2002, 06-19 Permit App: 02004967 Remodel 1;11A PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
509-477-3675
SPOKN Conry
SPECIFIC SITE INFORMATION
Street Address: �k
ANd. 4016,,,.. D... 9')-zoco
Assessor's Tax Parcel Number(s):
Legal Description:
L`
Project Description: - ----- > - ---t mac ! ` tJ,,,4. � 7'71' C.�+v, of 4U 7-, c/3.— )ex—)vs
r
7 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
0 lndicale abs//should he conladed re;urdinr,ibis project
❑(Tuner: r Phone 1Z� z O�O ❑Applicant:Ap (� Phone
Qc 4 I✓Ix, I "l lC✓V Fax: Z4>\A.. Y ` c- a7 I•ax:
Mailin�Address: Mailing Address:
City,State,Zip City,State,Zip
❑Co etorPhone 4.1. �3b-7 ❑ Architect Engineer Phone
t,r1J.. MG,(:.L Fax I"' Fa
Mailing address Mailing address
.11 to LJ. CLikkt V Pa,\G--)C.y
City,State Zip � / � City,State Zip
Soo e a, 5 Zv
V\A Sta Contractor license# Contact name.
c.P7L- (0L.cgUZS-fir
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 sg.ft.
Occupancy group Construr\ty e Garage sq.ft. Deck sq.ft. /72_
Cost of project I teat source(electric,gas,etc.)
O�'
73 O
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 O Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? t7) Yes O No What is the current property size? �y�
If yet,identf,on site plan (square feet or acres) -7j X'WT.D1L.
Is any part of the property within 250 feet of a shoreline? What is the current use of this property?
Ifyes,idents on site plan 0 Yes 0 No fin h e
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?7 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,identify on site plan Ifyes,identi)5 on the site plan 0 Yes 71'No
0 Maybe 0 Don't know 0 Yes Z 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,identify on site plan 0 Yes 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 Yes Sa No o Yes 21/No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes O No
0 Yes 0 No
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes Cl No
0 Yes 0 No
Is the property inside the PSSA? Cl Yes Cl No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received: Staff Representative: .
.
METHOD OF PAYMENT
SUBTOT:V,
VISA
❑ CASI I ❑ CI n?cK ❑ UMW 0 0 --
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD •
EXPIRES: TOTAL FEE
BAN NUMBER: MINIMUM PERMIT FEE ISt35,AOPLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AWllORI'/,I:D SIGNATURE: COUNTY PERMIT CENTER