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2004, 09-24 Permit App: BLD-04-07759 Residence**Wane .000 Valley 11707 E. Sprague Ave., Suite 106 Spokane Valley, WA 99206 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit NEW SINGLE FAMILY RESIDENTIAL Application #: Job Address: 905 S SHELLEY LAKE LN SPOKANE VALLEY WA 99037 Description: NEW RESIDENCE W/ATTACHED GARAGE - NATURAL GAS Subdivision: Owner: Applicant: Address: Contractor: Address: FOWLER, VERNON 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: Bik: Parcel No: Phone: (509) 921-9752 Phone: Lic No: (509) 921-9752 GEORGHWO91 P8 Applied: Issued: Expires: BLD -04-07759 Zoning: 09/24/2004 09/27/2004 03/26/2005 General Information: TYPE OF RESIDENTIAL PERMIT VALUATION CLOTHES WASHER WATER USING DEVICE FUEL BURNING APPL <= 100,000 GAS LOG, INSERT, FIREPLACE DRYER FUEL BURNING WATER HEATER GAS PIPING (ea. OUTLET) VENTILATING FANS TYPE II HOOD BUILDING HEIGHT TO PEAK DIMENSIONS # OF STORIES # OF BEDROOMS FRONT SETBACK REAR SETBACK LEFT SETBACK RIGHT SETBACK OCCUPANCY GROUP CONSTRUCTION TYPE STRUCTURES ON PROPERTY CURRENT PROPERTY SIZE SERVED BY SEPTIC SYSTEM WELLS LOCATED ON PROPERTY TOILETS TUBS SINKS DISHWASHER sfr 192291 1 2 1 1 1 1 3 4 1 22 60 X 42 1 2 21 40 11 10 r-3 5-n 1 9734 no no 2 2 5 1 Fees: PLAN CHECK FEE TYPE II HOOD GAS LOG, INSERT, FIREPLACE DRYER FUEL BURNING WATER HEATER GAS PIPING VENTILATING FANS BASIC PERMIT FEE WSBCC SURCHARGE TOILETS TUBS SINKS DISHWASHER CLOTHES WASHER WATER USING DEVICE FUEL BURNING APPL <= 100,000 Total Calculated: Deposits/Receipts: Total Due: 605.82 10.00 10.00 10.00 10.00 3.00 40.00 1,514.55 4.50 12.00 12.00 30.00 6.00 6.00 12.00 15.00 2,300.87 0.00 2,300.87 )'/4 i1( CITY OF SPOKANE VALLEY APPROVED FOR SUBMITTAL[ranc"�� ABVIEWED FOR CODE CAN Initials / Date S_5RGAN VALLEY BUIL,ING VI .CE C9,2 SSI N Building ;< < Ht anrling �^ , Public Works / % (! i . C' ' — THIS IS NOT A RECEIPT 00"444... Spo'lane 011-99s1 • BUILDING PERMIT APPLICATION WORKSHEET City of Spokane Valley Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 • Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax: (509) 688-0037 REQUIRED SITE INFORMATION' treet Address; _,�� „_ . r' _ � '�) I ) - Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: I1LT 2". Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home D Tenant Improvement D Fire Safety ❑ Other ❑ Relocation OWNER/APPLICANT INFORMATION • Owner: Phonez .290- 3-2Fax: 623-.2 Address: Eof OC. i.:./darery 40 t= i-1/4".«4 9909 State Zip Code City ❑ Contractor:(i \ t:�.: _Thl( Phone: q1 f I- o e.-f;.z y Fax: 1.1. - Address: 2 Address: .; 6) City State Zip Code WA State Contractor License #: l Cc 4t r .) je./ O Applicant 65-.6 l� , tA) ra 1 rc _r Phone: 99 r- (J`/ O -e, Fax: n.' - Address: C3 Q y S'7 4► , , ch, Oei City State Zip Code O Architect n r MI? 4 Phone: 710- I d k'7 Fax: Address:' City - State Zip Code Contact: CL'^orr4[ die I -602.c>" PERMIT/BUILDING G INFORMATION HEIGHT TO PEAKj ©EMEt SI ,� # OF STORIES:. MAIN FLOOR TO SQ. FTG: 1920 Du FLOOR SQ. FTG: UNFU4 EMENT SQ. up: - /// FINISHED BASEMENT SQ. FTG; GARAGE SQ: FTG: L,(-\(-2, DECK/GOV. PATIO SQ. FTG: IC. IT' I )C,'i V)( 16)6 OCCUPANCY GROUP: CONSTRUCTIO TYPE: ,... li•..i o C) 6J I tr Or , L. HEAT SOUR : # OF BEDROOMS: ."---., TOTAL H • ,spEprCE: IMPER OVS SURFACE AREA: Imo'' C' P - COST OF PROJECT: • 30% SLOPESROPERTY: SEWER R ON-SITE SEPTIC 1 Contractor: J L HAWKINS EXCAVATING License #: JLHAWE*222LE SEWER CONNECTION 1 $85.00 PROCESSING FEE Total Permit Fee: FOR SEWER INSPECTIONS CALL (509) 477-3604 UTILITIES 8:30-5:00 PM MONDAY THRU FRIDAY 1 $15.00 $100.00 Call for inspection prior to cover. ONE WORKING DAY NOTICE REQUIRED. Contractor or applicant is to field locate and confirm the elevation and position of sewer stub prior to any other excavation. Sewer stubs are to be checked prior to connection to ensure that they have acceptable grade and are clear and unobstructed to the main sewer. Sewer lines should be constructed to allow for gravity flow from the lowest level of the structure. This permit must be presented to the job site inspector for verification. To locate buried cables, gas piping, water lines, etc. CALL BEFORE YOU DIG, (509)456-8000. STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE "CALL BEFORE YOU DIG" CENTER BE NOTIFIED. CALL BEFORE YOU DIG AT LEAST 2 WORKING DAYS IN ADVANCE, (509)456-8000. Spokane County Code requires the installer comply with all requirements of the Washington State Dept of Labor and Industries, including those related to trench safety. 1 SpoKANE Courm SPOKANE COUNTY DEPARTMENT OF BUILDING & PLANNING 1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050 Site Information Project Information Site Address: 905 E SHELLEY LAKE LN Parcel Number: 45244.2901 Subdivision: Block: 1 Lot: 1 Zoning: UNK Unknown Owner: FOWLER, VERNON Address: 903 SHELLEY LAKE LN VERADALE, WA 99037 - Building Inspector: BOBBY STONE Water Dist: Project Number: 04007067 Inv: 1 Issue Date: 9/23/2004 Permit Use: SEWER CONNECTION - SHELLEY LAKE 4TH Applicant: JACK HAWKINS E. 9722 NORA SPOKANE, WA 99206 Contact: JACK HAWKINS E. 9722 NORA SPOKANE, WA 99206 Phone: (509) 924-9025 Phone: (509) 924-9025 Setbacks - Front: Left: Right: Rear: Group Name: Project Name: Permits Sewer Connection Permit 1 Payment Summary Total Fees AmountPaid AmountOwing $100.00 $100.00 $0.00 Tran Date 9/23/2004 Processed By: SHATTO, JULIE Printed By: HINTZ, FAITH Page 1 of 1 Receipt # Payment Amt 5624 $100.00 n. PLUS - Permits Land Use System Finn hoer Records Toots -Wio Plat Note s lector District 1 Images l Other 1 1000 GENERAL J 9/3/2004 SYSTEM zj THIS SITE IS IN THE CITY OF SPOKANE VALLEY. 9/24/2004 ri1 Sita on l,+tap GispIay Notes r Map Tips !Contours 16411 16423 16427 ,.16505 16513 ;Ready Friday, Sep 24, 2004 04:11 PM NUM; f / ADDRESS (Lc) l� I.1.l(�e J�4 tI'r ,i4 . Ll: ZONE l ) '-' . J ROAD WIDTH /3 FRONT ,';C I ` LANKING This site plan is being submitted for the purpose of COMMENTS obtaining a building permit and is a true and correct REVIEWED ST 1 a' I. '"l.i ) representation of the proposal• kid ease, lines/dimensions.curb t - ant es have been ide or olha otiYcd areas. bodies j, ' D� /� _i • S5, 411 51 1 3 nE '" s .<. ---,....... .,......„..... - .,-..-., ,..,...„-::. 1,,- i ..0100.111°' ' .7 ....„ *"."--,- - ,..,......- ;.I - ' . ' eia-I --- ' ..„:, ' --. -'''''' j • . • • ' R&.." i I! • i ! X E . O ' 6/0 \ -.f'.0 • - \. i { • -05 . ,..„::.r . : \,___. eslore- . .'. ., . ,, . S it , '. , If) • 1°4 . 1 0/N _ . colt\o‘k .0 V 1 ••• • . j f . *: r 100 li 905 Shelley Lake Lane Lot 1, Block 1, Shelley 4th Addition Geo. II. White, Inc. 921-9752 9/12/04 .`4(, FROM : GHJ INC ��15�[1111i FAX NO. : 5099219776 CITY OF SPOKANE VALLEY Community Development Department 11707 East Sprague Avenue, Suite 106 Spokane Val;ey, WA 99206 Tel: (509) 921-1000 Fax: (509) 9214008 plan ingnspokar.evallev,orq Sep. 30 2004 11:49AM P1 DATE SOSMrrrgD: FILE No./ NAME: FEE; (FrjrS aft Only) 1l,1 r Lit RECEIVED BY' T(tf�C(rJ- -r" FLOODPLAIN DEVELOPMENT APPLICATION PART I - APPLICATION INFORMATION APPLICANT INFORMATION: 2� , , Fo SER APPUCANT: tf �!+ SC S + `� MAILiUo ADDRESS: r. 6 • (S O / h O l C� CITY: 41 e It1) -P �c LE .., STATE kf./ A .y ZIP: �t 7Cs' ,F! SHONE: (HOME/WORIC)S�� o (FAX (CELL ?6-` ! 2 . PkucCircle 623—.266_q j&5 NOTE: IF APPUCANT III NOT THE OWNER, INCLUDE, WRITTEN OWNER AUTHORIZATION, PART IV, FROM THE LEGAL OWNER. OWNER INFORMATION: LEGAL OWNER: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: (HOME/WORK) Please C:rce FAx) (CELL) PART 11- SUBMITTAL REQUIREMENTS Check box to indicate that required information has been provided. All Floodplain Permit Applications shall contain the following required information. If required and not submitted, the application will be returned to the applicant as incomplete: Three (3) to -scale (minimum scale is 1 inch = 20 feet) site plans showing the nature, location, dimension:3 and elevation of the property and identifying the portion of the property located within the designated floodplain, existing or proposed structures, location of proposed fill, location of storage of materials, and the location of drainage facilities. Proposed elevation in relation to mean sea level of the lowest floor including basement of all structures. o Proposed elevation in relation to mean sea level for any structure that has been flood -proofed • For non-residential construction only, certification by a registered professional engineer or architect that flood -proofing methods for any non-residential structures meet the flood -proofing criteria of P.ection 5.06.08.2 of the City's Fioedpfain Ordinance_ ▪ Written description if applicable describing the extent to which a watercourse will be altered or relocated as a result of the proposed development. Version 1: 05/04 1 FROM : + iKJ I NC FAX N0. : 5099219776 Sep. 30 2004 11:49AM P2 PART III — PROJECT INFORMATION PARCEL NUMBER(S) OF SITE: STREET ADDRESS; OF SITE (if any): 10 5 (-c�" �"I 4'14 ' L-:: SIZE OF SUBJECT PROPERTY (square feet): /7 3 ' EXISTING ZONE C..ASSIFICATION(S): LIST PREVIOUSr,LAND USE ACTIONS INVOLVING THIS PROPERTY: ..40"7"" ! i D c� i�J 1 F�! r°�'J7STS/St)./ ✓ `�+'f J/ ; � Areas of Special Concern: ?ursuant to Section 5.06.13 of the Spokane Valley Floodplain Ordinance, the following areas shall not be covered by impervious surfaces or fill unless an engineering study prepared by a professional engineering licensed in the State of Washington is completed that shows no impact to the ability of the 9oodplain to infiltrate, store and release floodwaters. Please check the box If your property is located in one of these areas: ❑ Chester Creek (downstream of Mohawk Road) Saltese Creek (all areas of ponding and infiltration) ❑ Forker (south of the intersection of Forker Road and Progress Road) ❑ Central Park (west of Park Road) ❑ Glenrose (we_;t of Carnahan Road and south of e Avenue) DESCRIPTION OF WORK: 1. Proposed Development Descriptions (check boxes that apply): New Construction ❑ Alteration & Repair ❑ Stream Alteration ❑ Manufactured/Modular Housing ❑ Road, Culvert, Utilities ❑ Other - Describe: 2. Types of Construction (check boxes that apply): ',,"New or Existing Residential: C squ_a rt feat ❑ Addition: square feet ❑ Acces<_.ory Structure: sgaare feet • Renovation: ❑ Interior ❑ Exterior ❑ Temporary [] New Non -Residential ❑ Repair ❑ Utility Installation ❑ Other - Describe: For Alterations, Additions or Improvements to an Existing Structure: If the cost of the proposed ,onstruction equals or exceeds 50 percent of the market value substantial improvement requirements shall apply. Please answer the following questions: a. What is the estimated market value of the existing structure?: $ b. What is the estimated cost of the proposed construction?:$ Version 1: 05/04 2 FROM : GHLJINC FAX hJO. : 5099219775 Sep. 30 2004 11:50AM P3 3. Filling & Grading (check boxes that apply): ❑ Filling 0 Excavation ❑ Cubic Yards to be Removed: cubic yards ❑ Cubic Yards to be Placed: cubic ards ASSOCIATED APPLICATIONS: This permit is being applied for In conjunction with one or more of the following (check boxes): _esidentialfCommercial Building Permit E Grading Permit 0 Land Division Application ❑ Critical Areas; Permit ❑ Shoreline Substantial Development Permit ❑ Other - Describe: PART IV - LEGAL OWNER SIGNATURE (Signature of legal owner or representative as authorized by legal owner) ,tu)� I, / t°4C_ (print name) SWEAR OR AFFIRM THAT THE ABOVE RESPONSES ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. I FURTHER SWEAR OR AFFIRM THAT 1 AM THE OWNER OF RECORD OF THE AREA PROPOSED FOR THE ABOVE IDENTIFIED LAND USE ACTION, OR, IF NOT THE OWNER, ATTACHED HEREWITH IS WRITTEN PERMISSION FROM THE OWNER AUTHORIZING MY ACTIONS ON HIS/HER BEHALF. It is hereby agreed that the City of Spokane Valley, its boards, officers. employees and agents shall be saved, indemnified and held harmless from all liabilities imposed by law by reason of Injury to or death of any person(s) or damage to any property, including without limitation, liability for trespass, nuisuance or inverse condemnation, which may arise out of the work covered by this permit, and does agree to defend the City. its officers, employees and agents against any claim or action asserting such liability. Accepting this permit or starting any work hereunder shall constitute acceptance and agreement to all conditions and requ'rements of this permit and the ordinance and specifications authorizing issuance of such permit. 7 STATE OF WASHINGTON COUNTY OF SPOKANE ) ) ss: NOTARY (For Part IV above) SUBSCRIBED AND SWORN to before me this NOTARY SEAL /( _D/ tf (Date) day of Oc-�F1c..- , 20 0 `1 MIKE MALECKI NOTARY PUBLIC - ARIZONA MARICOPA COUNTY My Commission Expires June 13, 2008 Version 1: 05/04 NOTARY SIGNATURE Notary Public iri and for the State of Wash torr Za.^ Residing at: My appointment expires: .lid -\ /3 2-.0 0 r 3 FROM : GHi,J I NC FAX NO. : 5095'215776 Sep. 30 2004 11:51AM P4 PART V — CONDITIONS OF APPROVAL FOR INTERNAL USE ONLY - TO BE COMPLETED BY THE CITY OF SPOKANE VALLEY Communi Number: 530-342 ___ _ Panel Number: y Jig Flood Zone: A _ Flood Zone Depth No.: / 10.2-7 Scrr eJ_ Base Flood Elevation at Site: Re. uired To• of the Lower Floor Elevation: C%)- ' If the structure is to be floodproofed, the required floodproofing elevation is: Elevation Certificate Required: 21 Yes 0 No *No Rise" Verific ition Required: tNumbered A Zone) 0 Yes 51 No Conditions of Approval: In addition to those listed above and below, please refer to attached conditions of app•oval if applicable. 1. Required Elevation of the "top of the next higher floor" shall be (AE) feet M.S.L. 2. Required Elevation of the "top of the next higher floor" shall be (AO) feet M.S.L 3. Required elevaton of flood resistant materials, utilities, etc. or floodproofing construction for non- resdiential structures (the flood protected elevation) shall be 2e'2 3 feet M.S.L. 4. A "Building Under Construction" elevation certificate ❑ shall 12 shall not be completed and submitted to the City for review and approval prior to any vertical construction. AA "Finished Construction" elevation certificate 51 shall 0 shall not be completed and submitted to the City for review and approval prior to human o cupancy or final inspection of on-site building(s), whichever comes first. NO HUMAN OCCUPANCY OR FINAL INSPECTION SHALL BE GRANTED PRIOR TO THE SUBMITTAL AND APPROVAL OF THE "FINISHED CONSTRUCTION" CERTIFICATION, Version 1: 05/04 4 FROM : GHLJINC FAX NO. : 5055219776 Sep. 30 2004 11:51AM P5 PART VI — DEPARTMENT SIGN -OFF & APPROVAL City of_S,.pakanti Valley Commpnity Development Department: As the Floodplain Administrator for the City of Spokane Valley, I certify the following has been reviewed and approved by me: The "Building Under Construction" elevation certificate has been reviewed and approved: ta Structure elevated BFE + 1 foot 0 Structure built with waterproofed materials to the flood protected elevation or more Marina Sukup, AICP, Community Development Director The "Finished Construction" elevation certificate has been Date 20 . It has been reviewed ❑ returned for more information on k _( S, 20 0k -1;1;3 -approved on S , 204b 1; Marina Sukup, ACP, Community Development Director Date PLEASE NO THIS PERMIT SHALL EXPIRE WITH THE ISSUED BUILDING PERMIT OR IF THERE IS NO BUILDING PERMIT WITHIN TWELVE MONTHS OF THE DATE OF ISSUANCE IF ACTIONS AUTHORIZED UNDER THE PERMIT ARE NOT SUBSTANTIALLY 1N -PROGRESS. EXTENSIONS OF APPROVAL MAY BE SOUGHT IF SUBSTANTIAL PROGESS HAS TAKEN PLACE. Version 1: 05/04 5 FROOIY1 : GHWINC FAX NO. : 509S219775 Sep. 30 2C04 11:52AI`1 P6 2021.0 EA6E P -0017 LEVAT1014 LOT 1 SLK1 S�+ELLEY LAKE 4T14 70.0 F06.144-7(42/ 2q �.a 70' !T EBV • S1..TE FLAK C.ALE � = 2o`--0ir i