2005, 05-05 Permit App: 05001453 Ice Maker < < PROJECT APPLICATION WORK SHEET
ik SPOKANE COUNTY DEPARTMENT OF BUILDING AND PLANNING
1026 WEST BROADWAY AVENUE
1 I= SPOKANE,WA 99260
0 :/5_ __L.... .4_,.. ,„.._2.
SPOKE CuN rY 509-477-3675
SPECIFIC SITE INFORMATION ) C S.
Street Address:
CIS oS ice. 2b“A SQao e i 6-)Pt, ck_cc-2..0L
Assessor's Tax Parcel Number(s): '_`_.
Legal Description:
Project Description: <L0.1` \K t irlt� tn flan 0�xt �>t _ �- �e_A�( lc a '
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Building Permit ❑ Change in Use ❑ G +ding E3 Mannfac red Home Permit
❑ Relocation Cl Sign CI Ten. t(New/Change) ❑ Other
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OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted rtgavding ibis project
❑ Owner: Phone: C1,14.*FJ q ❑App.ant: Phone:
S4ste- PaLite Oar t, Fax: C( . O\) Fax:
Mailing Address: Maili Address:
1125 E.
City,State,Zip City,State,Zip
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In Phone Phone 3�2_ts7� ❑Arc �ct/Engineer Phone
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Mailing address Mailing address
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City,State Zip •City,State Zip
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DPI-1 LA'•
WA State Confractor license# •Contact name:
PRC-_rFrvee_,taC. F
PROJECT INFORMATION
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ar i 0 E z. , 4ratir 'rt1rs.. 4+ 'u' a n E '3- "i Rs -F a i - 1
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space ltd 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: Len! -• What is the square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area of existing signs
Reloca,t on Fire Safe
Previous address -lie Sprinkler Tent
Paint booth Fire Alarm Fireworks display
Proposed use V ltie
'Special Inspections Required? 'Non-Residential Energy Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
0 Concrete O Welding 0 Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 No What is the current property size? n
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 propertyr
Ifyes,identf on site plan 0 Yes
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes O No
O Don't know 0 Yes CYNo
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifyes,identi,on site plan Ifyes,identify on the site plan 0 Yes 0 No
O Maybe O Don't know 0 Yes C3�o
Are there any wetlands,streams or ponds within 200 feet o operty? Is there evidence of fill or excavation on the property?
Ifyes,identz,on site plan O Yes o O Yes II No
Are there slopes greater than 30%on the property?(30 ft rise in 1 Are critical or hazardous materials used or stored on site?
( /%) O Yes O Yes O No
DEPARTMENT USE ONLY
�t a desx Iat Slos er afx Irl Area? Ts public se�vet av labie to the site? d Yep; l7 Nes
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Date Received: Staff Representative:
METHOD OF PAYMENT
.5•01
1i41 SUBTOTAL
❑ CASH ❑ CHECK 0 0 . ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
' r
BANKCARD NUMBER: MJNmwMF�RM1rFE JSs35eot'xEA Rr
`MAKE.CHECLS,S'PAYABf E TO SPOKANE,
AUTHORIZED SIGNATURE: CC3t1NLY,PER3stt CCITT