2002, 01-14 Permit App: 02000217 Pool, FencePROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 NVEST BROADWAY AVENUE
i��� SPO 509-4E77-3675 9260
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SPECIFIC SITE INFORMATION
Street Address: 10?
Is � �N
Assessor's Tax Parcel Number(s):
Legal Description:
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Project Description: !-1 P Vl/ S 1A (4 Poo
5 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
W
' lyinc/)i 9�?�6
2m, Floor sq. ft.
Front: Rear.
School District:
Fire District:
Zoning
Mailing Address:
I a-�4
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Left: Right:
OWNER/APPLICANT INFORMATION
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®Thence
Building height to peak
Phone:
ApplicanC Phone:
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t
W
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2m, Floor sq. ft.
15'
OccuPance group
k Ias:
Fas:
Mailing Address:
I a-�4
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\tailing Address:
Cite, Statc, Zip
A
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Cin', State, Zip
o64,e
® Contractory,
11
I Phone Gj ��
❑ Architect, Engineer Phone
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Mailing address
071
Mailing address
Cin', State Zip
9 9 �
Cin, State 'Zip
VC A State .on a
for
it ense. #
Contact name:
'D0"T1F7!'T 1NP"PX4ATTnN
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2m, Floor sq. ft.
Finished basement sq. ft.
OccuPance group
Construction tvpe
Garage sq. ft.
Deck sq. ft.
Cost of project
I Icat source (clrctrie, gas, etc.)
Manufactured Home
Si
Width:
Length:
What is the square footage of the sign
face?
I logy high is the sign?
Year:
Make:
# of signs
Area of c-,isting signs
O Don't know O Yes O No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Relocation
Fire Safety
Previous address
Fire Sprinkler fent
Inspectors:
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
1 f pes, identify on .rite lan O Yes O No
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
What is the current property size?
I yes, idenfifi, on siteplan
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
What is the current use of this property?
1 f pes, identify on .rite lan O Yes O No
0 No
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 O No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Ifj,es, identify on site plan
If yer, identifi, on the siteplan 0 Yes O No
O Maybe 0 Don't know 0 Yes 0 No
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?
1 f yes, identi , on siteplan 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?
° o O Yes O No
O Yes O No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
Is public sewer available to the site? 0 Yes 0 No
0 Yes
0 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?
0 Yes 0 No
Dale Rcccivcd: Staff Representative:
METHOD OF PAYMENT
❑ CAS II ❑ CIII?CK ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I ). V VI":
B_ANKC:AIZD NU.NIBFIZ:
\UI'l TORI/.I,:D S1GN.ATU1ZF:
VXP1RI?S:
SUBTOT.V.
TOTAL FEE
MINIMUM PERMIT FEE IS $15.00 111. 1 1S@
M 1KE CI IECKS PAY 113LE TO SPOK ANL_
COUNT) PIXNII'I CEN -ITR
83'
Denis Waltermire
12504 E. 23 th ave.
99216
927-5878
25'
95'