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2000, 12-08 Permit App 00011085 Re-Roof, 2 Doors, Insulate1 t PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE 10H SPOKANE, WA 99260 .SPO &W CAW T 509-477-3675 arr,k,lr1t..J11C,111411UnMEi I ION Street Address:c5' 11 7 Z/– Assessor's Tax Parcel Number(s): Legal Description: Project Description: '11-1d (y O Building Permit O Change in Use O Grading O Manufactured Home Permit O Relocation O SignO Tenant (New/Change) O Other OWNER/APPLICANT INFORMATION 10 Indicate who should be contacted regarding this project n ,e.- Phone: �2�/jq r ), Jr c-'�'l% LJ Phone: r�(.i Main floor sq. ft. :=TFinished nished basement sq. ft. Mailing Addres: _ Total habitable space Fax: Mailing Add gss: Ci f Construction type , State, Zip / Z/ I �� City, State, Zip ❑ Con ractor Phone Architect/Engineer Phone Mailing address FaxFax TO iling address City, State Zip City, State Zip WA State Contractor license N Contact name: � il a1111V1\ v,F m IN -01AL;L�� Building height to peak X of stories Main floor sq. ft. :=TFinished nished basement sq. ft. Dimensions Total habitable space 2nd floor sq. ft. basement sq. ft. Occupancy group Construction type Garage sq. ft. Deck sq. ft. Cost 6f project Heat source (electric, gas, etc.) �. - ���� ����sz.To-� �.� ��-_.� .*.�'�� ,� � �.c .. �1�11��- ��. ��h� � . .. '.. "'fo ."ys �.�.:., Width: Length: What is the square footage of the sign How high is the sign? face? Year: Make: #of signs Area of existing signs Previous address Fire Sprinkler Tent Paint booth Fire Alarm Fireworks display Proposed use Value 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? O Yes O 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 shoreline? What is the current use of this property? If yes,identify 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?O Yes O No 0 Don't know O Yes CI 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,identify on site plan If yes,identify on the site plan O Yes O No O Maybe O Don't know O Yes O No Are there any wetlands,streams or ponds within 200 feet of the Is there evidence of fill or excavation on the property? property? O Yes O No If yes,identify on site plan El Yes O 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 O No O Yes O No DEPARTMENT USE y ONLY y .e pr 7er .sh; .l i- "?t -a r r a s 3 z IS ublic sewer available t `the:sitexn'"_''""�. *. el � , - ,ff Is tli Arts JI}a designated ss:--,- ,,,--, CC)i1tl Area '3 a as Pr,. t C w , s gat q 44 �§ - 3 8 p-4^y_ eS t., Nq-., -� ` a":- r..,y !: 'r ''' i afi''a: �'jz r'" .''t�'° the orb ert rsnsidt t�e ASA x t Yes © i o N is ublic water ava lable to he site'" a is Y ,z `V ,g MrA PzYSs . ` a * '�`- 1 Mks A ' V"� -*'A 3' '.,A4: +`x1.?.: Pax- 17 Yes .�; � o,:�"'T sin m - s i v , x y _.+• r c a. ."x--sk4a''x, ,F gip".,"' ,:- " =,`,V S:G ' E Yees r� No .. Is the_property located Within.I000 feet of a atur4,4' c'r ,t $ Is the p op rty tnsrde te.I'SS tr f it o W ,a i!' t°e „ar� k 8x o$4iv u+ ` , #; ^t 3 Ito -, : . ,' ' : > .�� ,,€, .. .?�,<_,,,,f. rr + �.. �`d. ` _ is.'g.� ��,�, k? z 's7 .>."a , `a'�`,-k :. ."*.�,.�'". .w..;t;mot,. _-.=� _ Date Received: Staff Representative: METHOD OF PAYMENT SUBTOTAL ❑ CASH ❑ CHECK ❑ a1C VE`,: _ ❑ I 'mo` ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: EXPIRES: _ :TOTAL FEE *V�� BANKCARD NUMBER: _ MINIM UM PERMr7',FEElSE3#CO PLEASE MAKE Ci IEcKS PAYABIE'fo SPOKANI AUTHORIZED SIGNATURE: _ COU 1'YFEItIWit;1'cENC1I€�