2004, 12-14 Permit App: 04009392 ResidenceProject Number: 04009392 Inv: I Application Date: 12/14/2004 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
Parcel Number: 45244.2906
Block: 1
Lot: 6
SiteAddress: 915 S SHELLEY LAKE LN
Owner: Name:
GEORGE H WHITE, INC.
Address:
PO BOX 52
Location:: CSV
LIBERTY LAKE, WA 99019-0052
Zoning: UR -3.5
Urban Residential 3.5
Water District
Hold: ❑
Area: 16,865 Sq Ft
Width: 0
Depth: 0
Right Of Way (ft): 32
Nbr of Bldgs: 1
Nbr of Dwellings: 1
Review Information:
Revi'
Site
Plan
Approach / Drainage
Flooi
Sew(
s.mAIWI Mk
6 'u
Operator: K C Printed By: K_C Print Date: 12/14/2004
Project Number: 04009392 Inv: 1 Application Date: 12/14/2004
Permits:
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: GEORGE H WHITE CONST Firm: GEORGE HARVARD WHITE CON
Address: 0 BOX 52 Phone: (509) 921-9752
LIBERTY LAKE, WA 99019
Building Characteristics
Group: R-3 Type: VB
Total Area 3218
Building Height 20
Stories 1
Dwelling Units 1
Description
Grp
Type
BASEMENT F
R-3
VB
BASEMENT U
R-3
VB
DECK
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
VENTILATING FANS
CLOTHES DRYER
RANGE
GAS LOG OR GAS INSERT
HOOD -TYPE II
This Application:
Total Project:
Notes So Ft
Valuation
So Ft
Valuation
1,000
$20,000.00
1,000
$20,000.00
600
$9,000.00
600
$9,000.00
140
$2,100.00
140
$2,100.00
800
$15,200.00
800
$15,200.00
1,618 $120,832.24 1,618 $120,832.24
Totals: 4,158 $167,132.24 4,158 $167,132.24
Units
Unit Desc
Fee Amount
1
SELECT
$1,374.55
1
SELECT
$4.50
1
SELECT
$549.82
Permit Total Fees: $1,928.87
Mechanical Permit
Firm: S & R HEATING, INC
Phone: (509) 467-3960
Units
Unit Desc
1
NUMBER OF
1
NUMBER OF
4
# OF UNITS
1
NUMBER OF
4
NUMBER OF
1
NUMBER OF
1
NUMBER OF
1
NUMBER OF
1
NUMBER OF
Fee Amount
$10.00
$15.00
$4.00
$12.00
$40.00
$10.00
$10.00
$10.00
$10.00
Permit Total Fees: $121.00
Operator: K_C Printed By: K_C Print Date: 12/14/2004
Page 2 of 3
Project Number: 04009392 Inv: 1 Application Date: 12/14/2004 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: UNKNOWN
Address: UNKNOWN
UNKNOWN, WA UNKNOWN
Item Description
TOILETSBIDETS
SINKS
SHOWERS
TUBS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
FLOOR DRAINS
WATER USING DEVICES
Notes: : :::;»::
Payment Summa
Plumbing Permit
Firm: UNKNOWN
Phone: (000) 000-0000
Units
Unit Desc
Fee Amount
3
NUMBER OF
$18.00
6
NUMBER OF
$36.00
1
NUMBER OF
$6.00
3
NUMBER OF
$18.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
1
NUMBER OF
$6.00
3
NUMBER OF
$18.00
Permit Total Fees:
$120.00
Permit Type
Fee Amount
Invoice Amount
Amount Paid
Amount Owing
Building Permit
$1,928.87
$1,928.87
$0.00
$1,928.87
Mechanical Permit
$121.00
$121.00
$0.00
$121.00
Plumbing Permit
$120.00
$120.00
$0.00
$120.00
$2,169.87
$2,169.87
$0.00
$2,169.87
nion�niss�nr•
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: 12/14/2004
e
;o0%lley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
1170 7 East Sprague A ve Ste 906
Spokane Valley, WA 99206.
Phone: 509)688-0036 Fax.- 509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER
LEGAL DISCRI
Go T
PERMIT DESCRIPTION:
,' ILDING PERIITIT
13RELOCATION
Bea(- ;'- ►
13 CHANGE IN USE E GRADING [j MANUFACTURED HOME
[}SIGN I 12TENANT BOTHER
OWNER /APPLICANT INFORMATION
13OWNER:t/L9Z . /-/, /^_�l I Z_%�( ,
PHONE:FAX: 2?/-- ei/
ADDRESS: � U y S G/� t'.1A ft/f
CITY,STATE, ZIP
CONTRACTOR:
PHONE: FAX:
0 APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
0 ARCHITECT:
ADDRESS:
CITY/,.STATE,,ZZIIP r
WA ST CONTRACTOR LICENSE
PHONE:
ADDRESS:
CITY, STATE, ZIP
CONTACT: (D�/ / G Y'
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 1 6 ()c6l
BUILDING HEIGHT TO PEAK
BUILDING DIMENSIONS:�X 70
NUMBER OF STORIES: /
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK: 9 2 -
REAR SETBACK: 5
30% SLOPES ON PROPERTY: �I G
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT, PROPERTY SIZE:
CURRENT PROPERTY USE: LG '
CURRENT SEPTIC USE:
LEFT SETBACK: 25 CURRENT WELL USE:
i
RIGHT SETBACK: 9 IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: �6
2ND FLOOR SQ FT:
UNFIN BASEMENT: 6 G
FINISHED BASEMENT: 16"
GARAGE..
COVERED DECK: —
DECK: /yo d S4 /=r.
1 11 0/\� PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
;swky For Inspections, Call (509) 688-0054
Project Address:
c P;kvc
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Owner. Gam, / 7(, wN i r6 17y r, Phone (Daytime Contact): VC -11 -,' !,Z
Mailing
Mailing Address: L6X C 2, LIE c -k w4L.
city State Zip Code
Contractor. 0- �L� (if c_ /4 License #: Phone*
Mailing Address: 0(3
a C�w )\--- �� � / f� State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
_
3
TUBS
X
$6-00
=
4
SHOWERS PER TRAP
BATH STALL ON-SrrE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
L/
X
$6.00
=
6
DISHWASHER
X
$6.00
-
7
CLOTHES WASHER
/
X
$6.00
-
8
GARBAGE DISPOSAL
X
$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
/
/
X
$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
C OR COFFEE MAKER, HOSE BIB,
C5"1STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
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 r outlet
NITROUS, OXYGEN
X
$6.00
-
20
MISCELLANEOUS PLUMBING
FUTURE
X
$6.00
-
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
-
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
-
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD 1
DATE: EXPIRES: I
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
MECHANICAL PERMIT APPLICATION
io
oe
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address:// >� _Sl)��� Y c nll--
Owner: G &-t9N /'T6!--
Mailing
T --
Mailing Address: 13� t/ «-� `u
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
Z-rp
Contractor: C -4.p /-i 6-24 T _ License #: Phone #:
Mailing Address:
CHV stem zm code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS X
COST = TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00 -
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00 =
3
UNLISTED APPLIANCE Additional FeeEqual
to or less than 400,000
X
$50.00 -
4
UNLISTED APPLIANCE Additional Fee
More than 400,000
X
$100.00 -
5
USED APPLIANCE SEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00 -
6
USED APPLIANCE SEC min. AFUE ratio
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 INSER , tAS FIREPLACE
X
$10.00 -
13
RANGE
X
$10.00 -
14
DRYER
X
$10.00 -
15
1 FUEL BURNING WATER HEATER
X I
$10.00 -
16
MISC. FUEL BURNING APPLIANCE
X
$10.00 -
17
GAS PIPING each outlet
/
X
$1.00 -
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 ES NOT include ducting)
Greater than 10,000 CFM
X
$15.00 -
22
EVAPORATIVE COOLERS
X
$10.00 -
23
TYPE 1 HOOD
X
$50.00 -
24
TYPE II HOOD
X
$10.00 -
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$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 STOVEIINSERT
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 ❑ CHECK ❑ VISA ❑ MC
CARD #:
DATE:
EXPIRES:
SUBTOTAL
PROCESSING FEE $35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Tuesday, Dec 14, 2004 10:45 AM
SPOKANE COUNTY
DEPARTMENT OF BUILDING & PLANNING
111tl1p1° 1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
SPOIL COUNTY
Site Information Project Information
Site Address: 915 S SHELLEY LAKE LN
Parcel Number: 45244.2906
Subdivision:
Block: 1 Lot: 6
Zoning: UNK Unknown
Owner: GEORGE H WHITE INC
Address: PO BOX 52
LIBERTY LAKE WA 99019
Building Inspector: BOBBY STONE
Water Dist:
Sewer Connection Permit
Project Number: 04008570 Inv: 1 Issue Date: 11/16/2004
Permit Use: SEWER CONNECTION - SHELLEY LAKE 4TH
Applicant: GEORGE H WHITE INC
PO BOX 52
LIBERTY LAKE WA 99019
Contact: GEORGE H WHITE INC
PO BOX 52
LIBERTY LAKE WA 99019
Setbacks - Front: Left: Right:
Group Name:
Project Name:
Permits
Contractor: J L HAWKINS EXCAVATING License #: JLHAWE*222LE
Phone: (509) 991-0429
Phone: (509) 991-0429
Rear:
SEWER CONNECTION 1 $85.00 PROCESSING FEE 1 $15.00
Total Permit Fee: $100.00
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 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 AmountOwine Tran Date Receipt # Payment Amt
$100.00 $100.00 $0.00 11/16/2004 6885 $100.00
Processed By: SHATTO, JULIE PERMIT
Printed By: WENDEL, GLORIA Page 1 of 1
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