2005, 04-12 Permit App: 05001156 ResidenceProject Number: 05001156 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/12/2005 Page 1 of 3
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -
NATURAL GAS
Setbacks: Front 20 Left: 8 Right: 8 Rear: 30
Site Information:
Plat Key:
Contact: GEORGE H WHITE, INC.
Address: PO BOX 52
C - S - Z: LIBERTY LAKE, WA 99019-0052
Phone: (000) 000-0000
Group Name:
Project Name:
Name: SHELLEY LAKE 4TH ADD PUD
District: East
Parcel Number: 45244.3004 Block: 2
SiteAddress: 910 S SHELLEY LAKE LN
Location:: CSV
Zoning: UR -3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 9,004 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 32
Lot: 4
Owner: Name: GEORGE H WHITE, INC.
Address: PO BOX 52
LIBERTY LAKE, WA 99019-0052
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Plan Review
Sewer Review
Permits:
Released By:
Operator: K_C Printed By: K_C Print Date: 04/12/2005
Project Number: 05001156
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/12/2005 Page 2 of 3
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Building Characteristics
Group: R-3
Total Area
Building Height
Stories
Dwelling Units
Type: VB
4383
24
2
1
Building Permit
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Description Grp lug Notes
2ND FLOOR R-3 VB
BASEMENT U R-3 VB
CARPORT U-1 VB
GARAGE U-1 VB
RESIDENCE R-3 VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Contractor: S & R HEATING
Address: 15501 N YALE RD
MEAD, WA 99021
Item Description
GAS WATER HEATER
GAS APPLIANCE<=100,000BTU
GAS PIPING
HEAT PUMP OR A/C 0-3 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
CLOTHES DRYER
RANGE
GAS LOG OR GAS INSERT
This Application: Total Project:
Su Ft Valuation Sq Ft Valuation
1,251 $93,424.68 1,251 $93,424.68
1,566 $23,490.00 1,566 $23,490.00
144 $2,160.00 144 $2,160.00
733 $13,927.00 733 $13,927.00
1,566 $116,948.88 1,566 $116,948.88
Totals: 5,260 $249,950.56 5,260 $249,950.56
Units
1
1
1
Unit Desc
SELECT
SELECT
SELECT
Permit Total Fees:
Mechanical Permit
Fee Amount
$1,833.75
$4.50
$733.50
$2,571.75
Firm: S & R HEATING, INC
Phone: (509) 467-3960
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
4 # OF UNITS
1 NUMBER OF
5 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Operator: K_C Printed By: K_C
Fee Amount
$10.00
$12.00
$4.00
$12.00
$50.00
$10.00
$10.00
$10.00
$10.00
Permit Total Fees: $128.00
Print Date:
04/12/2005
Project Number: 05001156 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/12/2005
Contractor: PRECISE MECHANICAL
Address: 1310 S AVALON CT
SPOKANE WA 99216
Item Description
TOILETSBIDETS
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
Page 3 of 3
Plumbing Permit
Firm: PRECISE MECHANICAL
Phone: (509) 922-9666
Units Unit Desc
3 NUMBER OF
5 NUMBER OF
2 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Permit Total Fees:
Fee Amount Invoice Amount
$2,571.75 $2,571.75
$128.00 $128.00
$96.00 $96.00
$2,795.75 $2,795.75
Fee Amount
$18.00
$30.00
$12.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
Amount Paid
$0.00
$0.00
$0.00
$96.00
Amount Owing
$2,571.75
$128.00
$96.00
$0.00 $2,795.75
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 construed 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: K_C Printed By: K_C
Print Date: 04/12/2005
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: l e
S14k-z t i y1 .
PERMIT DESCRIPTION: N .�
ItIBUliDING PERMIT 0 CHANGE IN USE 0 GRADING C MANUFACTURED ROME
10-0THER
EIRELOEATION El TENANT
OWNER / APPLICANT INFORMATION
IR -OWNER: C6 L V/ ) t \AI—) -rt.
PHONE: / / 1- 0 41 e).--1 FAX:
ADDRESS: 0 Y S p
•
CONTRACTOR:
PHONE: ' FAX:
ADDRESS:
CJTY,STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # Cil''°'1 '
APPLICANT:
PHONE:
ADDRES
ARCHITECT:(
PHONE: `►D
ADDRESS:
("W STATE, ZIP
CONTACT: �}
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT: / { ~ r 0:'`
BUILDING HEIGHT TO PEAK: 2y
`/7Y 5
BUILDING DIMENSIONS:1/7Y
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK: 2-0
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
?7 r
30% SLOPES ON PROPERTY: "6'
OCCUPANCY GROUP:
1)1 Ce
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS: /� /�
t0
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: 6
CURRENT SEPTIC USE:
CURRENT WELL USE: �ip�
IMPERVIOUS SURFACE AREA: a'" ` r 6 0
'MAIN FLOOR SQ FT: / 6-64
2N0 FLOOR SQ FT: +2
.51
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE: 7'
COVERED DECK:
DECK:
"Aft.
Sri°'lane
4,Valley
h9
Project Address: ,
Owner: Kms' . / )`) I TC
Mailing Address:
Contractor: 7` d !^l L7
Mai ing Address:
-
4/103672
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development
Bnt dinpart neon
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
ejer-Ar 9'
License #: _
METHOD OF PAYMENT:
❑ CASH ❑ CHECK [VISA ❑ MC
CARD #:
AUTHORIZED SIGNATURE:
FM
City
Ci
# OF
UNITS
DATE:
EXPIRES:
-/
X
1
X
COST
$15.00
519.00
$50.00
$100.00
$50.00
$100.00
$15.00
$28.00
$39.00
$57.00
$95.00
$10.00
$10.00
$10.00
$10.00
510.00
$1.00
$10.00
$10.00
$12.00
$19.00
$10.00
$50.00
$10.00
$12.00
$20.00
$25.00
535.00
$60.00
$10.00
$10.00
525.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
State
Phone #:
State
TOTAL
AMOUNT
535.00
-
Zip Code
Zip Code
DESCRIPTION OF WORK
Equal to or less than 100,000
More than 100,000
Equal to or less than 400,00C
More than 400,000
1
FUEL BURNING APPLIANCE
2
FUEL BURNING APPLIANCE
3
UNLISTED APPLIANCE (Additional Fee)
4
UNLISTED APPLIANCE (Additional Fee)
5
USED APPLIANCE (WSEC min. AFUE
rating)
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or less than 400,00(
More than 400,000
1 - 100M BTU
101 - 500M BTU
6
7
BOILER/REFRIGERATION
8
BOILER/REFRIGERATION
9
BOILER/REFRIGERATION
501 -1,000M BTU
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
11
BOILERiREFRIGERATIONo, -;
, More than 1,750M BTU
12
GAS LOG, GAS INSFttT, GAS FIREPLACE--
IREP[-ACE "13
13
RANGE
14
DRYER
15
FUEL BURNING WATER HEATER
6 P- ( ,
16
MISC. FUEL BURNING APPLIANCE
17
GAS PIPING (each outlet)
18
DUCT SYSTEMS
19
VENTILATING FANS
C
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000
CFM
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000
22
EVAPORATIVE COOLERS
23
'TYPE IHOOD
24
TYPE II HOOD
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
26
AIR CONDmONER
3-15 TON
27
AIR CONDITIONER
15-30 TON
TON
28
AIR CONDITIONER
30-50
More than 50 TON
29
AIR CONDITIONER
30
LPG STORAGE TANK
31
WOOD OR PELLET STOVE/INSERT
32
WOOD STOVE - FREE STANDING
METHOD OF PAYMENT:
❑ CASH ❑ CHECK [VISA ❑ MC
CARD #:
AUTHORIZED SIGNATURE:
FM
City
Ci
# OF
UNITS
DATE:
EXPIRES:
-/
X
1
X
COST
$15.00
519.00
$50.00
$100.00
$50.00
$100.00
$15.00
$28.00
$39.00
$57.00
$95.00
$10.00
$10.00
$10.00
$10.00
510.00
$1.00
$10.00
$10.00
$12.00
$19.00
$10.00
$50.00
$10.00
$12.00
$20.00
$25.00
535.00
$60.00
$10.00
$10.00
525.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
State
Phone #:
State
TOTAL
AMOUNT
535.00
-
Zip Code
Zip Code
4,Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development
DepartBuildingDis nt
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: 37
FOR INSPECTIONS, CALL (509) 688-0054
Project Address:
a -"- a' ' L` 47.94/4 ermit Use:
/'l t T' ( . Phone (Daytime Contact):
(1y�j
Owner .
Mailing Address: G?
Contractor:
i ( I Y r ' " License #: Phone #:
Mailing Address:
State
DESCRIPTION OF WORK
2
3
4
5
TOILETS
WATER CLOSET, BIDETS
URINALS
TUBS
SHOWERS (PER TRAP)
SINKS
BATH, STALL, ON-SITE BUILT
LAVSBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
6
DISHWASHER
7
CLOTHES WASHER
8
9
GARBAGE DISPOSAL
WATER SOFTENER
10
11
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
12
ROOF DRAINS/OVERFLOW DRAINS
13
14
FOUNTAINS, DRINKING
City
*OF
UNITS
3
I
1
1
X
X
X
X
X
X
X
X
x
X
X
X
X
X
COST
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
m
Zip Code
State Zip Code
TOTAL
AMOUNT
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
15
16
SEWAGE EJECTOR
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
GRINDER, SUMP PUMP
X
$6.00
(ICE AN;QR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
18
INTERCEPTORS
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR
VATS, TANKS, BOILERS
X
$6.00
X
$6.00
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
20
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
X
$6.00
/ISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
$35.00
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET: -
MANUFACTURER:
SQ FT OF SIGN: HEIGHT Or SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATEITIME:
1
WA STATE NON=RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:'.
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
0 CONCRETE
REINFORCEMENT
PHONE:
WELDING
FAX:
BUILDING .STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 11:1YES 13 NO IF YES: E COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 YES ® NO IF 'YES, WHICH WATER DISTIIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY' LOCATED WITHIN ASA: 0YES' ® NO PSSA: 0 YES 0 NO
DATE:
STAFF:
METHOD OF PAYMENT:
® 0
CASH
CHECK
BANKCARD #; EXPIRES. VIN #
AUTHOR/ZED SIGNATURE.•.
*FAXED PERMIT APPLIC IONS L ONLY ACCEPTED WITH MAJOR BANKCARD
FAX NU. : V6J.J 17 ((t7
SPOKANE COUNTY
DEPARTMENT OF BUILDING & PLANNING
1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
Site Information
FROM : GHWINC
�suwNrti
SpoKA\T CooNf?
1
Site Address: 910 E SI-IT.:LLEY LAKE LN
Parcel Number: 45244.3004
Subdivision:
Block: Lot:
Zoning: UNK Unknown
Owner: GEORGE 1-1 WHITE, INC.
Address: PO BOX .i2
LIBERTY LAKE, WA 99019-0052
Building Inspector: BOBBY STONE
Water Dist: UNKNOWN
1
Project Information
Project Number: 05002041 Inv: I Issue Date: 4/112005
Permit Use: SEWER CONNECTION
Applicant; CiEORGE FL WHITE INC
BOX 52
LIBERTY LAKE, WA 99019
Contact: GEORGE H. WHITF, INC
BOX 52
LIBERTY LAKE, WA 99019
Setbacks - Front:
Group Name:
Project Name:
Phone: (509) 255-5000
Phone: (509) 255-5000
Left Right: Rear:
Permits
Sewer Connection Permit Contractor i L HAWKINS EXCAVATING
License 4: .ILHAWE'222LE
SEWER CONNF..CTION 1 SS5.00 PROCESSING FEE
Total Permit Fee:
FOR SEWER INSPECTIONS CALL (509) 477-3604 UTILITIES 8:30-5:00 PM MONDAY THRU FRIDAY
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 ch.xkcd 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 LIG, (509)456-8000.
STATE 1,AW RCW 19.: 22 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 rt quires the installer comply with all requirements of the Washington State Dept of Labor and Industries,
including those related t+t trench safety.
1 515.00
S100.00
Payment Summary
Total Feta Amoun_Paid AmountOwing
5100.00 5100.00 S0.00
Tran Date
4/1/2005
Processed By: HOWARD, 1)AN
Printed By: WENDF,I., C LORIA Page 1 of 1
Receipt # Payment Amt
1654 $100.00
PERMIT
APR 05 2005 10:55 5099219776 PAGE.03
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