2001, 10-04 Permit App: 01008691 Pool li0c1 PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260
SPOIL COUNTY
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: j I „Lt F-66 - 35-41 Ave
Assessor's Tax Parcel Number(s):
Legal Description:
N C Foo I h�
Project Description:
I( 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 inc/mite ubo.duo%l be contacted tr,urzlori ibisptej'tl
❑ (honer: Phone ❑ Applicane Phone:
Pas: Pas:
\lailing:Address: Mailing Address:
City,State,Zip City,State,tip
Contractor . Phone%?a )e$3— g❑ Architect,'Engineer Phone
Afforc abr Pay 13 has ham
Mailing address Mailing address
` 5q of --re-
cite,State/ip Civ,State Zip
Mot - $3roi
VA,-A State Contractor license= Contact name.
POrp 'ThQ
PROJECT INFORMATION
Building Infotination
Building height to peak #of stones Main flour sg. ft. Unfinished basement sq. tt.
Dimensions Total habitable space 20d floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sc.tt. Deck sc.ft.
Cost of project I Icat 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
0 Concrete 0 Welding O Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
.Are there structures on the property? A Yes O No What is the currentproperty size?
If yee',idem son site plan (square feet or acres) � /�f by /
Is any part of the property within 250 feet of a shor cline? \V'hat is the current use of this property?
11
If yes,idem *on site plan 0 Yes No
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 0 Yes X No
Is any part of the property within a 100 yr flood plain? ,Are or will there be wells located on the property?
If yes,identilY on site plan I/yes,identify on the site plan Yes Ai No
0 Maybe O Don't know 0 Yes No ffff��������
Are there any wetlands,streams or ponds within 200 eet of the property? Is there evidence of fill or excavation on the ropertf?
If yes,idente'on siteplar 0 Yes 317 No 4 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?
( /
Orr) 0 Yes X No 0 Yes X No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
DYes 0 N
Is the property inside the ASA? 0 Yes D No Is public water available to the site? D Yes D No
0 Yes 0 No
Is thc property inside thc PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received: Staff Itepresartato e:
METHOD OF PAYMENT
VISA _
1CCVE' SUB'lOI':V,
❑ C.vSI1 0 ClINCK 0 0 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
ENPIRI:S: TOTAL FEE
MINIMUM PERMIT FEE IS$35.07
13.AN MCAIM N U NI I31(R: PLEASE MAKE ca IECKS P:vY UtI.E To
SPOK SAE COUNTY PERMIT CENTER
AU'I'I loRl/,I:D SICN:A1'UR1'::
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This se "ar is being submitted for the purpose of
obtaining a building permit and is a true and correct e
••••••..... A
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representation of the proposal.All known property � (�
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linesldimensions.curb lines.structures and easements h M ` """
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have been identified.Also indicated are wetlands. �+.,,
bodies of water.steeVi
pes or other critical areas. � �
---Signed.
Date: /0 X110/ _ �
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