2003, 03-14 Permit App: 03001654 Garage lOcl PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
Aii
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
i 509-477-3675
SPOKE COUNTY
SPECIFIC SITE INFORMATION
Street Address: /97/2,/ d."/" � e f� /% 11----.0.-
_ . vQ 77
Assessor's Tax Parcel Number(s):/ , . ,// ?.40.. ' //!� !�!� /J
Legal Description: y
, '/, 4 /
Project Description: iAp`"
A' Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
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 lndi,ule who should be roularled r;�ardint lhir project
❑ Owner: Phone: (� '7 El Applicant Phone
5 .L—L , I, ,f.v.0 J l:ax: /ii-�'�(/, ) X�f� I.ax:
Mailing Address: / Mailing Address:
/77/0 /f 2/7,/
City,State,Zip (in-,State,Lip
j%���//� i ,, Y7
Contractor Phone b Phone
❑ Architect;I:n sneer
I as Fax
Mailing address Mailing address
Cin-,State Zip City,State Zip
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 floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type d, Garage sq.ft. Deck sq.ft.
k74".Aar 9X
Cost of project !moi I teat source(electric,gas,etc.)
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 Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Finn 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 proper ? " Yes 110rNo What is the current property size?
Ifyes,
ident5,on site plane 5/ _ (square feet or acres)
Is any part of the property within 250 feet of a shoreline? \VThat is th'current use of this property?
If yes,identify on site plan O Yes 7K,No !�'
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O Yes jEr No
o Don't know O Yes It No
Is any part of the property within a 100 yr flood plain? Arc or will there be wells located on the property?
If yes,identify on site plan Ifyes,identify on the site plan El Yes lit No
O Maybe O Don't know O Yes frSZNo
Are there any wetlands,streams or ponds within 206 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identify on site plan 0 Yes ' No O Yes ,'No
Are there slopes greater than 30"/.on the property?(30 ft rise in 100 ft) Arc critical or hazardous materials used or stored on site?
0 Yes 7KNo 0 Yes prNo
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? O Yes O No
CIYes CINo
Is the property inside the ASA? O Yes O No Is public water available to the site? 0 Yes CI No
O Yes E No
Is the property inside the PSSA? O Yes D No Is the property located within 1000 feet of a Natural Resource Area?
O Yes O No
Date Received: Staff Representative:
METHOD OF PAYMENT
;iC t1C . SUB'l'OT_AL
❑
CASH ❑ ClIFCK 0 _Ma= 0 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: }?\PIRI':S: TOTAL FEE
BANKCARD NU\IBI'.R: MINIMUM PERMIT FEE IS$35.WPLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AUhIIORI'/.l'.D SIGNATURI?: COUNTY PERMIT CENTER
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This s'te_. ,s be-g submitted for tb-e purpose of
Obtaining a b.. '.::;permit and is a''uue end collect !
i representation of the proposal.All known property
+ `v Itnesfdimens,ons,curb tines.structures and e 540?
bodies of water.steep or+
have been identified.Also indibated are wetlands,
T slopes -rcri _: : 1
Signed: 1 --.16.n.e..a--'
Date:' - ... /:-