2002, 04-05 Permit App: 02002265 ResidenceProject Number: 02002265 Inv: I Application Date: 4/5/2002 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Parcel Number: 45241.2604 Block: 1 Lot: 4
SiteAddress: 845 S SHELLEY LAKE LN Owner: Name: GEORGE H WHITE INC
VERADALE, WA USA 99037 Address: PO BOX 52
Location:: VER LIBERTY LAKE, WA 99019
Zoning: UR -3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 18,176 Sq Ft Width: 80 Depth: 202 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: i
Ret Information:
nform
ation:
Plan Review
Approach / Drainag
Sew4
Itsleased By:
Permits:
re". �8110 (0
Operator: DMD Printed By: DMD 5awL)
Project Number: 02002265 Inv: I AppilC t * 1 Date: 4/5/2002 Page 2 of 3
Contractor:
Address:
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
GEORGE H WHITE CONST Firm: GEORGE HARVARD WHITE CON
0 BOX 52 Phone: (509) 921-9752
LIBERTY LAKE, WA 99019
Building Characteristics
Const Category: New
Group: R-3 Type. VN
Nbr Of Dwellings:
1,745
Occupant Load:
Building Height: 18
Bldg W x D: 54
x 52
Building Sq Ft:
3490 Sprinklers: El
Req Parking:
NUMBER OF
Handicap Parking:
Critical Materials: ❑
1
NUMBER OF
This Application:
Description
GM
Type Notes
Sg Ft Valuation
BASEMENT U
R-3
VN
1,745 $20,172.20
DECK
R-3
VN
160 $1,177.60
GARAGE
U-1
VN
576 $6,912.00
RESIDENCE
R-3
VN
1,745 $108,190.00
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
RANGE
HOOD -TYPE I1
Totals: 4,226 $136,451.80
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Permit Total Fees:
Mechanical Permit
Stories: 1
Total Project:
Sg Ft
Valuation
1,745
$20,172.20
160
$1,177.60
576
$6,912.00
1,745
$108,190.00
4,226 $136,451.80
Fee Amount
$1,080.00
$4.50
$237.60
$1,322.10
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Units
Unit Desc
1
NUMBER OF
1
NUMBER OF
4
# OF UNITS
4
NUMBER OF
1
NUMBER OF
1
NUMBER OF
1
NUMBER OF
Permit Total Fees:
Operator: DMD Printed By: DMD Print Date:
Fee Amount
$10.00
$12.00
$4.00
$40.00
$10.00
$10.00
$10.00
$96.00
4/5/2002
Project Number: 02002265 Inv: I iAppliaatjon Date: 4/5/2002 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
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 Summa
Plumbing Permit
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Units
Unit Desc
Fee Amount
2
NUMBER OF
$12.00
5
NUMBER OF
$30.00
1
NUMBER OF
$6.00
2
NUMBER OF
$12.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
2
NUMBER OF
$12.00
Permit Total Fees:
$96.00
Permit Type
Fee Amount
Invoice Amount
Amount Paid
Amount Owing
Building Permit
$1,322.10
$1,322.10
$0.00
$1,322.10
Mechanical Permit
$96.00
$96.00
$0.00
$96.00
Plumbing Permit
$96.00
$96.00
$0.00
$96.00
$1,514.10
$1,514.10
$0.00
$1,514.10
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: 4/5/2002
1 t PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE -AU>)
N i SPOKANE, WA 99260 �� y ` Z
SPOMMECaiwy
509-477-3675
A -TT.
Project Description: c>& A—'
c k 1,1.E /1 ?' C "` G f
TYPE OF APPLICATION
0 Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
I ❑ Other
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description: L
!Department Use Only
!Crater District/Purveyor. Sewer District/Purveyor Road width Setbacks
Front: Rear:
School District; Fire District: Zoning
Left: Right:
OWNER/APPLICANT INFORMATION
0 Indicate who should be contacted regarding this project
❑ Owner:
Phone:
Fax:
❑ Applicant:
Phone:
Fax:
Mailing Address:
# of stories
Mailing Address:
Unfinished basement sq. ft.
City, State, Zip
City, State, Zip
7 41
17 Contractor
Phone
F
❑ Architect/Engineer
Phone
Fax
Mailing address
/ •
Bar- 52
Mailing address
City, State Zip
Liberty L4, Wa. 99019
City, State Zip
Occupancy group
WA State Contractor license #
I P
Contact name:
R E C E I V E D
PROJECT INFORMATION APR 0 � 1002,
Building Information
-
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
7 41
/ '7q,
Dimensions,
Total habitable space
2na floor sq. ft.
Finished basement sq. ft.
514 " )( s L
/ 7 %S
-- -
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft. /
12 3
VN
Cost of project
2 (n
-7160
Heat source (electric, gas, etc.)
F A, C, A,
Manufactured Home Sign t
Width:
Length: What is the square footage of the sign
How high is the sign?
Is any part of the property within 250 feet of a shoreline?
face?
I yes, identify on site plan 11 Yes No
Year:
Make: A of signs
Area of existing signs
Relocation Fire Safety.
Previous address Fire Sprinkler _ Tent
Paint booth _ Fire Alarm _ Fireworks display
Proposed use
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes )2k No
What is the current property size?
I es, identiy on site plan
(square feet or acres
Is any part of the property within 250 feet of a shoreline?
What is the current use of this property?
I yes, identify on site plan 11 Yes No
Lk P LA S ,e k*°,, — 3e c! x' ? u F7 . •� •, a f L ?
Is your property in a designated wildlife habitat area?
Will the site be served by a septic system? O Yes No
O Don't know O Yes 'P No
Is the property inside the PSSA? 0 Yes
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
If yes, identify on site plan
If yes, identify on the site plan O Yes No
O Maybe O Don't know Q Yes K No
Are there any wetlands, streams or ponds within 200 feet of the
Is there evidence of fill or excavation on the property?
property?
O Yes �X.No
I es, identify on site plan O Yes A 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 ite?
O Yes No
O Yes o
DEPARTMENT USE ONLY
Is the property in a<designated Stormwater Control Area?
Is public sewer available to the site? 13 Yes O No
O Yes
O No
Is the property inside the ASA? O Yes `
O No
Is public water available to the site? 0 Yes 0 No
O Yes
O 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
[!ate Received: Staff Representative:
• t
PLUMBING PERMIT APPLICATION
PROJECT
Y S e LN
PERMIT
ADDRESS: S
USE:
OWNER:r
Geon e 14
-
f �L�, c-,
PHONE (Daytime Contact):
%L1 s7� �—
MAILING ADDRESS:
Street(City/State)—Zi
CONTRACTOR:
(7e ,e- 0 / CG 14 � f_ s rc
LICENSE:
S i,'-)
MAILING ADDRESS: PHONE:
_
�2 (-`-
S 4�---✓vt E'er
Street Cit /State Zi
PLUMBING FIXTURES
I
H OF
MUL77•
COST/
AMOUNT
DESCRIPTION
DETAIL
UNITS
PBYD
UNIT
EQUALS
B02
TOILETS
WATER CLOSETS, BIDETS
2
x
$6
B03
URINALS
x
$6
—
B04
TUBS
BATH, STALL, ON-SITE BUILD
2
x
$6
B05 I
SHOWERS(per trap)
x
$6
B06
SINKS
LAVS/BASINS, BAR, FLOOR,
x
$6
—
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, XRAY, FOOD
REP/CULINARY/MEAT
$
3 v
B07
DISHWASHER
x
$6
—
B08
CLOTHES WASHER
x
$6
—
B09
GARBAGE DISPOSAL/GRINDER
j
x
$6
B10
WATER SOFTENER
(NOTE: if gas water tank see
x
$6
—
mechanical
B11
ELECTRIC HOT WATER TANKS
AREA, CASE, COIL, TRENCH,
x
$6
—
CONDENSATE
B12
FLOOR DRAINS
l
x
$6
—
B13
ROOF DRAINS/OVERFLOW DRAINS
x
$6
—
ea.
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,
x
$6
—
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
B18
CROSS CONNECTION DEVICES
VACUUM BREAKER, CHECK
$6
—
VALVE, 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
MEDICAL GAS(per outlet/bottle station
NITROUS, OXYGEN
x
$6
—
B21
MISCELLANEOUS FIXTURES
$6
—
METHOD OF PAYMENT
SUBTOTAL
t Q
VW
El CASH ❑ CHECK ❑ e ❑ ❑
PLUS PROCESSING FEE
S 25.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE DUE
MINIMUM PERMIT FEE IS $35.00
DATE: EXPIRES: -
PLEASE MAKE CHECKS PAYABLE TO
BANKCARD NUMBER:
SPOKANE COUNTY PERMIT CENTER
AUTHORIZED SIGNATURE:
Spokane County Division of Building & Planning
1026 West Broadway Avenue * Spokane, WA 99260-0050
Telephone No. (509) 477-3675 * Fax No. 324-3198 * TDD No. (509) 324-3166
MECHANICAL PERI\ZIT APPLICATION
ADES�(
PERMIT
UE:
l/OF MUL77•
COST/
AMOUNT
OWNER:
UNITS PBY°
PHONE (Daytime Contact):
v
MAILING DDRESS: r
rt`/
Lk
` , v vi- t? 5 o �r
Street
— OR < 100,.000
X
Cit /State Zi
CONTRACTOR:
B03
FUEL BURNING APPLIANCE
> 100,000
LICENSE:
MAILING ADDRESS:
$
B04
PHONE:
— OR <400,.000
X
$50 —
_
B04
UNLISTED APPLIANCE ADDITIONAL CHARGE
> 400,000
X
Street
$
B06
Cit /State Zi
Spokane County Division of Building & Planning
1026 West Broadway Avenue * Spokane, WA 99260-0050
Telephone No. (509) 477-3675 * Fax No. 324-3198 * TDD No. (509) 324-3166
l/OF MUL77•
COST/
AMOUNT
DESCRIPTION OF WORK
UNITS PBY°
UNIT
EQUALS
B02
FUEL BURNING APPLIANCE
— OR < 100,.000
X
$12 —
b 12-
B03
FUEL BURNING APPLIANCE
> 100,000
X
$15 —
$
B04
I UNLISTED APPLIANCE ADDITIONAL CHARGE
— OR <400,.000
X
$50 —
$
B04
UNLISTED APPLIANCE ADDITIONAL CHARGE
> 400,000
X
$100
$
B06
USED APPLIANCE(Must meet WSEC's min. AFUE Latin
— OR <400,.000
X
$50 —
$
B07
USED APPLIANCE(Must meet WSEC's min. AFUE rating)
> 400,000
X
$100 —
$
B08
BOILER/REFRIGERATION
1-100M BTU
X
$12 —
$
B09
BOILER/REFRIGERATION
101-500M BTU
X
$20 —
$
B10
BOILER/REFRIGERATION
501-1,000M BTU
X
$25 —
$
B11
BOILER/REFRIGERATION
1,001- 1,750M BTU
X
$35 —
$
B12
BOILER/REFRIGERATION
+1,750MBTU
X
$60 —
$
B13
GAS LOG, GAS INSERT, AND/OR GAS FIREPLACE
X
$10
$
B14
RANGE
/ X
S10 —
$ /0
B15
DRYER
X
$10 —
$
B16
FUEL BURNING WATER HEATER
X
$10
S /0
B17
MISCELLANEOUS FUEL BURNING APPLIANCE
X
$10 —
$
B18
GAS PIPING ea. Outlet
X
$1
$
B19
DUCT SYSTEMS
X
$10
$
B20
VENTILATING FANS
-
X
$10
$ 4' U
B21
AIR HANDLER(DOES NOT include duct stems
— OR < 10;000 CFM
X
$12
$
B22
AIR HANDLER OES NOT include ducts stems
> 10,000 CFM
X
$15 —
$
B23
EVAPORATIVE COOLERS
-
X
$10
b
B24
TYPE I HOOD
X
$50 —
$
B25
TYPE II HOOD
X
$10 —
$ / d
B26
HEAT PUMP/AIR CONDITIONER
0-3 TONS
X
$12
$
B27
AIR CONDITIONER
3-15 TONS
X
$20
$
B28
AIR CONDITIONER
15-30 TONS
X
$25
E
B29
AIR CONDITIONER
30-50 TONS
X
E35 —
$
B30
AIR CONDITIONER
+50 TONS
X
$60
$
B31
LPG STORAGE TANK
X
$10 —
$
B32
WOOD OR PELLET STOVE/INSERT
X
b25 I
$
METHOD OF PAYMENT
SUBTOTAL
rL O n
❑ CASH ❑CHECK ❑ VISA
� ❑
❑
PLUS PROCESSING FEE
E 25.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE DUE
v J
/17 I
DATE: EXPIRES:
MINIMUM PERMIT FEE IS $35.00
PLEASE MAKE CHECKS PAYABLE TO
BANKCARD NUMBER:
SPOKANE COUNTY PERMIT CENTER
AUTHORIZED SIGNATURE:
Spokane County Division of Building & Planning
1026 West Broadway Avenue * Spokane, WA 99260-0050
Telephone No. (509) 477-3675 * Fax No. 324-3198 * TDD No. (509) 324-3166
ADD E
ZON
ROA \NT) '"
Fu
G,
COM EN ---
Fjl2 ---�
' e
t • k
This s•"�; �' ��. it ;;esng s1,. ,pitted for nurp.ose of
ohia;r,�r� wing per!;'�if and is a tnae and correct
representation of the proposal. All known property
line s/dimensi s, c rb structures r i easements
have been i entif.)t "cllcat ars: wetlands,
bodies o; t , s ep , or they critical areas.
Signed:
Date:
L'
90,,27
Glen/
mar Ar _5 riz-,? tr�l IAA -gym-
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