2001, 07-03 Permit App: 01005354 Tear Off, Reroof , 3, 6 33-y,'
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
AA SPOKANE,WA 99260
509-477-3675
SPOW COUNDI
SPECIFIC SITE INFORMATION
Street Address: S —7 2 e , /6.-Fk
Assessor's Tax Parcel Number(s): 03<96
, �f [J0
Legal Description: J<� (�" ���j
f •ea.r Od-c /ccs6t k oshes.
Project Description:
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
Water District/Purveyor. Sewer District/Pun-eyor Road width Setbacks
Front Rear.
School District: Fire District: Toning
Left Right
OWNER/APPLICANT INFORMATION
0 Indiade aho.chould be ce nhnied m gardln„lhi.r projer/
❑ Owner Phone: _C-3te -et 7_r 1.. ❑ Applicant: Phone:
Mc l i✓ a. Fax:
Mailing:Address: Mailing Address:
Cin-,State,Lip (;itc,State,Zip
❑ Contractor Phoneg- Phone
❑ Architect i'I�.n anccr
AffoK114-(3puit-or,f tN1 gN : Fax
Mailing address Mailing address
Roti OMR sk- d pg.
City,State Lip Cin",State Lip
L, r� C C/ o r
\\A State Contractor license 4. Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stones Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2"`I floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of proje t I!cat source(electric,gas,etc.)
131g0 . ��
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 I'ire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Firm Name Phone flans 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 O No What is the current property size?
Ifyes,ident '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?
1 f yes,identiz 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 O 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?
Ifyes,identib,on site planI f ye.t,identif'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?
Ifyes,identib,on site plan D Yes 0 No 0 Yes 0 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?
( /4/0) 0 Yes Cl NO 0 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
0 Yes 0 No
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No
0 Yes 0 No
Is the property inside the PSSA? 0 Yes 0 NO Is the property located within 1000 feet of a Natural Resource Area?
O Yes O No
Date Received: Staff Repressnmtive:
METHOD OF PAYMENT
fCOVH SUB'l'o'l':U.
VISA
❑ c ysl l ❑ c111:C1< ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
\'1'I: I:NPIRI:S: TOTAL FEE
BANKC.ARI)NUNIBIR: MINIMUM PERMIT FEE IS$35OQILFASE
at.VKN CI IECKS PAYABLE TO SPOKANE
ATM IORl/1[1)SIGNATURI cot°NT'i PERMIT CENTER