2001, 09-17 Permit App: 01007936 Reroof sl. /
1
4cl PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
Ilk
SPOKANE,WA 99260
509-477-3675
SPox<CovWI
SPECIFIC SITE INFORMATION
Street Address: 7_5/i L
Assessor's Tax Parcel Number(s):
Legal Description:
- Project Description: ,67,._ ,f c7/
-)C
'ilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Purveyor Sewer District/Purveyor -Roadwidth Setbacks
Front Rear.
School District: Fire District: Zoning
Left: Right:
OWNER/APPLICANT INFORMATION
� El Indicate nbo should he contacted re arding this pr project
.-E thcner: Phone '72 Z 7 t/`v ❑ Applicant: Phone
N/.pii7 Fax: fl2 y 9-724 flax:
Mailing Address: � Mailing Address:
--7Z---7Z- /' a/ N` 'JET X .
'
City,State,Zip City,State,Zip
.3/) mow.- 4,,-,4 , I1,,ZaL
❑ Contractor PhonePhone
❑ Architect/hnginecr
las las
Mailing address Mailing address
I Sty,State Zip City,State Zip
WA State Contractor license a Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions 'Total habitable space 2' floor sg.ft. Finished basement sq.ft.
Occupancy group Construction type Garage se1.ft. Deck sq.B.
Cost of project I feat 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 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
0 Concrete 0 Welding 0 Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes 0 No What is the current property size?
If yes,ideatir 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,idenl(f on site plan 0 Yes 0 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes 0 No
0 Don't know 0 Yes 0 No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifye.r,identify on site plan If yes,identify on the site plan 0 Yes 0 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?
If yes,identify on site plan 0 Yes 0 No 0 Yes 0 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?
( So) O Yes O No O Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
DYes 0 N
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 NO
DYes 0 N
Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received: Staff Representative:
METHOD OF PAYMENT
VISA — 41VE SUH'I'O"1'.Al.
0 CASH ❑ t:Ill:(:K ❑ ❑ 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
PI RFS: TOTAL FEE
MINIMUM PERMIT FEE IS$35.00
B:ANRC.ARI)NL'\IRI?R: PLEASE i1:vKEClIECFSr:ti.-tu1.E TO
SPOKANE COUNTY PFRV11T CENTER
ALAI IORI'/.I:D SIGN:A'l LTRI1: