2002, 09-09 Permit App: 02007758 Pool4
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► PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING 8& CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
IU19 SPOKANE, WA 99260
�MVAMP C11 WrV 509-477-3675
SPECIFIC: SiTR iNFC)RMATTnN
Street Address: 3 —7
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: 6 \A1 QnA 2A a
O Building Permit O Change in Use O Grading O Manufactured Home Permit
O Relocation O Sign O Tenant (New/Change) Other
OWNER/APPLICANT INFORMATION
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Owner.
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Mailing Address: ' i
Fax:
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Mailing Address-
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City, State, Zip
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O ContractoPhone
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O Archit ct/Engineer Phone
Fax Qi oy
Fax
Maung address
Occupancy group
Mailing address
Ciry, State Zip
Garage sq. ft.'
City, State Zip
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Contact name:
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Building height to peak
N of stories Main floor sq. h.
Unfinished basement sq. h.
Dimensions
Total habitable space
2 d 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.)
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Manu aCtueIYl�
Length:
What is the square footage of the sign
face?
How high is the sign?
Width:
Year:
Make:
N of signs
Area of existing sighs
Will the site be served by a septic system? O Yes 13 No
O Don't know O Yes No
Is any part of the property within a 100 yr flood plain?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement Address
A nnTTTlIN A T CTTF TATt~!lT? Ad A r T(lt�i
Are there structures on the property? Yes O No
What is the current property size?
I es, identify on site plan
(square feet or acres
Is any pan of the property within 250 feet of a shoreline?
What is the current use of this property?
1 yes, iden t ify on site plan O Yes No
Is your property in a designated wildlife habitat ar a?
Will the site be served by a septic system? O Yes 13 No
O Don't know O Yes No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Ifyes, identify on site plan
If yes, identify on the site plan O Yes O No
O Maybe O Don't know O Yes No
Are there any wetlands, streams or ponds within 200 feet of the
Is there evidence of fill or excavation on the property?
property?
O Yes O No
I es, identify on site plan O Yes 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?
% 11 Yes No
O Yes O No
DEPARTMENT USE ONLY
Date Received: Staff Representative:
METHOD OF PAYMENT
ElCASH F1CHECK ❑ Y/SA ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL
7-
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7,7777
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CHECKS PAYAB[ E TO SPQ%ANE
�MABE
COUNTXPERMIT CENTER
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