2002, 07-30 Permit App: 02006438 Tear Off, Reroof PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY'DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
SPOT'COUNTY
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: I oc O 3
Assessors Tax Parcel Number(s):
Legal Description:
Project Description: .1.
-s-v O `(e�
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 Indicate who should be contacted rrgardmR this project
❑ Owner: 1,�1`__ Phone: 171 Applicant- Phone:
,tI✓ 1/vvsirOe Fax: Fax:
Mailing;\d ss: Marling Address:
1 Cf1 l O
Cin,State,Zip Cin',State,Zip
u)� '9°1z-<
❑ Contractor Phone --4) �
� (( ❑ Architect/Engineer Phone
QM\L Z\l O C Fax �Z f/ " J O Fa.
Maitrig address Mailing address
va ))( t Lk
Cit `% i e ge11� Cin',State Zip
\\A State Contractor license# Contact name:
JR : * qi°i LGS-3
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
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 prof' t I leat 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?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding 0 Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes 0 No What is the current property size?
Ifyes,ident'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,identO,on site plan 0 Yes O No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes 0 No
0 Don't know 0 Yes 0 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,identify on the site plan 0 Yes 0 No
Maybe 0 Don't know 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?
Ifyes,identifif on site plan 0 Yes 0 No 0 Yes 0 No
Arc there slopes greater than 30%on the property?(30 ft rise in 100 ft) Arc critical or hazardous materials used or stored on site?
(
°i°) O Yes 0 No 0 Yes 0 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
CI Yes ONo
Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
DYes 0 N
Date Received: Staff Representative
METHOD OF PAYMENT
VE' SUB'1'O't':A].
❑
CASH ❑ CI II?CK ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D;VI'F: 1(Y1)112.1?5: TOTAL FEE
B:ANKCARD N UMBI':R: MINIMUM PERMIT FEE IS$35.00PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AU h11OR1'/Fi)SIGN\CURT: COUNTY PERMIT CENTER