2002, 05-08 Permit App: 02003482 RemodelM
it PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY I)IVISION OF BUILDING & CODF. ENFORCEMENT
T1026 \NEST BROAD\V.AY ,AVFNUF.
X sPoi�,vNE, W.\ 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street .Address: I
Assessor's Tax Parcel Numbcr(s):
Legal Description:
I _
Project Description: -1-N S1' At 1 '3t G L4
USWWW 12 IPJCX nji-4 (- ris7 T-) i . 9-^,c l/- nf- \-VA.,3z
Building Permit ❑ Change in Use ❑ Grading O Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) 1 ❑ Other
Department Use Only
Water District/Purveyoe
Sewer District/Purveyor
Road width
Setbacks
2 • LA • Q) (-)( F t?5ovi Fax:
Mailing Address:
13 9 io E .
a 6TH AVE
Front: Rear.
School District
Fire District:
Zoning
Contractor
Phone
o�3L
13 :Architect,'Frignncer Phone
Left: Right:
OWNER/APPLICANT INFORMATION
P/ d;,>,r,- nd,r, h,,Il h,•,,,,a,,•r,•.1.....d;,,,, Mi, nrd,-,
10 Om ner:
Phone
70 � 2 2 I;t;,
❑ Applicant: Phone:
0 k VN n 1
cP
2 • LA • Q) (-)( F t?5ovi Fax:
Mailing Address:
13 9 io E .
a 6TH AVE
Mailing Address:
3 '9) 1 AL Man f7v f:
Cih', State, 'Zip
6 �N
W4, q� po
Cit), State, 'Lip
I a o S,
Poles 9 C
Contractor
Phone
o�3L
13 :Architect,'Frignncer Phone
'c t lrs
vs
ON Fax
Pas
Mailing address
3'112- N.
ovlaoE
Mailing address
Cit" State rip
S 0r-A,v`-
W/A, cls? U
ctr, Stntc rip
\C :A State Contractor license #
Contact name
W
PROJECT INFORMATION
Building Information
Building height to peak
# of stories
"'lain floor sq. ft.
Unfinished basemcnt sq. R.
Dimensions
"Total habitable space
2-1 floor sq. ft.
Finished basement sq. ft.
(>ccupancy group
Construction tvpc
Gar,igc Sy. ft.
Dcck sq. ft.
Cost of proicct
I Icet Source (electric, gas, etc.)
Manufactured Horne
Sim
\Ci�lth:
Length:
What is=thr, square footage of th( sign
face?
I low high is the sign?
Year.
\lake:
# of signs
Area of existing 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 Tent _
jPaint
booth _ Fire Alarm Fireworks display
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name Phone
Plans I(samincr Phone
Inspectors:
Address
Ifyes, identi# on site plan 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?
Ifyes, identib 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 property?
Ifyes, identi# on site plan O Yes O No
O 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?
Ifyes, ident!�, on site plan
Ifyes, identij on the site plan O Yes 0 No
O Maybe O Don't know O Yes O No
O Yes C3 No
Are there any wetlands, streams or ponds within 200 feet of the property?
Is there evidence of fill or excavation on the property?
Ifyes, identi on site plan O Yes O No
O Yes O No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
ire critical or hazardous materials used or stored on site?
�% O Yes O No
O Yes O No
DEPARTMENT USE ONLY
Is the property in a designated Storrnwater Control Area?
Is public sewer available to the site? O Yes O No
O Yes
O No
Is the property inside the ASA? 0 Yes
O No
Is public water available to the site? O Yes O No
O Yes
C3 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 C3 No
Date Iteceived:
Staff Rcprescntatic-e:
METHOD OF PAYMENT
vo,!
❑ CASH ❑ CHECK ❑ � ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA"I'E:
BAN KCARD NUMBER:
AU'l`HORIZED SIGNATURE:
EXPIRES:
SUK170'I7:11.
TOTAL FEE
MINIMUM PERMIT FEE IS 05.Q7PLFASE
AfAKE CHL.CK,S PAYABLE TO SPOKANE
COUNTY PERMIT CENTER