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2001, 05-15 Permit App 01003592 Re-Roof
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. Boa ! -r &'acd Assessor's Tax Parcel Number(s): Legal Description: Project Description: % 'Pew fa Building Permit 0 Relocation oc- Idop 0 Change in Use O Grading O Manufactured Home Permit ❑ Sign O Tenant (New/Change) OWNER/APPLICANT INFORMATION 0 Indicate who should be contacted regarding this project O Other Yhone: // t f-€ P C 01 e,ti Fax: 0 Applicant: Phone Fax: Mailing Address: Mailing Address: City, Sure, Zip City, State, Zip 0 Comnaor Photo AFro gi).4 L 6' AI IN 7� G'{ htv i 0 Architen/Engineer Phone Fax Mailing address Mailing address City, State Zip City, State Zip WA State Contractor licenser Contact name "zn } 4^`^, �- t �� . '.d` y! V.1 GL © .y�y- r 7 '. . Building height to peak B of stories Main floor sq. h. Unfinished basement sq. ft. Dimensions Total habitable space p ^d 2 floor sq. E. Finished basement sq. ft. Occupancy group Construction type Garage sq. ft. Deck sq. ft. Cosi of pro �L7 id0J.O v Heat source (electric, gas, etc.) lIltii 1Ciil 1 foii t', 3 Ih y �, Al� ..._ �. Width: Length: What is the square footage of the sign face? How high is the sign? Year: Make: # of signs Area of existing signs ; rm _ ` `�" a . rt Previous address': Paint booth Fire Sprinkler Fire Alarm Tent Fireworks display Proposed use Value O Concrete O Welding 0 Bolting 0 Reinforcement ADDITIONAL SITE INFORMA Are there structures on the property? 0 Yes O No I%yes, identi 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 sire be served by a septic system? 0 Yes O No Is any part of the property within a 100 yr flood plain? If yes, identify on site plan O Maybe O Don't know O Yes 0 No Are or will there be wells located on the property? lfyes, identify on the site plan 0 Yes 0 No Are there any wetlands, streams or ponds within 200 feet of the property? If yes, identf on site plan 0 Yes 0 No Is there evidence of fill or excavation on the property? O Yes 0 No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( / %) O Yes 0 No Are critical or hazardous materials used or stored on site? 0 Yes O No DEPARTMENT USE ONLY ri It$LU CrtiW Cam v S U i Sir y; '5 � a o.� ` _ YeLa roper 1nsui��1.) 3r3' v^et-x-a G�- l iti '£y.^i .Y+�. - �r'k .. $ tY r}� - �• .rZ War +.s'r. Ur S"..t<+M�,' Date Received Staff Representative METHOD OF PAYMENT ❑ CASH ❑ CHECK ❑ 1NEINN ❑ ❑ ast FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: EXPIRES: BANKCARD NUMBER: 'AUTHORIZED SIGNATURE: