2005, 04-18 Permit App: 05001211 ResidenceProject Number: 05001211 Inv: 1
' Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/18/2005 Page 1 of 3
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -
NATURAL GAS
Setbacks: Front 25 Left: 76 Right: 129 Rear: 68
Site Information:
Plat Key:
Contact: GRAY, RICK L & JODI P ci 9 -170,98i
Address: 17223 E MONTGOMERY
C - S - Z: SPOKANE VALLEY, WA 99016
Phone: (509) 924-3587
Group Name:
Project Name:
Name: GREENACRES IRR DISTRICT A
District: East
Parcel Number: 55073.0464 Block: Lot:
SiteAddress: 17223 E MONTGOMERY AVE Owner: Name: GRAY, RICK L & JODI P
Address: 17223 E MONTGOMERY
SPOKANE VALLEY, WA 99016
Location:: CSV
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Area: 36,168 Sq Ft Width: 0
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Review Information:
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Site Plan Reviewr Released By:
C . _ w -&-cath p�
Plan Review
Released By:-°
Critical Area Review
r' 1
v% I 1 .
Septic System Review
Permits:
c pm-
Released B
llA✓ Y.. t. (4Sfr. lit/
A —CaJfl C4 /Acre ( '03 A_11)
56' cam, n2..
Released By:
r,e V/7/ -
Operator: K_C Printed By: K_C
Print Date: 04/18/2005
Project Number: 05001211
Inv: 1
' Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/18/2005 Page 2 of 3
Contractor: HILAND CONSTRUCTION
Address: 4135 S CONKLIN RD
GREENACRES, WA 99016
Building Characteristics
Group: R-3
Total Area
Building Height
Stories
Dwelling Units
Type: VB
2161
18
1
Building Permit
Finn: HILAND CONSTRUCTION
Phone: (509) 922-8980
Description Grp Type Notes
BASEMENT F R-3 VB
COV DECK R-3 VB
DECK R-3 VB
GARAGE U-1 VB.
RESIDENCE R-3 VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Contractor: OWNER
Item Description
GAS WATER HEATER
GAS APPLIANCE<=100,000BTU
GAS PIPING
HEAT PUMP OR A/C 0-3 TONS
VENTILATING FANS
CLOTHES DRYER
RANGE
GAS LOG OR GAS INSERT
HOOD -TYPE 11
This Application:
Total Project:
Sq Ft Valuation Sq Ft Valuation
885 $17,700.00 885 517,700.00
78 $1,170.00 78 $1,170.00
118 $1,770.00 118 $1,770.00
1,462 $27,778.00 1,462 $27,778.00
2,161 5161,383.48 2,161 $161,383.48
Totals: 4,704 $209,801.48 4,704 5209.801.48
Units Unit Desc
1 SELECT
1 SELECT
1 SELECT
Permit Total Fees:
Mechanical Permit
Fee Amount
$1,609.75
$4.50
$643.90
$2,258.15
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
4 # OF UNITS
1 NUMBER OF
4 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Operator: K_C Printed By: K_C
Permit Total Fees:
Print Date:
Fee Amount
$10.00
$12.00
$4.00
$12.00
540.00
$10.00
$10.00
$10.00
$10.00 .
$118.00
04/18/2005
Project Number: 0500/27/
Inv: /
' Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/18/2005
Contractor: OWNER
Item Description
TOILETS/BIDETS
SINKS
SHOWERS
TUBS
GARBAGE DISPOSAL
CLOTHES WASHER
FLOOR DRAINS
WATER SOFTENER
WATER USING DEVICES
Nates •
Plumbing Permit
Page 3 of 3
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
3 NUMBER OF
4 NUMBER OF
2 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
2 NUMBER OF
Permit Total Fees:
Fee Amount
$18.00
$24.00
$12.00
$6.00
$6.00
$6.00
$6.00
$6.00
$12.00
$96.00
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount
$2,258.15
$118.00
$96.00
Invoice Amount
52,258.15
$118.00
$96.00
$2,472.15 $2,472.15
Amount Paid
$0.00
$0.00
$0.00
Amount Owing
$2,258.15
$118.00
$96.00
$0.00 $2,472.15
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 04/18/2005
04/19/2005 10:33 5093241567 SRHD EHS PAGE 01
-.'V.,Numb'ei:.1.05001211 " 'l Inv:' 1: 4410..00C:::: Date)4i18/2005 Page l oil.
enaltiesw111'be' assessed "fo'r.commenl:ing work withoult a' permit,; ,.
I f wo zon:'...,..:,i;.;.
�rdlBCi pori ��(;. �.... .<,:;: :`��'•l; ._.,r:. ��':='''.i`�. F-']. :C.� ;. _! ._.n:, ;. ,:_:`;rv;. ..: .
`=Ysr�.�;,:..,;,e,.4.-:Nt�i3^srS.izssmm^,..«_."�iu�;s:r�sm.��eirrr.:•��:rr_.-e•>^^..�`_:�:nt:is:zunip!: rlec __
Petuti[Usr.,NEW RESIDENCE �W/ATTACIfED.GARAGE=;'•._,'-touitadt: G12&Y CIC,L&JOD1 P: , 9i-GD.Pgr.
,NATURA1.CAS-v'='::': `"='r,"-)1•"--,. •::r.;:; ...
)c ;�.... z'..' Address ' 17223 E MONTGOMERY,, •
C,) ... .:.:.. q , S • z: -SPOKANE VALLEY, WA 99016
on
Setbacks Front 251 Left 76 Rlghr.: 129; Regi '. 68 i Phe: (509) 9243587 -.
. . Group Name: . ..
Projedt Name:
Et...l fOrmatr on ma�.-nrsa• cry 11,,�,a:mzrm.�..-a.."••••rm,c,...-vx:•s.•.xn•--..rx-s:.iintr^z-, ^-717^:ac
Plat Key:.. - Name: .'GREENACRESERR DISTRICT A District: Ease
ParcelNnmber 56073.0464 •Block: Lot
SiteAddress: 17223 E MONTCOMERY AVE Owner. Name: GRAY, RICK L & JODI P
Address: 17223 E MONTGOMERY '
Location:: CSV . .SPOKANE VALLEY, WA 99016
Zoning: UR3.5 .Urban Residential 3.5
Water District
Area: 36,168- Sq Ft Width: 0
Review .Nbr of Bldgs: 2 Nbr of Dwellings: 1
geview information: vsysenzzarr.rm.y16z .miuxvae 3,.tsICrocr�eevrcxaII'c.,_:,2an.arrx:•a2irrsx�u.uu-uz•,.1-rrcona-.�.,:
Hol& ❑
Depth: 0 , Right Of Way (1t): 0
Bab!
Site Plan Review
Seaga 13y:
Plan Review
Rebased By:
Critical A res Review / (L1.4 A i'
Relea nd.13 :::'";;-...
Septic System Review F
Releasgll $y.
mao¢ ooeeaa, ntsxk ardt
bedrms, ar day
PCr1nf1S• .. ittrir scmacr.mmarn nrmtwc .,
^�-+x�ac�-rcnvm..s_,�s:•.:�rxxe:acn. x:, a�-m-+�^c:
itositedus hsaDWkiOawed
Operator. ICC
Printed By: KS
Print Date: 04/18/2005
PPR 19 2005 11.41
5093241567
PRGE.01
BUILDING PERMIT APPLICATION WORKSHEET
City of ckane Valley Community Development Department
IE C 1E r IE Building Division
11707 E. Sprague Avenue, Suite 106
APR 0 1 2005 Spokane Valley, WA 99206
(ThPhone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
/7_2.2-3
/Y/11i /toom '
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
IM Building Permit
❑ Relocation
S `„'(/-Tr GtcY&
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
[Owner: 1-C:IC I *JGI4i Pi GAY ❑ Applicant: conithoicpor
Phone: 9.2q'35 7 Fax: Phone: Fax:
Address:Addd��/7,223 . rnm*•ffcpuv7 Address:
C°ib ofrit/jth?ty State 970 /6Code �� City State Zip Code
❑ Contractor: f////y/yg COM5 rae/io4) ❑ Architect:
Phone: 50V yz tfyorFax:.s'%pz.Z 8`>8'd Phone: Fax:
Address: 9/95 S CO/ilA-hn/ Address:
a/Y''OnW/2') / h/4 770/6
City State Zip Code City State Zip Code
t ced 99/ - c/5 S' ,g
r r WA State Contractor License #: ,$/,owei�C *OdjPContact: ?6`/,y tT /29ej'4L
i
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK J1 /
DIMENSIQN%+�a
3
# OF STORIES: /
MAIN FLO R_.Ty.O S�Q_ FTG: /
117S -
•.2".".FLOObi R SQ_ FTG:
-UNFIN BASEMENT SQ. FTG:
FINISHED BAS MENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV PATIO SQ FT
n��emmv INpla
,s
i6z
OCCUPANCY
OCCUPANCY GROUP:
R3
CONSTRUCT ON TYPE:
.s-�
HEATSOURCE_
,ae/yr /kW-fr
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
�r/bl
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
a ys-- 00
30% LO ES ON PROPERTY:
yn,
SEWER OR ON-SITE SEPTI
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: 1. t' 'iYe'ar; I
Pit Set:
,_RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone: Fax:
Address:
State
Zip
City
State -
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the"dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit intire to the
property owner." 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name
1-A7c7 (1 /<Cea_ Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Authorized Signature:
Check ❑ Mastercard
❑ VISA ❑ Other
Expires: VIN#:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address: / 7? -23 F rn0/7/�%00,ne
Permit Use:
Owner. qir�/A4l
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
/Ugly J#o '
Phone (Daytime Contact): '/.,2 47/
Mailing Address: /'.2..m , m0 V9 3C4S,,--,-,/ 4'0t lfh//y 9ya/(i
City State Zip Code
Contractor. M'/nip/%i Goias f/U/ 7v/i/ License #: ft//4/Uct d6t /9,415one #: 997 0/ 5l ev
rte.? /fc/'Fs 14/A1 990/h
Zip Code
Mailing Address: y/3C S, ('on/4v/n;
City / State
SANKCARD NUMBER:
AUTHORIZED SIGNATURE:
.61
DESCRIPTION OF WORK
*OF UNITS
X
. COST -
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS'
7
X
' 56.00
=
2
URINALS
-
X
56.00
=
3
TUBS ' '—
—'=
if
X
56.00
-
4
SHOWERS (PER TRAP)
BATH, STALL ONSITE BUILT
.
X
56.00
=
5
-
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,�,,/
X-RAY, FOOD. PREP/CULINARY MEAT
"/
X
56.00
=
6
DISHWASHER
0
X
5600
=
7
CLOTHES WASHER
/
X
56.00
-
-
5
GARBAGE DISPOSAL
/
X
5600
=
9
WATER SOFTENER
/
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE. COIL, TRENCH, CONDENSATE
/
X
$6.00
=
12
'ROOF DRAINS/OVERFLOW
DRAINS
-
X
5600
=
13
FOUNTAINS, DRINKING
X
5600
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP •
X
55.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER CARBONATOR, SWAMP COOLER
X
55.00 .
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR VATS. TANKS, BOILERS
X
55.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
i NITROUS, OXYGEN
X
56.00 '
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X-
515.00
=
METHOD OF PAYMENT:
0 CAS�i- 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
.575.00
TOTAL PERMITFEEDUE:
SANKCARD NUMBER:
AUTHORIZED SIGNATURE:
.61
MECHANICAL PERMIT APPLICATION
ne
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Departmen
Building Divisioi
11707 E. Sprague Avenue, Suite 10(
Spokane Valley, WA 9920(
Project Address: /7tp_23 rn%l
o'q/0/??n;ye Permit Use:
Owner: R/('�[ f,� / Phone (Daytime Contact): 9') i/ 53 re/
Mailing Address: W /72.23 £. 141O/1/1-6amey/ cochk6""t0 1/A -//n7/ t"2 99"%
Contractor. 0/2-49, tad/45 t License #: f{/1.(1f't/I <YD(o 64'A- Phone #: n/dg5"Fi
Mailing Address:
Zip Code
C
State
Zip Coda
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
f
X
MOO
=
2
FUEL BURNING APPLIANCE
More than 100,000
' X
515.00
=
3
UNLISTEDAPPLIANCE (Additional Fee)
Equal to or less than 400.000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
550.00
=
6
USED APPLIANCE (WSEC min. AFUE rating) .
More than 400,000
X '
5100.00
=
7
• BOILERREFRIGERATION
1: 100M BTU
X
512.00
=
8
BOILERREFRIGERATION
101 - 500M BTU
X
520.00
=
9
BOILERREFRIGERATION
501 - 1,000M 8711
X
525.00
=
10
BOILER/REFRIGERATION '.
1,001 - 1,750M BTU
X
535.00
=
11
BOILER/REFRIGERATION
More than 1 750M BTU
X
560 DO
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
• 510.00
=
13
RANGE
'
X
510 00
=
14
DRYER
l'
X
510.00
=
15
FUEL BURNING WATER HEATER
t
/
X
510 00
=
'
16
MISC. FUEL BURNING APPLIANCE
X
510.00
=
17
GAS PIPING (each outlet)
l11
X
51.00
=
16
DUCT SYSTEMS
X
510.00
=
19
VENTILATING FANS
X
510.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10.000 CFM
X
512 00
=
21
AIR HANDLER (DOES NOT Include ducting)
Greater than 10,000 CFM
X
515.00
=
22
EVAPORATIVE COOLERS
X
510.00
=
23
TYPE HOOD
X
550.00
=
24
TYPE it HOOD
X
510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
/
X
. 512.00
=
26
.AIR CONDITIONER
3-15 TON
X
520.00 -
. r..
27
AIR CONDITIONER
15-30 TON
X
52500
=
26
AIR CONDITIONER
30-50 TON -
X
535.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
510.00
=
31
WOOD OR PELLET STOVE/INSERT
- X
510.00
=
32
WOOD STOVE - FREE STANDING
X
525.00
=
33
REPAIR E ADDITIONS
•
-
X
515.00
=
34
VENTILATION SYSTEMS
X
- 512.00
=
35
VENTILATION MECHANICAL EXHAUST
X
512.00
=
36
INCINERATOR - RESIDENCE
X
519.00
=
37
INCINERATOR - COMMERCIAL
X
522.00
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD t: yr&
DATE
SUBTOTAL
'PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
11lzalai lz:ua "MeV az4
aoua
br Cf -t w aian
ay uU1
LTH DEPARTMENT
2B.,H.P.fl.: 11enitfi Officer
Division of Sanitation
efferaon Street
Washington Silly DA
'
• Ip$$NIT
APPL CATION FOR PERMIT 0 INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
10 A 05324,
Addressof •.• 'C• Site
type of TinJJ♦%
Danner of aA tldioS
Water Supp
Soptie. tank capacity
.QA s4 -0-d ifue Tr boSement or buildioa
ppoeity r _ Capacity
City. We11. Spring). Derrell -"to.
2C7)
solo Style of took
•MT'
orption Pit• eat m.
• Iengtfi.ef didpeppi field
'.Other
(1) Shaw r.letive leeetteee11 Prepeted.tiouitalk.s. .optic talk.
diepaml'11.44a well. garage and ether oat buildings.
(arifake Gate of ®y barn, slopor e110mp7 area or aa7
;,,:other itpotteot tepagraphia detttule.
)C <
INVOICE
H&R COMPLETE
Septic & Grease Trap Services
PO Box 749 Newman Lake WA 99025
(509) 228-9955 (208) 769-4885
SOLD TO�,� IC ^
/lJ[ ���
SHIP TO - ,�' -1 t'+ -2
//
ADDRESS
I
1 72,R 2 t 1 L f-Gcanoe/
ADDRESS
STATE, ZIP
CITY,
STATE, ZIP
CUSTOMER ORDER NO.
SOLD BY
RicK
TERMS
',...:i ('K
F.O.B.
DATE
3721/0.5 --
ORDERED
SHIPPED
DESCRIPTION
PRICE
UNIT
'AMOUNT
RLmp4/44frt 75& c.cd- and
J59 int)
a3,19 uwF- I Sb 'Al— oui— rf Cis ROO G
91 e9e9?q_c_
1 / 1` 71411
S
M C —if,� was 4- Ev- I svcii
ippr,S
--ra
be Noidany ind;ca+lni :Sysfe4.
is.. iv.
1 r. +-II 0
IA.I`Yk -
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c
.\Jl
II
I t, ['IA n
C
'3 e -I
1,..! v. jj r
--
C 7,R 5`l.
Madams 5840
3 b 1
r C7�Z `f
ADORERS
ZONE
ROADCOMMENTS
A
REVIEWED eV
L
This Bile plan is being submitted for the purpose of
obtaining • building permit and is a true and correct
representation of the proposal. AN known ferry
fines/dimensions, curb Nnss, structures and easements
have been identified. Also indicated are wetlands,
bodies of M% oaf, steeppQebN por other critical areas.
�-.+�r/ T �- t//
"
Date: L('f g – —
spv(140E (Lf/
JP
stp, - - yC
1v
SVAL
TNS FiemE ,41' 17,223 t, 14A0,6-cyovgtzk.v a)14 -S
—��Mo�iSu toZ1 O.\ 3 -23 -Os— 7 Mp4r� (A)/:yY" ,,D