2003, 03-10 Permit App 03001499 MHSPOKE COUNTY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: / / q"lo
Assessor's Tax Parcel Number(s):
Legal Description:
P/II? 6vvf/ //oh,/904,e_
�aa/ 22
Project Description: / '/ a 6,1 , Jl0In C Se_
❑ Building Permit
❑ Relocation
❑ Change in Use
❑ Grading
actured Home Permit
❑ Sign
O Tenant (New/Change)
❑ Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Hear:
Left. Right
School District
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
❑ Owner:
?
11�� / - /
�/-%�ijoknIec
Phone: p 6
�/ �%pp ,3' �p!p
t.a a9-99y-'-r�/06
..,..
❑Applicant:
Phone.
Fax:34-r
(ailin Address:
Li CD
Mailing Address:
City, State, Zip
Veafra C4 IC
PiZq q96012
City, State, Zip
❑ Contractor
,5 �0tG /r p
''��ii CV /
Phone L ,yq���y`/y
✓ [{/
Inc
❑ Architect/Engineer
Phone
Fax
P ,thug address
5(41 Se TJ/,14
Mailing address
i/V e57`' / / 51/s
to Zip
CJj)-n4y/-Izi 47
City, State Zip
\\ A State Contract r license #
Contact name:
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
'Total habitable space
2rtd floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Crust of project
I-lcat source (electric, gas, etc.)
y«
Manufactured Home . — 1
Sign
Width: _
0
/ ` (/:
�/
Length:
/11 IT
What is the square footage of the sign
face?
How high is the sign?
Year:
)-te 3
Make:
Pled 1.ih. echp.b
# of signs
Area of existing signs
Relocation
Fire Safety
Previous address
lire Sprinkler
'fact
Fireworks display _
Paint booth Fire Alarm
_
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Finn Name
Phone
Plans l inunmet
Phone
Inspectors:
\ddress
Inspector
Phone
❑ Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
Are there structures on the property? 0 Yes 0 No
1/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?
If yes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
lfyes, identifi, on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
If yes, identifr an the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identify on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
('%) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
• 0 Yes 0 No
Is the property in a designated Stormwater Control Area?
❑ Yes
yy` `a " _,.
❑ No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA?
0 Yes
❑ Yes
0 No
❑ No
Is public water available to the site? 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?
❑ Yes ❑ No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CAST I -ii I I:CK ❑ - ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATI?:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE.:
SUBTOTAL.
TOTAL FEE
MINIMUM PERMIT FEE 1S F35.00PLE• ASE
NI A KE CHECKS PAYABLE TO SPOKANE
(X.-PUNTS' PERMIT CENTER