2002, 07-18 Permit App: 02006062 Tear Off, Reroof - --
iiidci PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
il
it SPOKANE,WA 99260
SPOK II\E COUIyTY 509-477-3675
SPECIFIC SITE INFORMATION
Street Address: /� // -2 D 5' 3 2 7."''.-
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: r e rd 6.• % -c-� S,C
O Building Permit O Change in Use O Grading O Manufactured Home Permit
O Relocation O Sign O Tenant(New/Change) O 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 contucled regarding Ibis j rojeci
O Owner: Phone: O Applicant: Phone:
Fax: F:ax:
Mailing Address: Mailing Address:
City,State,Zip City,State,Zip
Contractor71 � Phone .<-7,2_,, c O r\rchitect/IMginecr Phone
-t tO $ Ce:"(..,/I 5Y4 .Z7z,Taz Fax
Mailing address Mailing address
-2 3 ,-/ "s o-,../ ..—
City,
Cin•,State Zip City,State Zip
i t .z � % b '.--
'A A State Contractor licens Contact name:
A S G 0 AJ U 4i 9'Q /-
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habitable space 2"ll floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Costproject I feat source(electric,gas,etc.)
y 0 cl cci.r
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
—y —
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
0 Concrete O Welding 0 Bolting O Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No What is the current property size?
If yes,identify on site plan (square feet or acres)
Is any part of the property within 250 feet of a shorelne? What is the current use of this property?
If yes,/detail),on site plan 0 Yes 0 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?
I fyes,identi fj'on site planIf j'es,identify on the site plan 0 Yes 0 No
0 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?
If yes,identify on site plan 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 0 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
Date Received: Staff Representative:
METHOD OF PAYMENT
l eft SUB'I'OTAI.
❑ CASH CHECK' ❑ ❑ 0 ...
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
TOTAL FEE
B:ANKC\RD NUMBI':R: MINIMUM PERMIT FEE ISOA00PLL SE
MAKE CHECKS PAYABLE TO SPOKANE
:AUTl IORIZED SIGNATURE: COUNTY PERMITCENTFR