2002, 04-24 Permit App 02002920 Re-Roof Shed11H
SPo C'oujy
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:
jai
47/
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: � roc.) 84-pki S vj (2 d
O Building Permit
O Change in Use
O Grading
O Manufactured Home Permit
O Relocation
O Sign
O Tenant (New/Change)
O Other
Depail. iient Use Only
Water District/Pun'eyoe
Sewer District/Purveyor
,Rod Width
'.
Setbacks •
Front.
',Left - -
Rear -
Right:
School District:
Fire District:
:
Zoning
-
OWNER/APPLICANT INFORMATION
0 Indieale uho should be eonladed rrfardin2 ther broieee
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L �r^+
C38 Hj t t›
Phone:
I.) ,a.:
'7 2. (a.
9 �i —7 �'_
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❑Applicant:
Phone
Fa.:
failing Address: ,�
! 6 v 7 k. II D Id/ I
0 44-12 �✓
Mailing Address:
City, State, Zip
SpoK„-�� ui�-s
/
T9G
,u
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City, State, Zip
O Contractor
Phone
Fax
❑ Architect/Fngincer
Phone
Fax
Alading address
Mailing address
(sits', State Zip
City, State Zip
WA StateContractor license 4
Contact name:
PROJECT INFORMATION
Building Information
Building height at peak
# of stones
\lain floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Dotal habitable space
? floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq- ft.
Deck sq. ft.
Cost of�vtyi T�
C1� C/f9 S r G
I Ieat source (t electric. gas, s e.)
Manufactured Home
Width:
Year.
Length:
Sign
What is the square footage of the sign
face?
flow high is the sign?
Make:
# of signs
Area of existing signs
Relocation
Previous address
Proposed use
Fire Safety
Fire Spnnkler
Paint booth Fire Alarm
Tent
Fireworks display
Value
Special Inspections Required?
Firm Name
Non -Residential Energy Code Compliance?
Inspectors:
Phone
Plans Examiner
Phone
Address
0
Inspector
Phone
Concrete 0 Welding 0 Bolting 0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Ycs 0 No
fyes, ideatf on site plan
Is any part of the property within 250 feet of a shoreline?
Ifyes, ident f on site plat 0 Ycs 0 No
is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If, y r, identz on site plat
0 Maybe 0 Don't know 0 Ycs 0 No
Arc there any wetlands, streams or ponds within 200 feet of the property?
fyes, identify on site plan 0 Yes 0 No
Are there slopes greater than 30°'0 on the property? (30 ft rise in 100 ft)
( / of
'°) 0 Yes 0 No
Is the property in a designated Stonnwater Control Area?
O Yes ONo
Is the property inside the ASA?
O Yes 0 No
O Ycs ONo
Is the property inside the PSSA? 0 ,Yes 0 No
Date Received:
Staff ItcpO-'.. :ui. r:
\X hat is the current property size?
(square feet or acres)
What is the current use of this property?
Will the site be served by a septic system? 0 Ycs 0 No
Are or will there be wells located on the property?
if yes, identfy on the site plan 0 Ycs 0 No
Is there evidence of fill or excavation on the property?
O Ycs O No
Are critical or hazardous materials used or stored on site?
O Ycs ONo
DEPARTMENT USE ONLY
Is public sewer available to the site?
O Yes O No
Is public water available to the site? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
O Ycs 0 No
METHOD OF PAYMENT
VISA
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FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
1 ATN: I:SPIRT S:
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TOTAL FEE
MINIMUM PERMIT FEE IS $3S.A9 PLEASE
>I.uuF CI ICci:S PAN:ISLE TO SPOL-t\E
COUNTY PERMIT CENTER