2000, 09-15 Permit App: 00008300 Residencei
Project Number: 00008300 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 09/15/2000 Page 1 of 3
Project Information:
Permit Use: RESIDENCE W/GARAGE - GAS
Setbacks: Front 25 Left: 8 Right: 8 Rear: 35
Site Information:
Plat Key: 005977 Name: SHELLEY LAKE 2ND ADDITION
Contact: GEORGE H WHITE INC
Address: BOX 52
C - S - Z: LIBERTY LAKE WA 99019
Phone: (509) 921-9752
Group Name:
Project Name:
Parcel Number: 45242.2201
Block: 1
SiteAddress: 706 S SHELLEY LAKE LN
VERADALE, WA USA 9903
Location:: VER
Zoning: UNKN Unknown
Water District: 010 VERA
Area: 11,632 Sq Ft Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Department
BUILDING
Hold Reasons:
Permit Conditions:
BUILDING
Review
Site Plan Review
Plan s:_ iew
easons:
Permit Conditions:
ENGINEER
Hold Reasons:
Permit Conditions:
BUILDING
Hold Reasons:
Permit Conditions:
UTILITIES
Hold Reasons:
Permit Conditions:
Permits:
Lot: 1
District: F
Owner: Name: GEORGE H WHITE INC
Address: BOX 52
LIBERTY LAKE WA 99019
Hold: ❑
Depth: 0 Right Of Way (ft): 30
BY: „La__ 44.4,- *IC•C-3
Approach / Drainage
Special Reviews
esed By.
Sewer Review
(3 36
used By:
Project Number: 00008300
Inv: 1
Apr;lication
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Date: 09/15/2000 Page 2 of 3
Contractor: GEORGE H WHITE CONST
Address:
Firm: GEORGE HARVARD WHITE CON
0 BOX 52 Phone: (509) 255-9204
LIBERTY LAKE, WA 99019
Building Characteristics
Group: R-3 Type: VN
Const Category: New
Nbr Of Dwellings:
Bldg W x D: x
Req Parking:
Occupant Load:
Building Sq Ft:
Handicap Parking:
Description Grp Type Notes
2ND FLOOR R-3 VN
BASEMENT F R-3 VN
BASEMENT U R-3 VN
GARAGE U-1 VN
RESIDENCE R-3 VN
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Item Description
HOOD -TYPE II
DUCT SYSTEMS
GAS WATER HEATER
GAS APPLIANCE >100,000BTU
GAS PIPING
AIR CONDITIONER:4-15 TONS
VENTILATING FANS
CLOTHES DRYER
GAS LOG OR GAS INSERT
Building Height: 25
4125 Sprinlders:
Critical Materials: 0
This Application:
Su Ft Valuation
1,115 $69,130.00
700 $11,032.00
800 $9,248.00
760 $9,120.00
1,510 $93,620.00
Totals: 4,885 $192,150.00
Units Unit Desc
Y OR BLANK
Y OR BLANK
Y OR BLANK
Permit Total Fees:
Mechanical Permit
Stories: 2
Total Project:
Sq Ft Valuation
1,115 $69,130.00
700 $11,032.00
800 $9,248.00
760 $9,120.00
1,510 $93,620.00
4,885 $192,150.00
Fee Amount
$1,360.00
$4.50
$299.20
$1,663.70
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 255-9204
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
3 # OF UNITS
1 NUMBER OF
5 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Permit Total Fees:
Fee Amount
$10.00
$10.00
$10.00
$15.00
$3.00
$20.00
$50.00
$10.00
$10.00
$138.00
1
Project Number: 00008300 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 09/15/2000 Page 3 of 3
Plumbing Permit
Contractor: GEORGE H WHITE CONST Firm: GEORGE HARVARD WHITE CON
Address: 0 BOX 52 Phone: (509) 255-9204
LIBERTY LAKE, WA 99019
Item Description Units Unit Desc Fee Amount
TOILETS/BIDETS 4 NUMBER OF $24.00
SINKS 6 NUMBER OF $36.00
SHOWERS 2 NUMBER OF $12.00
TUBS 1 NUMBER OF $6.00
DISH WASHERS 1 NUMBER OF $6.00
GARBAGE DISPOSAL 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
FLOOR DRAINS 1 NUMBER OF $6.00
CROSS CONNECTION DEVICES 1 NUMBER OF $6.00
WATER USING DEVICES 3 NUMBER OF $18.00
Payment Summary: „m
Operator: JAS
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Notes
Printed By: JAS
Fee Amount
$1,663.70
$138.00
$126.00
$1,927.70
Permit Total Fees: $126.00
Print Date: 09/15/2000
Invoice Amount
$1,663.70
$138.00
$126.00
$1,927.70
Amount Paid
$0.00
$0.00
$0.00
$0.00
Amount Owing
$1,663.70
$138.00
$126.00
$1,927.70
l 1
SpoKARE COUNTY
Project Description:
PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
hni(? ,
706 S. S 14L2L 17/ C 147-1, L f/&.T
I /
TYPE OF APPLICATION
Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
SPECIFIC SITE INFORMATION
Street Address: 7 0 6 S,
S H 2 z.'`t-// L. P` k (- ` P r'1 L
Assessor's Tax Parcel Number(s):
Mailing Address:
G/L (,I IS tkr ` I 9w 1
Mailing Address:
Legal Description: Or' /
0EZ 0(k c H LI \, C A irl[ 2 "
Pd)
Department Use Only
/
❑ Architect/Engineer
Water District/Purveyor
Sewer District/Purveyor
Mailing address
Road width
Setbacks
Front:
Left:
Rear:
Right:
School District:
Fire District:
Contact name:
Zoning
OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted regarding this project
` �q / Phone: '''" G' '162
citOwner://1 Y-1
, t ). 1 r W 1 ' ` t X I `) t • Fax: /9 i— `7 % %
❑ Applicant:
Phone:
Fax:
Mailing Address:
G/L (,I IS tkr ` I 9w 1
Mailing Address:
Dimensions
City, State, Zip
City, State, Zip
Finished basement ement sq. ft.
7 6
❑ Contractor �� ( 1. %Phone �
G ) t t \V t ? j� , ! L}_ 11\1 Y Fax / IL1`, /42 8
❑ Architect/Engineer
Phone
Fax
Mailing address
o x ca/ t►t, LJ' ma, glai
Mailing address
Heat source (electric, gas, etc.)
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROJECT INFORMATION
Building Information
Building height to peak
25 '
# of stories,„....)Main
floor sq. ft.
)5M
Unfinished bas ment sq. ft.
gO 0
Dimensions
Total habitable space
2"d floor sq. ft.! r—"
1 `)
Finished basement ement sq. ft.
7 6
Occupancy group
Construction type
Garage sq. ft. 74 O
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
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
Relocation
Fire Safety
Firm Name
What is the current use of this property?
Previous address
Will the site be served by a septic system? 0 Yes 0 No
Paint booth
Fire Sprinkler
Tent
_ Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? 0 Yes 0 No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
Address
Inspector
Phone
O Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, identify 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, identz 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 site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
If yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 Yes 0 No
Is public sewer available to the site? O Yes 0No
Is the property inside the ASA?
0 Yes
O Yes
0 No
0 No
Is public water available to the site? 0 Yes 0' No
Is the property inside the PSSA?
0 Yes
O'' No
Is the property located within 1000 feet of a Natural Resource
Area? 0 Yes 0 No
Date Received:
Staff Representative:
UTlt.rnEs DIVISION
N. Bruce Rawls, P.E., Utilities Director
C O U N T Y
• A DIVISION OF THE PUBLIC WORKS DEPARTMENT
GENERAL FACILITIES CHARGE (GFC)
PAYMENT OPTION SELECTION RECORD
Date: Parcel No(s): L4 t
Site Address(es): 70 C e ` /e j �� LKA
Builder Name: (r)OC9 e lY (Ile 3C OR Owner Name:
Payment Option Selected (Check One):
1. ( ) GFC payment received at issuance of Sewer Connection Permit by
1 Division cf Utilities
1.0 - )TO 6c.pa.t A` CkOStn5.
2. ( ) GFC payment in 24 equal monthly payments upon establishment of Sewer Billing Account.
Complete one of the following statements.
a. Owner's Statement: I, , understand that I will
be billed for the applicable GFC amount in 24 monthly installments. The monthly GFC
installments will be added to my monthly sewer service charges.
Owners Signature/Date
b. Builder's Statement: I, aeo P 1.1 I F' `S f' understand that
because I am selecting this option for payment of the GFC, that the purchaser of the home will
be responsible for payment of the applicable GFC in 24 equal monthly installments. I agree to
formally disclose to potential buyers of the property that the GFC charges will be added to the
monthly sewer service billi gs as soon as billing comments.
Spokane County,
Division of Utilities
O -F -C v14A�r / -S
Date
ori -d Representatives Signature
GFC Payment Option Form
Revised 1/26/99
1026 W. Broadway • Spokane. WA 99260-0130 • (509) 4:7-3604 FAX: (509) 477-1715 15 TDD: (509) 324-3166
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