2003, 12-23 Permit App: BLD-03-03328 Residencee -
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v�ley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
Job Address:
Description:
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
•
NEW SINGLE FAMILY RESIDENTIAL PERMIT
847 SHELLEY LAKE LN
SPOKANE WA 99212
NEW SINGLE FAMILY RESIDENCE W/ATTACHED GARAGE - FA GAS
GEORGE H WHITE INC
GEORGE H WHITE INC
PO BOX 52
LIBERTY LAKE, WA 99019-0052
GEORGE H WHITE INC
PO BOX 52
LIBERTY LAKE WA 99019-0052
Lot:
Ic'y11 / t /`(
/
Permit #: BLD -03-03328
Applied:
Issued:
Expires:
Blk: Parcel No: 45241.2605 Zoning:
Phone:
Phone:
Lic No:
(509) 921-9752
(509) 921-9752
GEORGHWO91 P8
12/23/2003
12/23/2003
06/20/2004
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
ii I /fig
Building /—L212
Planning M--422-
Public Works
THIS IS NOT A RECEIPT
00
4ffolian'
40.0Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY
D
UNITY DEVELOPMENT
BUILDING
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509 688-0036 Fax: 509 688-0037
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: LID 1 J
PERMIT DESCRIPTION:
IILDING PERMIT
QRELOCATION
Iv e vJ (2e s W t 3 C �� o
CI CHANGE IN USE CI GRADING
® SIGN Q TENANT
A-Tt 14:C. tie , r
64 ,/ I.Lf(,444.,
CI MANUFACTURED HOME
Ci OTHER
OWNER / APPLICANT INFORMATION
Cl OWNER:
PHONE:
ADDRESS:
.'3
® CONTRACTOR:
CITY,STATE, ZIP
PHONE:
ADDRESS:
•
6i4), STATE, ZIP
® APPLICANT:
WA ST CONTRACTOR LICENSE #
PHONE: FAX:
ADDRESS:
ARCHITECT:
PHONE: FAX:
ADDRESS:
CONTACT:
CITY, STATE, ZIP
CITY, STATE, ZIP
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT: HO 1•10 a°
BUILDING HEIGHT TO PEAK: / Ct
BUILDING DIMENSIONS: 67 )A
NUMBER OF STORIES:
NUMBER of BEDROOMS: ?—
FLANKING
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
13
J3
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP: R
CONSTRUCTION TYPE: V k)
STRUCTURES ON PROPERTY:
CRITICAL AREAS: '—
CURRENT PROPERTY SIZE: 13;t3 6 2,
CURRENT PROPERTY USE: rr.T7 (-01-
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: / e
2N0 FLOOR SQ FT:
UNFIN BASEMENT: / '7?
FINISHED BASEMENT:
GARAGE: .% 3e
COVERED DECK: ""-
DECK: / 1% )e / 2"
MANUFACTURED HOME r
` It SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR:
T: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: ------- TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE _ 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS _ I
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
I BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES 0 NO
DATE: I STAFF:
METHOD OF PAYMENT
0 111111111111•111® CASH CHECK illi ® L VISA
mti
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
.00.1"Valley
r
11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206
509.921.1000 ♦ Fax: 509.921.1008 ♦ cityhall@spokanevalley.org
Notice
This acknowledges receipt of notice to the
Spokane Valley Building Permit #
applicant that the applicant is aware of
state of Washington contractor registration
laws and the potential risk and monetary
liability to the homeowner for using an
unregistered contractor.
wTsc
Date
Project Number: 01001000 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Date: 12/19/2003 Page 1 of 2
Permit Use: SEWER LINE FOR FUTURE RESIDENCE - Contact: BOB/C B EXCAVATION
SHELLEY LAKE 3RD Address: 22708 N HWY 395
C - S - Z: COLBERT WA 99005
Setbacks: Front Left: Right: Rear: Phone: (509) 466-0105
Group Name:
Site Information: Project Name:
Plat Key: 006156 Name: SHELLEY LAKE -03RD ADD PUD
District:
F
Parcel Number: 45241.2605
Block: 1
SiteAddress: 847 S SHELLEY LAKE LN
GREENACRES, WA USA 9901
Location:: GRE
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Area: 13,862 Sq Ft Width: 93
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: , Permits:
Lot: 5
Owner: Name: GEORGE H WHITE
Address: BOX 52
LIBERTY LAKE, WA 99019
Hold: ❑
Depth: 172 Right Of Way (ft): 30
Sewer Connection Permit
Contractor: C & B CHIPPING & EXVTN INC
Address: 22708 N SR 395 HWY
COLBERT, WA 99005
Item Description
SEWER CONNECTION
PROCESSING FEE
1 1 1r-ro no 7e. 1- �•
Pte.'s -cer r 0- C-ec.11 \::744..c..
Firm: C & B CHIPPING & EXVTN INC
Phone: (509) 466-0105
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Operator: JAS Printed By: GMW
z-/ 1,1/403
Print Date: 12/19/2003
UTILITIES DIVISION
N. Bruce Rawls, P.E., Utilities Director
A DIVISION OF THE PUBLIC WORKS DEPARTMENT
Gary Oberg, Director
GENERAL FACILITIES CHARGE (GFC)
PAYMENT OPTION SELECTION RECORD
PLEASE NOTE: Form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Date: , % k14 e o3
Plat Name: S h F-- 4 i.., a K e.- Lot No(s): 5 Block No(s):
l
Site Address(es): ' 11 s S te14,(k., L !4- Parcel No(s):
Owner Name: OR Builder Name: George 5 White, Di -e,
PRINT Owner's Name PRINT Builder's
Liberty Lake, Wa. 99019
Payment Option Selected (Check One):
1. ( ) GFC payment received at issuance of Sewer Connection Permit by
Division of Utilities
2. (x) GFC to be paid at closing, at the GFC rate in effect at the time of closing.
3. ( ) 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.
b. Builder's Statement: I, , 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 billings as soon as
billing commences.
Special Conditions: ( ) No ( ) Yes — See Reverse Side of Form
Spokane County, GFC Payment Option Form
Division of Utilities Revised 03/06/00
1026 W. Broadway • Spokane, WA 99260-0180 • (509) 477-3604 FAX: (509) 477-4715 TDD: (509) 324-3166
[ETHOD OF
] CASH
ATE:
SpoTY (
Q;ane
Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
Spokane Valley, WA 91)206
509-688-0037 - Fax
PROJECT 8 `f 7 S S,*.//c y Lie -/V
ADDRESS: 5Q 0L iJ t4- ((e--( ice./ Q 59037
PERMIT
USE:
rk)c . ,e.e S
OWNER Coe'v F( W (,., a
Z,
PHONEtime Da
PHONE(Daytime � Contact):gzi 57 ,)---2_
)---2-
MAILING
MAILING ADDRESS:
0-
t b . y L. K
t", 4- F79
Mer cam! gt...LA-Q.-
(street)
(city/state)
(ZIP)
CONTRACTOR _ .5 4E.,_
$6
LICENSE #:
FEO7' ? w 9/ P 8
MAILING ADDRESS:
URINALS
PHONE #:
J
X
$6
(street)
(city/state)
(ZIP)
PLUMBING FIXTURES
'NKCARD NUMBER
JTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
Z
X
$6
-
/ 2-
2
URINALS
X
$6
-
3
TUBS
Z
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6
-
/ L-
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
S
X
$6
-
3 0
6
DISHWASHER
/
X
$6
-
7
CLOTHES WASHER
X
86
-
Co
8
GARBAGE DISPOSAL
(
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
-
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
/
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR
SWAMP COOLER
.:
X
$6
..Q
�-+
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR VATS, TANKS, BOILERS
/
X
$6
-
ee,
17
SPRINKLER SYSTEM
/
X
$25
-
Z j
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
'
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
3 CHECK
VISA
41";:rs-OirtaTt
SUBTOTAL:
/ ' , 9 vo
PLUS PROCESSING FEE
$35.00
■ ■
VIrT]TD =C.
TOTAL PERMIT FEE DUE:
! 71,00
'NKCARD NUMBER
JTHORIZED SIGNATURE:
Spo°ane
Valley
Mechanical Permit Application
11707 East Spra„ue.Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT 8 y 7
ADDRESS: 5 9 0
5 5 Ine ((Qc/ 1. � Ice, LA)
(c._ V'# -1(e1' (,,<j4 5'0 /,
PERMIT /'lid' c c I '�ra-7Q . e. --r-13 G',4f
USE:
OWNER: C
V 14 W L L -f . z,„i v_.
PHONE (Daytime Contact): 13
,7—,eMAILING
ADDRES
�1�C]�
1_L 7
J Z
L,t-k-.
LA-, 14%
y`
j 2/ _g7� Z
(street)
/
X
(city/state)
(ZIP)
CONTRACTOR
S ►T
> 100,000
X
LICENSE 1:
4 er..., (..1. 1., Wim! / A E5
MAILING ADDRESS:
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- OR < 400,000
PHONE 1:
92
/ 9?S2—
-
(street)
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
(city/state)
(ZIP)
METHOD OF PA
❑ CASH 0
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE
DESCRIPTION OF WORK
t OF LIMITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR < 100,000
/
X
515
• ) s."---
2
2
FUEL BURNING APPLIANCE
> 100,000
X
519
-
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- OR < 400,000
X
550
-
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
5100
-
5
USED APPLIANCE (WSEC min AFUE rating)
- or < 400,000
X
S50
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFRIGERATION
1-100M BTU
X
515
-
8
BOILER/REFRIGERATION
101- 500M BTU
X
528
-
9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
-
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
557
-
11
BOILER/REFRIGERATION
+1750M BTU
X
595
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
/
X
510
/ t?
13
RANGE
-
/
X
510
-
/Z?
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
'
X
510
-
1 C
16
MISC FUEL BURNING APPL
-
X
510
-
17
GAS PIPING (ea Outlet)
-
`X
51
-1
18
DUCT SYSTEMS
-
X
510
-
3 0
19
VENTILATING FANS
-
3
x
510
-
20
AIR HANDLER (DOES NOT include ducting) .
- OR < 10,000CFM
X
512
-
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
519
-
22
EVAPORATIVE COOLERS
-
X
510
-
23
TYPE I HOOD
-
X
550
-
24
TYPE 11 HOOD
-
i
X
510
•
w
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIR CONDITIONER
3-15 TON
(
X
520
-
.7-..-G7
27
AIR CONDITIONER
15-30 TON
X
525
=
28
AIR CONDITIONER
30-50 TON
X
535
-
29
AIR CONDITIONER
+50 TON
X
560
-
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
510
-
32
WOOD STOVE - FREE STANDING
-
X
$25
-
KENT
— ��">sf
SUBTOTAL
/ o 9
PLUS PROCESSING FEE
$35.00
AU
TOTAL PERMIT FEE DUE: / qL/ -
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE
City of
2001 WSEG.Resitlential Compliance Form
Prescriptive (Chapter 6) Options for all R Occupancies, Climate Zone 2
Heat source: ALL
0; 1
SPOKANE VALLEY BUILDING DEPARTMENT
11707 E. Sprauge Avenue, #106, Spokane Valley, Washington 99206 - Tel 509-921-1000 - Fax 509-921-1008
SITE ADDRESS: 34./7 S �u. f (e 7 Lk PERMIT NO. DATE: 2-7/. 0.c. 03
5p1.3k v010. LA..) IA 7940 37
INSTRUCTIONS
1) Your permit will be processed more efficiently if you provide all of the requested information. Department staff can
help you with general questions about this form. Your building must match the selected option requirements without
exceptions or substitutions.
2) Glazing percentage determines which option to choose. Complete the following glazing area calculation before
proceeding to the option table below.
GLAZING AREA CALCULATION:
te- t't, Low
SF. - `/ ' (i'' pi i SF. =
Z % r
TOTAL WINDOW AREA _ HEATED FLOOR AREA (ALL FLOORS) = % OF GLAZING
NOTE: Use rough opening (RIO) for window area. Include all half -lite and full -lite door glazing in this
calculation.
CAN'T COMPLY? If none of the Prescriptive (Chapter 6) Options below are acceptable, consider systems analysis
(Chapter 4) or, Component Performance (Chapter 5) Approach. The main advantage is flexibility to juggle individual U -
factors (R -values) as long as an overall maximum value isn't exceeded. Note that the overall performance requirements •
are no less stringent than the Prescriptive requirements. Calculations may be performed by hand or, using an acceptable
computer software program. Helpful forms and other resources can be downloaded at http://www.eriergy.wsu.edu/
buildings.
INSPECTORS COPY
MUST BE ATTACHED TO APPROVED PLANS
SKS (ic11 4rs
Q
Option
Glazin
ro 9
Area : % of
Floor
Glazing U -Facto
Door'
U-factorCeiling,Grade
Ceilin 9
2
Valuted
Wall
Above
Wall' int'
Below
Grade
Watt'
ext
Below
Grade
•
Floor'
Slab' on
Grade
Vertical
Overhead"
❑
i
10%
0.40
0.58
0.20
R-38
R-30
R-21
R-21
R-12
R-30
R-10
If.'
15%
0.40
0.58
0.20
R-38
R-30
R-19 +
R-21
R-12
R-30
R-10
❑
III.
17%
0.37
0.58
0.20
R-38
R-30
R-19+ •
R -Ss
R-21
R-12
R-30
R-10
❑
IV. '
Unlimited
Group R-3
Occupancy
Only
0.35
0.58
0.20
R-38
R-30
R-21
in
R-21
R 12
R-30
R-10
0. Nominal R -values are for wood frame assemblies only or assemblies built in accordance with Section 601.1
1. Minimum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area of 13%. it
shall comply with all of the requirements of the 15% glazing option (or higher). proposed designs, which cannot meet the specific
requirements of a fisted option above, may calculate compliance by Chapters 4 or 5 of this Code.
2. Requirement applies to all ceilings except single rafter or joist -vaulted ceilings. 'Adv' denotes Advanced Framed Ceiling.
3. Requirement applicable only to single rafter or joist vaulted ceilings.
4. Below grade walls shall be insulated either on the exterior to a minimum level of R-12, or on the interior to the same level as walls above
grade. Exterior insulation installed on below grade walls shall be a water resistant material. manufactured for its intended use, and installed
according to the manufacturer's specifications. See Section 602.2
5. Floors over aawt spaces or exposed to ambient air conditions.
6: Required slab perimeter insulations shall be a water resistant naterial,-rrenufactured for its intended use. and installed according to
manufacturer's specifications.'
7. Int denotes standard framing 16 inches on center with headers insulated with a minimum or R-5 insulation.
8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing.
9. Doors, including all fire doors. shall be assigned default U4actors from Table 10-6C.
10. Where a nexirrum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross conditioned floor area
shall be less than or equal to that value. Overhead glazing with L1 -factor of U--4.40 or less is not included in glazing area limitations.
11. Overhead glazing shall have U -factors determined in,acoordance.with NFRC 100 or as specified in Section 502.1.5.
12. Log and solid timber walls with a minimum average thickness or 3.F are exempt form this insiulation requirement.
Form 5-050801-2001 Residential Comp Form
ADDI-SLSe. 841...4-xeitei
ZONE us:41\05
ROADWIDTH .50
FRONT_ .23" FLANKING
COMMENa-
REVIEWED
Thi S heing submitted for the purpose of
permit arid is a triie and correct
representiaton of the propi)aal. All knoiin propert
lines/dimensions. curb hoes. structures and
have been identified. Also irdicated aa
bodies of water, steep slopes or ot
Signed:
Date:
PLANNING DEPT. APPROVED
Lii
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