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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�/� ��-- QYBuilding Permit O Change in Use O Grading O Manufactured Home Permit O Relocation 0 Sign 0 Tenant (New/Change) 0 Other if g <$°', 1 S -5°"t ; Ignoffitia t �� > .ate ; g _ m ; 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 '' �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 tll prt7 a nat,~tl Sie'ji ehaltT iWa ��®. r -, , able rs`„ 1e .t e mtf p G t31r.1tet=Wlth 13 CeG r, ,�"�.,� �p,�,���`a 'ieS- 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 �;;