : as >c_,"� --€`' 'r�''e
Width: Length: What is the square footage of the sign How high is the sign?
face?
Year: Make: N of signs Area of existing signs
[ T
Previous addressFi
re Sprinkler Tent
Paint booth_ Fire Alarm Fireworks display
Proposed use Value
Firm Name Phone. __...�_,..._._'.�b°�...Plans Examiner Phone
Inspectors: Address
Inspector Phone
0 Concrete O Welding CI Bolting CI Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes 0 No What is the current property size?
If yes,ident_iff 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 0 Yes O No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O Yes CI No
0 Don't know 0 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 ye5,identify on site plan If yes,identify on the site plan O Yes CI No
O Maybe O Don't know Cl Yes 0 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 0 No
If yes,identify on site plan Cl Yes O 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?
( /%) Cl Yes Cl No Cl Yes 0 No
,.�.. DEPARTMENT USE ONLY
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Date Received: Staff Representative:
METHOD OF PAYMENT
ttNICOVER SUBTOTAL
❑ CASH ❑ CHECK ❑ UMW ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE EXPIRES: a•V_ R r
BANKCARD NUMBER: �� '
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AUTHORIZED SIGNATURE: �t I (.I I �Ks3?j�Y\i i i"o'sr.;
r Cflt"ai E..ucGENT£tt -.