2005, 05-05 Permit App: 05001452 Hood Vent 1 i PROJECT APPLICATION WORK SHEET
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SPOKANE COUNTY DEPART TENT OF BUILDING AND PLANNING
1026 WEST BROADWAY AVENUE
It SPOKANE,WA 99260
509-477-3675 --
09-477 3675 (:::IIIIi :aIII:I::)SPOKANE CouNrY
SPECIFIC SITE INFORMATION ) �S'�
Street Address:
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Assessor's Tax Parcel Number(s):
Legal Description:
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Project Description: jric .1 �{tArL.ot� flenat ,__ 'rte--_—e_ Me1ce '
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Building Permit D Change in Use O G :ding -'tet4 _._._._--T.--E]--Man. .c, red Home Permit
Cr] Relocation O Sign 0 Ten. t(New/Change) 0 Other
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OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted regarding this project
0 Owner. Phone:Cwt._5c ,s. 0 App'ant Phone:
S---. . k P 1 € s'\ t Fax: l�`5(-9-tc..c.'O� Fax:
Marling Address: Maili Address:
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City,State,Zip City,State,Zip
SI ►ar2 LeLD Pt-. g4A04.
Phonesit.-csr(� Phone
❑Contractor x l ❑Arc ect/Eng neer
fact.'ti-tL N.up. +.5t,At,, Fax CO-.i.— t q Ct \ / Fax
Mailing address (�,, Mailing address
Lilac K. Cotenh Pa -
City,State Zip City,State Zip
D,L�J^ S
e � CA-.
WA State Con ractor license# Contact name:
Q QCT FY11Cc.D C_F
PROJECT INFORMATION
x . ata ��S3 , 1�ow `.*CINVS ®, gym_ fc .rcn _ l� Sc . A "V6(.40:410,
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Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2^0 floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project Heat source(electric,gas,etc.)
Manufactured Home
Width: Lent What is the square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area of existing signs
Relocation F`ire`Safety
i E i
Previous address Fite Sprinkler Tent
Paint booth Fire Alarm Fireworks display
Proposed use a e
Special I spect�ons Regni ed Non Residential Energy,Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O No What is the current property size? n
Ifyes,identi 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(
Ifyes,identfr on site plan O Yes o
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 C3'Tlo
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifye,
rdentztv on site plan Ifyes,identify on the site plan O Yes O No
O Maybe El Don't know O Yes [}1G
Are there any wetlands,streams or ponds within 200 feet o e-property? Is there evidence of fill or excavation on the property?
Ifyes,identfr on site plan O Yes O Yes 0 No
Are there slopes greater than 3O%on the property?(30 ft rise in 1 - Are critical or hazardous materials used or stored on site?
( /%) O Yes O Yes 0 No
DEPARTMENT USE ONLY
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Date Received: Staff Representative:
METHOD OF PAYMENT
VISA ;;A
' tIKvC__ SUBTOTAL
❑ CASH ❑ CHECK ❑ . ❑ . ❑ •
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
BANKCARD NUMBER: 4.1 10
MAKE CHECRSLtYAgLE TQ SPOKANE i r
AUTHORIZED SIGNATURE: CotIN1YPERMITcrtvr5t l °