2001, 02-16 Permit App: 01000906 Remodel 61 - 964
i , I PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
A. 1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
SPOKA4 COUlgY 509-477-3675
SPECIFIC SITE INFORMATION
Street Address: /= //722 /¢7/`1
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: ,9L 2//1/6' 2 .mod >' �D�i�l/ e A/ �� �� CJS✓ /^i�✓iS/f�/�
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QYBuilding Permit O Change in Use O Grading O Manufactured Home Permit
O Relocation 0 Sign 0 Tenant (New/Change) 0 Other
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Ignoffitia t �� > .ate ; g _ m
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Man it.t iw r a e ff :. 1 c
Width: Length: What is the square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area of existing signs
izt5iA ^ .? s .a..1 ,u6-4r;:: _ -.rte '�'� ;
Previous address Fire Sprinkler Tent
Paint booth_ Fire Alarm Fireworks display
Proposed use Value
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�w -sv, %- - y '.a'i'"a- -..., a i` aA 6 �' ,, ;L.. `-x"�-?*s- `�"ia'`^+ as�Y"-"x '''
6 ® @ � !:' 0 ° ° der 4A4.3 2 ° t�� r
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O 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,identib 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 D No
0 Maybe O Don't know D 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 O No
If yes,identih,on site plan O 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?
( /%) Li Yes O No O Yes O No
DEPARTMENT USE ONLY
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Date Received: Staff Representative:
METHOD OF PAYMENT
C:42711CIVEI:.. SUBTOTAL
VISA 70,
El CASH ❑ CHECK El swam ❑ _ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES: r
BANK CA RD NUMBER: AfrtcuMl}Mi'FrMr7FSE3av�IEns> s
MAKE CHEc 4s5'AYABL E yO SPOKANE 't
AUTHORIZED SIGNATURE: CfJCJNiYPERIvIi.eCENTER �;;