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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