2002, 10-11 Permit App: 02009022 Remodel`tp-Qelt-1
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
"Wrii SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: 3 �o O 5- E 210
Assessor's Tax Parcel Number(s): L) Z ((D
Legal Description:
Project Description: [a�5e i%-oA,+- l�e►n1D�-1 G o" ve✓4- e� is �/l I n'to Z eJibm,t'►
/ 2 es' 1 i n s
Building Permit ❑ Change in Use Y❑ Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) 10 Other
DeparfitneiitUse Onlp. ..
°,WYAter DistriCk/Purr"typr'
Sewer District/Purveyor''
Road width
Setbacks
/i/' f Fax:
Mailing Address:
Fyke l oq>1 Q
Front Rear.
School District
Fire District:
Zoning,, ;
City, State, Zip
City, State, Zip
Left. Right
OWNER/APPLICANT INFORMATION
Indi�ale mhn thnuLl he ,nnliv lei/ reoardinn lhir hrnie,Y
Owner. ��^'Ae
hone: (50 `)7�9
❑ Applicant: Phone:
1n
VC7 • IV1J�Y `
Fas: 60p -6 ' `
/i/' f Fax:
Mailing Address:
Fyke l oq>1 Q
Mailing Address:
o5 4:,'
City, State, Zip
City, State, Zip
Dimc , ns
U.V - K
911 t
`total habitable space
2-2--4 2-,5.z0-
�,d Floor sq. ft.
--
Finished basement sq. k.
5(.0,9Occupancy
'roup
l
❑ Contractor
Phone
Architect/ Phone
'
(�
Deck sq. ft.
-
e ew„
Fax
Fax
Mailing address
Mailing address
Cin', State Zip
Cin', State Zip
WA State Contractor license #
Contact name.
PROIFCT INFORMATION
If
Building Information
Building height to peak
# of stories
Main floor sq. ft.Unfinished
ir3 .
basement sq. ft.
5�S
a 1
Dimc , ns
U.V - K
d-
`total habitable space
2-2--4 2-,5.z0-
�,d Floor sq. ft.
--
Finished basement sq. k.
5(.0,9Occupancy
'roup
l
Construction type
Garage sq. ft. I
I✓^r
Deck sq. ft.
-
e ew„
VYW
✓bt-� e
Cos f project1
Teat source (electric, gas, etc.)
Cg
oeO
a5
If
Manufactured Home
i ,
Width:
length:
What is the square footage of the sign
face?
How high is the sign?
Year.
Nlake:
# of signs
Area of existing signs
Is your property in a designated wildlife habitat area?
Will the site be served by a septic system? O Yes No
O Don't know O Yes No
O No
Relocation
Fire Safety
Previous address
Fire Sprinkler _ Tent _
Paint booth _ Fire Alann Fireworks display
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name Phone
Inspectors:
Plans Examiner Phone
Address
Is any part of the property within 250 feet of a shoreline?
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 9 Yes O No
What is the current property size? r
I �J
I es, idenfifi on site lal
feet or acres) J IN—
Is any part of the property within 250 feet of a shoreline?
—(square
What is the current use of this property?
Is the property inside the ASA? O Yes
I es, identi# on site plait O Yes X No
Is public water available to the site? O Yes , `O No
0 Yes
Is your property in a designated wildlife habitat area?
Will the site be served by a septic system? O Yes No
O Don't know O Yes No
O No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Yyes, identift on site plat
Ifyes, idents on The site plan O Yes � No
O Maybe O Don't know O Yes No
Staff Representative:
Are there any wetlands, streams or ponds within 200 feet of the propertye
Is there evidence of fill or excavation on the property?
If yes, identifi, on site plan O Yes No
I 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?
% O Yes No
1 O Yes No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control, Area?
Is public sewer available to the site? O "Yes. O No
O Yes
O No
Is the property inside the ASA? O Yes
O No
Is public water available to the site? O Yes , `O No
0 Yes
O No
Is the property inside the PSSA? O Yes
O No
Is the property located within 1000 feet of a Natural Resource Area?
O Yes 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASA ❑ CHECK ❑ � ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCARD NUMBER:
AUf11ORI'LED SIGNATURE:
F.XPIRI?S:
SUBTOTAL
TOTAL FEE
MIN7MUM PERMITFEE IS,{ .00 PLEASE
MAKE: CHECKS PAYABLE TO SPOKANE
COUNTY. PERMIT CENTER