2002, 04-16 Permit App: 02002633 ResidenceProject Number: 02002633 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE - GAS Contact: GEORGE H WHITE, INC
Address: PO BOX 52
C - S - Z: LIBERTY LAKE, WA 99019
Phone: (509) 921-9752
Group Name:
Site Information: Project Name:
:::.:.......................................................................
Plat Key: 005977 Name: SHELLEY LAKE 2ND ADDITION
Date: 4/16/2002 Page 1 of 3
Setbacks: Front 25 Left: 10 Right: 5 Rear: 35
District: F
Parcel Number: 45242.9999
Block: 1
SiteAddress: 712 S SHELLEY LAKE LN
VERADALE, WA USA 99037
Location:: VER
Zoning: UR -3.5
Water District:
Area: 0 Sq Ft
Urban Residential 3.5
Lot: 2
Owner: Name: GEORGE H WHITE, INC
Address: PO BOX 52
LIBERTY LAKE, WA 99019
Hold: ❑
Width: 67 Depth: 120 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
eleasee a,lTr#:01".".0.1...
Plan Review
Released By:
Approach / Drainage
Released By:
Sewer Review
Permits:
Operator: DMD Printed By: DMD Print Date: 4/16/2002
Project Number: 02002633
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/16/2002 Page 2 of 3
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Building Characteristics
Group: R-3
Const Category: New
Nbr Of Dwellings:
Bldg W x D: 52
Req Parking:
Description
2ND FLOOR
BASEMENT U
DECK
GARAGE
RESIDENCE
Building Permit
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Occupant Load:
x 40 Building Sq Ft:
Handicap Parking:
R-3
R-3
R-3
U-1
R-3
Tye Notes
VN
VN
VN
VN
VN
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Item Description
GAS WATER HEATER
GAS APPLIANCE<=100,000BTU
GAS PIPING
VENTILATING FANS
CLOTHES DRYER
GAS LOG OR GAS INSERT
HOOD -TYPE II
Type: VN
Building Height: 25
3028 Sprinklers: ❑
Critical Materials: 111
This Application:
Sq Ft Valuation
864 $53,568.00
1,082 $12,507.92
120 $883.20
651 $7,812.00
1,082 $67,084.00
Stories: 2
Total Project:
Sq Ft Valuation
864 $53,568.00
1,082 $12,507.92
120 $883.20
651 $7,812.00
1,082 $67,084.00
Totals: 3,799 $141,855.12
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Permit Total Fees:
Mechanical Permit
Units
1
1
3
4
1
1
1
Operator: DMD Printed By: DMD
3,799 $141,855.12
Fee Amount
$1,105.00
$4.50
$243.10
$1,352.60
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Unit Desc
NUMBER OF
NUMBER OF
# OF UNITS
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
Permit Total Fees:
Print Date:
Fee Amount
$10.00
$12.00
$3.00
$40.00
$10.00
$10.00
$10.00
$95.00
4/16/2002
Project Number: 02002633
Inv: 1
Apfilication
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/16/2002
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Item Description
TOILETS/BIDETS
SINKS
SHOWERS
TUBS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
FLOOR DRAINS
WATER USING DEVICES
Notes:
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Plumbing Permit
Units
3
6
1
2
1
1
1
1
2
Page 3of3
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Unit Desc
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
Permit Total Fees:
Fee Amount Invoice Amount
$1,352.60 $1,352.60
$95.00 $95.00
$108.00 $108.00
$1,555.60 $1,555.60
Fee Amount
$18.00
$36.00
$6.00
$12.00
$6.00
$6.00
$6.00
$6.00
$12.00
Amount Paid
$0.00
$0.00
$0.00
$108.00
Amount Owing
$1,352.60
$95.00
$108.00
$0.00
$1,555.60
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 contrued 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: DMD Printed By: DMD Print Date: 4/16/2002
I 1
Ai
11111
SPOKE COUgI'Y
PROJECT APPLICATION RECE11<co
SPOKANE COUNTY DIVISION OF BUILDING & CODE Etirk5R1C2MANT
1026 WEST BROADWAY AVENUE LUO2
SPOKANE, WA 99260
509-477-3675
a
&/ <
Project Description: 1.1 Fz W <_ uvi s 0 -&le -a_ t.i/3 C r
TYPE OF APPLICATION
4 -TT Are %e 5A r
)1111 Building Permit
O Change in Use
O Grading
O Manufactured Home Permit
O Relocation
O Sign
O Tenant (New/Change)
O Other
`4 C i; (o',Z c-).
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel
7/2 S , Si l(e•( L 642._ LAtv-e.. vetr3-014-Le JA
Number(s): c9 9473 7
Legal Description:
LoT 7-/ (Loc, k
S� e 1 /e y L ,4 k e -
Department, Use Only
Water District/Purveyor:
School District:
Road width
Zoning
Setbacks
Front:
Left:
Rear:
Right:
OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted regarding this project
❑ Owner: Phone:
Fax:
❑ Applicant:
(� . ��� Phone:
t e Fax:
Mailing Address:
Mailing Address:
City, State, Zip
City, State, Zip
Total habitable space
ContractorPhone
Fax
❑ Architect/Engineer
Phone
Fax
Mailing address �^
George 9-1. White, 11 w.
Mailing address
Garage sq. ft.
City, State Zip (B 5Z,
Wa. 99019
City, State Zip
Cost of project
/ L14.,/ & i! , '
2 --`)
`` Lake,
WA State Contract. L6t t f 'fie/
Contact name:
PROJECT INFORMATION
Building Information
Building height to peak
r)–S—
# of stories
Main floor sq. ft.
/o 92
Unfinished basement sq. ft.
10Q2.
Dimensions, f
di Ow i' S-2. )
Total habitable space
2"d floor sq. ft.
ek
Finished basement sq. ft.
Occupancy group /,3
//e/
Constructing type
V/�(4J`/I
Garage sq. ft.
Decks . ft. r \
G V
Cost of project
/ L14.,/ & i! , '
2 --`)
Heat source (electric, gas, etc.)
6 /a S ci r c cn v-
rt i r.
Manufactured Home
, ;;4,Sign>
Firm Name
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
Previous address
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_
Is there evidence of fill or excavation on the property?
O Yes tir No
Proposed use
Value
Address
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
VW C/14,+ -t 1- Lv?
Phone
Will the site be served by a septic system? O Yes iif, No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
O Yes tir No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( /%) O Yes XNo
Are critical or hazardous materials used or stored on site?
O Yes No
Address
Inspector
Phone
O Concrete
O Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes A No
If yes, identify on site plan
What is the current property size?
(square feet or acres) 1/ O 9 / a
Is any part of the property within 250 feet of a shoreline?
Ifyes,identifyonsite plan O Yes No
What is the current use of this property?
VW C/14,+ -t 1- Lv?
Is your property in a designated wildlife habitat area?
O Don't know D Yes ,Mc No
Will the site be served by a septic system? O Yes iif, No
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan
O Maybe O Don't know b Yes %No
Are or will there be wells located on the property?
If yes, identify on the site plan O Yes N,No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on site plan O Yes pc.No
Is there evidence of fill or excavation on the property?
O Yes tir No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( /%) O Yes XNo
Are critical or hazardous materials used or stored on site?
O Yes No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 ` Yes - 0 No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA?
0 Yes
OYes
Cl No
0 N
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA?
0 Yes
0 No
Is the property located within 1000 feet of a Natural Resource
Area? 0 Yes 0 No
Date Received:
Staff Representative:
//6
This si
obt:.- ,
represe
lines/dim
havete.,
bodies of
Signed
p!an is being submitted far thepurpos�
a `,.) Iding permit and is a true and cc
anon of the proposal. All known prop
nslons. curb !roes. structures and ea
denti#ied Aso-tndicated are wettar
att j teep sicpes o cal
Date;
of
rect
rty
ements
s;
eas.
2 I o S roi