2004, 07-15 Permit App: BLD-04-07078 ResidenceTHIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
Job Address: 17009 E DAYBREAK
VERADALE WA
Description: NEW RESIDENCE W/ATTACHED
Subdivision:
Lot:
Owner:
W R LIBBY CONSTRUCTjNO
Applicant:
W R LIBBY CONSTRUCT
Phone:
Address:
5225 E VULCAN CT
MEAD, WA 99021-9478
Contractor:
W R LIBBY CONSTRUCT
Phone:
Address:
PO BOX 157
is No:
MEAD WA 99021
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
CURRENT PROPERTY USE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SHOWERS (PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
FLOOR DRAINS
WATER USING DEVICE
FUEL BURNING APPL <- 100,000
GAS LOG, INSERT, FIREPLACE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
TYPE II HOOD
sfr
253382
28
67.5 X 52.5
2
35
82
Application #: BLD -04-07078
(509) 46
WRLIBC
FeesNCHEE PLAN
�BA
YPE
SIC PERMIT F
SBCC SURCHA
TOUTS
TUBS
SHOWERS
15 SINKS
17 DISHWASHER
r-3 CLOTHES WASHER
5-b FLOOR DRAINS
1 WATER USING DEVICE
100 X 173 FUEL BURNING APPL <= 100,000
RESIDENCE
no
no
4
2
1
7
1
N
GAS LOG, INSERT, FIREPLACE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
1
3 mss,
1
REVIEWED FOR CODE CO
1 NE VAL EY B ILD N(
1 /i � �'%•AL1 �
1
3
5
1
Total Calculated:
Deposits/Receipts:
Total Due:
CITY OF SPOKANE VALLEY
#Fjf&gVED FOR SUBMITTAL
DIVISION _
Building
Planning Z5,
Public Works IJA v
THIS IS NOT A RECEIPT
ing:
07/15/2004
01/11/2005
742.46
10.00
1,856.15
4.50
24.00
12.00
6.00
42.00
6.00
6.00
6.00
18.00
15.00
10.00
10.00
10.00
3.00
50.00
2,831.11
0.00
2,831.11
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY BUILDING AND PLANNING DEPARTMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPFCIFIr CITF INFnRMnTInAI
Street Address: J Q �7 OeF7 j
Assessor's Tax Parcel Number(s): a SSI �� 6 7 S 5 3Q
Legal Description.
Project Description:
Building Permit ❑ Change in Use ❑Grading ❑ Manufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other
Department Use Only
Water District/Purveyor:
Sewer District/Purveyor
Road width
Setbacks
# of stories
J—
Phone:
Front: Rear:
School District:
Fire District:
Zoning
City, State, Zip
IUILD!
_
Left: Right:
OWNER/APPLICANT INFORMATION
❑ a7Owner: �;'`., �'
Phone:❑Applicant
Building Information
imu I'm runt
Building height to peak
# of stories
J—
Phone:
Mailing Address: .,.
Fax:.
Fax:
Mailing Address:
City, State, Zip
IUILD!
_
City, State, Zip
Dim io s�Total
x \�
habitable s ace
ab
2nd floor sq. ft.
ntractor
✓� Lf� ,� y
Phone
v-F"ax
❑ Architect/En ineer Phone
g 1
Mailing address
5�
Mailing address Fax
Occupancy group
Construction type
Garage sq. ft� j
City, State Zip
Deck sq. ft.
' .
City, State Zip i
Q
WA State Contractor license #
Contact name: t
Revised 07/25/03
Building Information
Building height to peak
# of stories
J—
Main floor sq.
Unfinished basement sq. ft.
/ SU ?-
Dim io s�Total
x \�
habitable s ace
ab
2nd floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft� j
Deck sq. ft.
Q
Cost of project
Heat source (electric, gas, etc.)
Revised 07/25/03
Manufactured Home
Sign
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Ifyes, identfi on site plan
Ifyes, ident j on the site plan 73Yes ji No
Relocation
Fire Safety
Previous address
Fire Sprinkler Tent
Paint booth _ Fire Alarm Fireworks display
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name Phone
Plans Examiner Phone
Inspectors:
Address
Is your property in a designated wildlife habitat are
Inspector Phone
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement
Address
ADDITIONAL SITE INFORMATION
.are there structures on the property? ❑ Yes ,. No
If yes. ident6 on site plan
What is the current property size? �� r
(square feet or acres) Y 7—
Is
Is any part of the property within 250 feet of a shoreline?
What is the current use of this property? j' m
bW
I 'es, identi , on site plan C3 Yes it No
1_ Alo
Is your property in a designated wildlife habitat are
\Y ill the site Ue served by a septic system? 171Yes No
73 Don't know C] YesJ6 No
❑ Yes
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Ifyes, identfi on site plan
Ifyes, ident j on the site plan 73Yes ji No
❑ Maybe ❑ Don't know ❑ Yes Qj No
Are there any wetlands, streams or ponds within 200 feet of the property?
Is there evidence of fill or excavation on the property?
,Vyes, identi on site plan ❑ Yes 45 -No
❑ 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?
❑ Yes & No
❑ Yes 0&0
11"1F11DA10TRACRIT I ICC nNIII V
Is the property in a designated Stormwater Control Area?
Is public sewer available to the site? ❑ Yes ❑ No
❑ Yes
❑ No
Is the property inside the ASA? ❑ Yes
❑ No
Is public water available to the site? ❑ Yes ❑ No
❑ Yes
❑ No
Is the property inside the PSSA? ❑ Yes
❑ No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Received: Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH ❑ CHECK ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Revised 07/25/03
EXPIRES:
SUBTOTAL
TOTAL FEE
\L{EE CHECKS PBLE TO SPOIL{NE
COUNTY PE1011T CENTER
PLUMBING PERMIT APPLICATION
PROJECT/ •� G q r
/ tq'y z 2 e✓�7 jC PERMIT
ADDRESS: `
USE:
OWNER: ^ . G //,� /3 /
c'
Ccr�Sr / ra v�--f� PHONE (Daytime Contact):
MAILING ADDRESS:
Street
(Ci /State)
(Zip)
CONTRACTOR. -LICENSE: G
v.- JO u Nr b A1116J
pL p19,
Via!
MAILING ADDRESS:
PHONE:
Street)
(Ci /State)
(Zip)
PLUMBING FIXTURES
# OF MULTI- COST/
AMOUNT
DESCRIPTION
DETAIL
UNITS PLI£DBY UNIT EQUALS
TOILETS
WATER CLOSETS, BIDETS
x $6 -
B03 URINALS
x $6 -
B04 TUBS
x $6 -
B05 SHOWERS (per trap)
BATH, STALL, ON-SITE BUILD
x $6 =
B06 SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
x $6 =
LAUNDRY, UTILITY, JANITOR,
u
PHOTO, X-RAY, FOOD
7 �—
PREP/CULINARY/MEAT
B07 DISHWASHER
x $6 =
B08 CLOTHES WASHER
x $6 -
B09 GARBAGE DISPOSAL/GRINDER
x $6 -
B10 WATER SOFTENER
x $6 -
B11 ELECTRIC HOT WATER TANKS
NOTE: if cias water tank see mechanical)
x $6 -
B12 FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
x $6
CONDENSATE
1(�
B13 ROOF DRAINS/OVERFLOW DRAINS ea.
x $6 -
B14 FOUNTAINS, DRINKING
x $6 -
B15 WATER PIPING/DRAIN-IN WASTE-
INSTALLATION, ALTERATION,
x $6 =
VENT/PLUMBING REVERSALS
REPAIR, REVERSALS
B16 SEWAGE EJECTORS
GRINDER, SUMP PUMP
x $6 -
B17 WATER USING DEVICES
ICE AND/OR COFFEE MAKER, HOSE
x $6 =
BIB, STEAMER, PROOFER
/
CARBONATOR, SWAMP COOLERS
OSS CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
$6 =
T
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER
SYSTEMS
B19 INTERCEPTORS
GREASE TRAP, SAND TRAP,
x $6 =
CHEMICAL HOLDING TANK
B20 I MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x $6 -
B21 I MISCELLANEOUS FIXTURES
$6 _
METHOD OF PAYMENT
SUBTOTAL
VISA
CASH El ❑
❑ ❑
., ❑
PLUS PROCESSING FEE $ 25.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT
CARD
TOTAL PERMIT FEE DUE
DATE: EXPIRES:
MINIMUM PERMIT FEE IS $35.00
BANKCARD NUMBER:
PLEASE MAKE CHECKS PAYABLE TO:
SPOKANE COUNTY PERMIT CENTER
AUTHORIZED SIGNATURE:
Spokane County Building and Planning Department
1026 West Broadway Avenue ` Spokane, WA 99260-0050
Revised 07/25/03 Telephone No. (509) 477-3675 ' Fax No. 477-4703 " TDD No. (509) 477-7133
MECHANICAL PERMIT APPLICATION
PROJECT ADDRESS: t' -
,L2�9�
PERMIT USE:
OWNER: y 4 a �s T, e a 2,a
PHONE (Daytime Contact):
MAILING ADDRESS:
CITY, STATE, ZIP:
CONTRACTOR:
S u/e-M /� T'r�.L'
LICENSE: S 7 ale- ►') / Y 3- J Q %/
MAILING ADDRESS:
PHONE (Daytime Contact):
DESCRIPTION OF WORK
BURNING \ITLIANCE
BURNING APPLIANCE
,TED APPLIANCE (ADDITIONAL CHARGE
,'TED APPLIANCE (ADDITIONAL CHARGE'
APPLIANCE (Must meet WSEC's min. AFUE rating)
APPLIANCE (Must meet WSEC's min. AF'UE tat;ngi
:R/REFRIGERATION
:R/REFRIGERATION
LOG, GAS INSERT, AND/OR GAS FIREPLACE
BURNING WATER HEATER
?LLANEOUS FUEL BURNING APPLIANCE
= OR <10Q.0(K)
>100,011()
= OR <400,.(N)0
>400,0(10
= OR <400,.000
1-1(X)NI RTU
1111-51N)M BTU
501-1,1X10M BTU
1,001- 1,750M BTU
+1,750M BTU
118 :AS PIPING (ea. Oudet)
AMOUN'
119 DUCTSWSTEMNS
120 VENTILATING FANS
-
121 AIR HANDLER (DOES NOT include duct system)
= OR <10,000 C NI
122 AIR HANDLER (DOES NOT include duct systems)
>10,000 CFrt
123 EVAPORATIVE COOLERS
$0.(1
124 TYPE I HOOD
$0.0
125 TYPE H HOOD
$0.0
126 HEAT PUMP/AIR CONDITIONER
0-3 TONS
127 AIR CONDITIONER
3-15 TONS
128 AIR CONDITIONER
15-30 TONS
;29 AIR CONDITIONER
30-50 TONS
130 AIR CONDITIONER
+50 TONS
31 LPG STORAGE TANK
$().111
32 \x'(i()U ()R PELLET STOVE/INSERT
METHOD OF PAYMENT
FAXED APPLICATIONS HALL ONLY BE ACCEPTED WTH PAYMENT OF A MAJOR CREDIT CARD
CASH CHECK u..V4S4
Revised 07/25/03
PAYMENT METHOD CHOICE:
DATE:
BANK CARD NUMBER:
EXPIRE DATE:
AUTHORIZED SIGNATURE:
COST/ wtMts
UNIT
AMOUN'
$5001 =
31Lu
$100.00
$50.011 =
$0.(1
$100. _
$0.0
$12. _
$0.0
$200
$0.0
$25. _
$0.0
$350 _
$().0
$60.1 =
$ILIN
$10.00 =
$(LtN
$().111
$10.00 =
$0.(N
$1.00 =
$11.01
$10.00 =
$0.01
pt(Nl =
$0.(N
$150 =
$().a
$100
WIN
$50.00 =
ioiu
$0.1N
$20.00
$25.00
$35.(X
$60. _
$ILIN
$10. _
$().(N
$2511
SUBTOTAL$0.00
PROCESSING FE
$25.00
TOTAL PERMIT FE
MINIMUM PERMIT FEE IS $35.00 PLEASE
MAKE CHECK PAYABLE TO: SPOKANE
COUNTY PERMIT CEN'T'ER
Spokane County Building and Planning Department
1026 West Broadway Avenue ' Spokane, WA 99260-0050
Telephone No. (509) 477-3675 ' Fax No. (509) 4774703 ' TDD No. (509) 477-7133
E-mail PermitHelp@spokanecounty.org
Jun 30 04 03:20p Wesley Libby 509-468-4060 p.2
Ute-
7
7
rexK �1