2002, 07-18 Permit App: 02006039 RemodelAinikNM
SPOK' COUNTY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING 8c CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
1 SS 0-7
Assessor's Tax Parcel Number(s):
S c� l l �t s
Legal Description:
� � e � 3 ..t , �
Project Description: 112a, W *�- 1( /� �-t �- i %2, t t4 e"- S— � r (2, c. s 4 s
Tr—Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
0 Tenant (New/Change)
0 Other
Department Use Only
Water atcr District/Purveyor
Sewer District/Purveyor
Road width
Setbacks
Front: Rear:
Left: Right:
School District
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
❑ Owner:
R,Jdal 1.
u IRus[uIc w/iv �i,vs,su vc ari.s,--./
Phone: —70 7- 4S 3 _11..,5-15
a..,5„_ F..:
la Applicant:
1
Building height to peak
na7 t
Phone:
Fax:
Mailing Address: '
(/ fr.
�IA- Re S V"l Pr 5n,
Mailing Address:
Unfinished basement sq. ft.
7 ''�
Dimensions
City, State, Zip
v A C .A U, V-
j C F7c
State, Zip
2"0 floor sq. ft.
r
4...is .,.
finished basement sq. ft.
-3 »
c
':ontrjjact�tor 1j
l `
Phone C Z' z_ 3 s' S 3
, c jw ez Fax 1
0 Architect/I:n
neer
Phone
!rex
V
Mailing address
1..'aZ f 1,=_
S, ...It-
..ItCity,
Mailing address
1 teat source (electric, gas, etc.)
City,State Zip
s.
a Pc r-.
w 'INs-- `i - Z t G.
City, State Zip
e.
WA State Conti3ctor license #
V FA (( Qi.
i
O 1/ a3
Contact name:
Building Information
Building height to peak
na7 t
# of stories
Z
Main floor sq. ft.
I'Z Oa
Unfinished basement sq. ft.
7 ''�
Dimensions
Total habitable space
A „t...,c. 9s
T
2"0 floor sq. ft.
r
4...is .,.
finished basement sq. ft.
-3 »
Occupancy group
Construction type
w .> ci
Garage sq. ft.
4/ tf o
Deck sq. ft.
Cost of pr ect
(o ..,�
oris
1 teat source (electric, gas, etc.)
Manufactured Home
Sign
Width:
Length:
\X'hat is the square footage of the sign
face?
1 -low high is the sign?
Year:
Make:
# of signs
Area of existing signs
Fireworks display
Are critical or hazardous materials used or stored on site?
O Yes 17YNo
.\ddress
Proposed use
Relocation
Vire Safety
Firm Name
What is the current use of this property?
Ra- ` 1-4,.. L
Previous address
Will the site be served by a septic system? O Ycs 0 No
Paint booth
Fire SprinklerI'cnl
Inspectors:
Fire Alarm -
Fireworks display
Are critical or hazardous materials used or stored on site?
O Yes 17YNo
.\ddress
Proposed use
\'aloe
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Ra- ` 1-4,.. L
Phone
Will the site be served by a septic system? O Ycs 0 No
flans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes 8- No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(—1 %) 0 Ycs lErNo
Are critical or hazardous materials used or stored on site?
O Yes 17YNo
.\ddress
Staff Representative:
Inspector
Phone
D Concrete
O Welding
1J Bolting
D Reinforcement
Address
ADD
Arc there structures on the property? 0 Yes El- No
If yes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ijyes, identify on site plan O Ycs ISr-No
What is the current use of this property?
Ra- ` 1-4,.. L
Is your property in a designated wildlife habitat arca?
0 Don't know 0 Yes 1Sio
Will the site be served by a septic system? O Ycs 0 No
Is any part of the property within a 100 yr flood plain?
f Eyes, idents on site plan
0 Maybe GIi'Don't know O Ycs 0 No
Are or will there be wells located on the property?
Ifyes, identin on the site plan O Yes Q' No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identify on site plan O Ycs IIYNo
Is there evidence of fill or excavation on the property?
0 Yes 8- No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(—1 %) 0 Ycs lErNo
Are critical or hazardous materials used or stored on site?
O Yes 17YNo
Date Received:
Is the property in a designated Stormwater Control Area?
O Yes
O
No
Is public sewer available to the site? O Yes O No
Is the property inside the ASA? 0 Yes
0 Yes
0
0
No
No
Is public water available to the site? O Yes 0 No
Is the property inside the PSSA? 0 Yes
in
No
Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH ❑ cFIECK ❑anain111❑ .
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
EXPIRES:
BANKCARD NUMBER:
AUTIK)RIZED SIGNATURE:
SUB"IYYI'AL
TOTAL FEE
MINIMUM PERMIT FEE IS $35. LN PLEASE
M'1KE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER