Permit Application

CITY OF TONASKET PERMIT APPLICATION

P.O. BOX 487/209 S. WHITCOMB, TONASKET, WA 98855 (509)486-2132

TYPE(S) APPLYING FOR ON THIS APPLICATION:

Building:Plumbing:Mechanical:Other:

Please provide the following contact information for the applicant:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail

Please provide the following contact information for the property owner:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail

ARCH/ENGIN/IND OF RECORD: 

FIRM:

PHONE:

BUILDER: 

PHONE:

MAILING ADDRESS: 

WA LICENSE #:   EXP DATE:   CITY LICENSE #: 

STREET ADDRESS OF WORK SITE: 

PARCEL #:  TOWNSHIP:   RANGE:  SECTION: 

SHORT LEGAL DESCRIPTION: 

Is the property subject to any easements or deed restrictions?    Yes  No  If yes, please describe: 

LOT SIZE: 

PROPOSED LOT COVERAGE:

WITHIN 200’ OF SHORELINE:  YES   NO

ENVIRONMENT: 

SETBACK FROM OHWM: 

IN THE FLOODPLAIN:  YES NO

BASE FLOOD ELEVATION/ZONE: 

ZONING DISTRICT: 

PROPOSED SET-BACKS TO PROPERTY LINES:

FRONT: REAR:  SIDES: &

DESCRIPTION OF PROPOSED WORK: 

INTENDED USE OF THE BUILDING: 

TYPE OF WORK (CHECK ALL THAT APPLY):

NEW ADDITION REMODEL MOVE DEMOLITION REPAIR ACCESSORY

SINGLE FAMILY MULTI-FAMILYCOMMERCIAL INDUSTRIAL PUBLIC

OCCUPANCY GROUP(S) TYPE OF CONSTRUCTION

OCCUPANT LOAD

IS THIS A PRE-MANUFACTURED STRUCTURE? IF YES, LIST MAKE AND MODEL OF UNIT:

SIZE PROPOSED WORK:

  X = SQ. FT. BASEMENT

X = SQ. FT. FIRST STORY

X = SQ. FT. SECOND STORY

X = SQ. FT. THIRD STORY

X = SQ. FT. GARAGE

X = SQ. FT. OTHER

PROPOSED HEIGHT OF BUILDING = TOTAL SQ. FT. WORK

TYPE OF PROPOSED HEAT

NUMBER OF PLUMBING FIXTURES

ESTIMATED VALUE OF THE PROPOSED WORK

Will the work require special inspection? If yes, please list type and agency

UTILITIES:

Water: City:

NEW SAME CHANGED TO

Sewer: City:

NEW SAME CHANGED TO

Type of discharges to sewer: Domestic and:

Will there be any work needed in a dedicated public right-of-way? If yes, please describe

All of the work is within feet of a dedicated fire hydrant.

Proposed works’ fire flow requirement:

gpm @ 20 psi residual, gpm @ psi is available

Will there be grading and filling in additional to nominal foundation dig out and superficial landscaping? If yes, please describe:

Is there any existing or historic fill on the site? If yes, please describe:

 

Are there any steep slopes on the site? If yes, please describe:

 

Will there be temporary structures connected to this proposal? If yes, please describe:

 

Will the proposed work or use of the property alter the access to the site? If yes, please describe:

 

I hereby apply for a permit to do the work indicated above and acknowledge that I have read this application and hereby certify that the above information is correct. I understand that incomplete, inaccurate or later changes may cause any resulting approvals to become null and void. I agree to pay the appropriate fees and have accompanied this application with at least two sets of plans and specifications indicating with clarity the entire scope of the proposed work and how the work will comply with code and relevant law or ordinance.

Water: City:

NEW SAME CHANGED TO

Sewer: City:

NEW SAME CHANGED TO

Type of discharges to sewer: Domestic and:

Will there be any work needed in a dedicated public right-of-way? If yes, please describe

All of the work is within feet of a dedicated fire hydrant.

Proposed works’ fire flow requirement:

gpm @ 20 psi residual, gpm @ psi is available

Will there be grading and filling in additional to nominal foundation dig out and superficial landscaping? If yes, please describe:

Is there any existing or historic fill on the site? If yes, please describe:

 

Are there any steep slopes on the site? If yes, please describe:

 

Will there be temporary structures connected to this proposal? If yes, please describe:

 

Will the proposed work or use of the property alter the access to the site? If yes, please describe:

 

I hereby apply for a permit to do the work indicated above and acknowledge that I have read this application and hereby certify that the above information is correct. I understand that incomplete, inaccurate or later changes may cause any resulting approvals to become null and void. I agree to pay the appropriate fees and have accompanied this application with at least two sets of plans and specifications indicating with clarity the entire scope of the proposed work and how the work will comply with code and relevant law or ordinance.

 

E-mail Address of Owner or Authorized Agent:

 

Date: