2001, 07-11 Permit App: 01005624 Demo Residence t PROJECT APPLICATION WORK SHEET
iiirilk SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
Il 509-477-3675
SPOKANE COUNTY
SPECIFIC SITE INFORMATION
Street Address:
lS�®3 e /4 ,,--
1.,, , .,/.. , lre)14
Assessor's Tax Parcel Number(s): 4S JJ > /Cly/ 7
Legal Description:
Project Description:
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
El Relocation ❑ Sign CI Tenant(New/Change) Other ��,,,,._��%�L ^-'
Department Use Only
Water District/Purveyor: Sewer District/Purveyor Road width Setbacks
Front Rear
School District Fire District Zoning
Left: Right
OWNER/APPLICANT INFORMATION
))El Indicate who should be conic ded nyurdinn i/os pies ad
❑Owner: Phone:(V') 1 7 7-j, i/' ❑ Applicant: Phone:
3,1,63111 . Co ut ✓i t/ I.as: I as:
Mailing Address: Mailing Address:
t /► Ri
City,State,�.ip Wil �1,16
8 Cm,State,''/.ip
in Cot tchx Phone( .)711,5—e07/� Architect/Engineer Architect' ngineer Phone
/ "'_' -1-14.4-t.,4_as Ci20 i?) 7g. (,/ l.ax
Mailing address Mailing address
‘',o. .5-60_3_ _j_sitiliv
City,Sta Lip Cin',State tip
Pc—a Cia:l, —: gS
WA State Contractor license# 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"`l floor sq.ft. finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project I Ieat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: 'What is the square footage of the sign Flow 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
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?
1 f j�es,idem,on site plan (square feet or acres)
Is ally part of the property within 250 feet of a shoreline? What is the current use of this property?
yes,,identify 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 Ycs 0 No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
I f yes,idenntifjy on site planIf j es,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,identfy on site plan 0 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?
( (i'o) O Yes 0 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 O No
0 Yes El 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 Receiv ed: Staff Representative:
METHOD OF PAYMENT
1:0111tVE SUBTO"1':Al.
VISA
El C:Asl I ❑ (:1 ll X k ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D.A'1'1':: I?XP1RFS: TOTAL FEE
B:ANI CARD NUMBI(R: MINIMUM PERMIT FEE IS$35.AJPLFySE:
MAKE CHECKS PAYABLE.7Y)SPOKANE
\F l'I lORI/J:D SIGN:A'I'URI COUNTY PERMIT CENTER