2005, 10-04 Permit App: 05003565 ResidenceProject Number: 05003565 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/04/2005 Page 1 of 3
Project Information:
1
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -GAS Contact: GEORGE H. WHITE INC
Address: BOX 52
C - S - Z: LIBERTY LAKE, WA 99019
Phone: (509) 255-5000
Group Name:
Site Information: Project Name:
Plat Key:
Setbacks: Front 20 Left: 20 Right: 7 Rear: 35
Name: SHELLEY LAKE 4TH ADD PUD
District: East
Parcel Number: 45244.3005
Block:
SiteAddress: 912 E SHELLEY LAKE LN
Location:: CSV
Zoning: UR -3.5
Water District:
Area: 7,875 Sq Ft
Urban Residential 3.5
Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information
Lot:
Owner: Name: GEORGE H WHITE, INC.
Address: PO BOX 52
LIBERTY LAKE, WA 99019-0052
Hold: ❑
Depth: 0 Right Of Way (ft): 32
Review
Site Plan Review
Released By:
Plan Review
Originally Released: 10/04/2005 By: CJJANSSE
Released By:
Approach / Drainage
Originally Released: 10/04/2005 By: TMELBOU
Released By:
N/A -PRIVATE LANE
Sewer Review
Originally Released: 10/04/2005 By: CJJANSSE
Released By:
Originally Released: 10/04/2005 By: CJJANSSE
Operator: CJJ Printed By: CJJ Print Date: 10/04/2005
Project Number: 05003565
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/04/2005 Page 2 of 3
Permits: ustwassmow,wmpayaltrA
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Building Characteristics
Total Area
Building Height
Stories
Dwelling Units 1
2308
26
2
Building Permit
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Description Grp Type Notes
2ND FLOOR R-3 VB
BASEMENT U R-3 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
RANGE
GAS LOG OR GAS INSERT
HOOD -TYPE II
This Application: Total Project:
Sq Ft Valuation Sq Ft Valuation
748 $55,860.64 748 $55,860.64
560 $8,400.00 560 $8,400.00
494 $9,386.00 494 $9,386.00
1,100 $82,148.00 1,100 $82,148.00
Totals: 2,902 $155,794.64 2,902 $155,794.64
Units
1
1
1
Unit Desc
SELECT
SELECT
SELECT
Permit Total Fees:
Mechanical Permit
Fee Amount
$1,307.35
$4.50
$522.94
$1,834.79
Firm: S & R HEATING, INC
Phone: (509) 467-3960
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
4 # OF UNITS
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Operator: CJJ Printed By: CJJ
Permit Total Fees:
Print Date:
Fee Amount
$10.00
$12.00
$4.00
$12.00
$10.00
$10.00
$10.00
$68.00
10/04/2005
Project Number: 05003565 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/04/2005 Page 3 of 3
Contractor: PRECISE CONSTRUCTION
Address: 602 S SHELLEY LAKE LN Phone: (509) 218-1718
VERADALE, WA 99037
Plumbing Permit
Firm: PRECISE CONSTRUCTION
Item Description
TOILETSBIDETS
SINKS
SHOWERS
TUBS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
FLOOR DRAINS
WATER USING DEVICES
Notes:...„,:womo,,,,FogEmERwargmamsTa
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
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
3 NUMBER OF
Fee Amount
$1,834.79
$68.00
$108.00
Permit Total Fees:
Invoice Amount
$1,834.79
$ 68.00
$108.00
Fee Amount
$18.00
$30.00
$12.00
$6.00
$6.00
$6.00
$6.00
$6.00
$18.00
Amount Paid
$0.00
$0.00
$0.00
$108.00
Amount Owing
$1,834.79
$68.00
$108.00
$2,010.79 $2,010.79 $0.00 $2,010.79
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: CJJ Printed By: CJJ
Print Date: 10/04/2005
*name
City of
'RED SITE INFORMATION
_BUILDING PERMIT APPLICATION WORKSHEET
\-Valley Community Development Department
; Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Jhone: (509) 688-0036; Fax: (509) 688-0037
Street Address: 912 S. Shelley Lake Lane
Assessor's Tax Parcel Number(s): 45244.3005
Legal Description: Block 2, Lot 5, Shelley Lake 4th Addition
PERMIT DESCRIPTION: New Residence
X Building Permit ❑ Change in Use ❑ Grading 0 Manufactured Home
0 Relocation ❑ Tenant Improvement 0 Fire Safety 0 Other
OWNER/APPLICANT INFORMATION
X Owner: George H. White, Inc.
Phone: 509.921.9752 Fax: 509.921.9776
Address: PO Box 52
City: Liberty Lake State: WA Zip: 99019
X Contractor: Same
Phone: Fax:
Address:
City: State: Zip:
WA State Contractor License #: GEORHWO998
X Applicant: Same
Phone: Fax:
Address:
City: State: Zip:
X Architect: Gallery 12 Designs
Phone: 483.2762 Fax: 483.4126
Address: PO Box 7420
City: Spokane State: WA Zip:
Contact: Dan, 509.710.1087
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: 26'
DIMENSIONS: 46' x 52'
# OF STORIES: 2
MAIN FLOOR TO SQ. FTG: 1100'
04--
2"u FLOOR SQ. FTG: 748'
Li iy
UNFIN BASEMENT SQ. FT f 56
'44 -
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: 5888' .,
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: Wd. Frame
HEAT SOURCE: Gas forced air
# OF BEDROOMS: 3
TOTAL HABITABLE SPACE: 2308'
IMPERVIOUS SURFACE AREA:
2688'
COST OF PROJECT: $ 150,000
30% SLOPES ON PROPERTY: N/A
SEWER OR ON-SITE SEPTIC
SYSTEM? Sewer
MANUFACTURED HOME
Width:
Manufacturer:
Length:
Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
Valuation:
# of Heads Fire Alarm:
Fireworks Display: Blasting:
Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
City, State, Zip:
Phone:
City, State, Zip:
Fax:
Fax:
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
Inspector(s):
❑ REINFORCEMENT
Phone:
Fax:
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name: George H. White Signature
7/5 CZ .?-76S
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash X Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
A
n' Phone: (509) 688-0036; FAX: (509) 688-0037
ValleyFor Inspections, CaII (509) 688-0054
PLUMBING PERMIT APPLICATION .
Project Address: 912 S. Shelley Lake Lane
Owner: George H. White, Inc.
509.921.9752
Mailing Address: PO Box 52
Contractor: Precise Construction
Mailing Address:
City
Liberty Lake
License #:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
WA
State Zip Code
Phone #: 926.0631
99019
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: "' '2 ? - o S
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
$6.00
=
$18.00
2
URINALS
X
$6.00
=
3
TUBS
1
X
$6.00
=
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
2
X
$6.00
=
$12.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
5
X
$6.00
=
$30.00
6
DISHWASHER
1
X
$6.00
=
$6.00
7
CLOTHES WASHER
1
X
$6.00
=
$6.00
8
GARBAGE DISPOSAL
1
X
$6.00
=
$6.00
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
1
X
$6.00
=
$6.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
3
X
$6.00
=
$18.00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
$108.00
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
$143.00
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: "' '2 ? - o S
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address: 912 Shelley Lake Lane
Owner: George H. White, Inc.
Mailing Address: PO Box 52, Liberty Lake, WA 99019
Contractor: S& R Heat
Mailing Address:
License #:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
City State
Phone #: 509-467-3690
Ci
State
Zip Code
Zip Code
��Cs,A
t
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
1
X
$12.00
=
$12.00
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
=
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
1
X
$10.00
=
$10.00
13
RANGE
1
X
$10.00
=
$10.00
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
1
X
$10.00
=
$10.00
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
4
X
$1.00
=
$4.00
18
DUCT SYSTEMS
X
$10.00
=
19
VENTILATING FANS
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE 11 HOOD
1
X
$10.00
=
$10.00
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
1
X
$12.00
=
$12.00
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
33
REPAIR & ADDITIONS
X
$15.00
=
34
VENTILATION SYSTEMS
X
$12.00
=
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
=
36
INCINERATOR - RESIDENCE
X
$19.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
❑CASH 0 CHECK 0 VISA 0 MC DATE:
SUBTOTAL
80
PROCESSING FEE
$35.00
��Cs,A
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SPOKANE COUNTY
DEPARTMENT OF BUILDING & PLANNING
S Cowl 1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
1
Site Information
Project Information
Site Address: 9125 SHELLEY LAKE LN
Parcel Number: 45244.3005
Subdivision:
Block: Lot:
Zoning: UNK Unknown
Owner: GEORGE H WHITE, INC.
Address: PO BOX 52
LIBERTY LAKE, WA 99019-0052
Building Inspector: BOBBY STONE
Water Dist: UNKNOWN
Project Number: 05002044 Inv: 1 Issue Date: 4/1/2005
Permit Use: SEWER CONNECTION
Applicant: GEORGE H. WHITE INC
BOX 52
LIBERTY LAKE, WA 99019
Contact: GEORGE H. WHITE INC
BOX 52
LIBERTY LAKE, WA 99019
Setbacks - Front: Left: Right:
Group Name:
Project Name:
Phone: (509) 255-5000
Phone: (509) 255-5000
Rear:
Permits
Sewer Connection Permit
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.
Payment Summary
Total Fees AmountPaid AmountOwing
$100.00 $100.00 $0.00
Tran Date Receipt # Payment Amt
4/1/2005 1654 $100.00
Processed By: HOWARD, DAN
Printed By: WENDEL, GLORIA Page 1 of 1
PERMIT