2003, 09-24 Permit App: BLD-03-02571 ResidenceCITY OF
pane
jMtlley
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 #: BLD -03-02571
Job Address: 921 S SHELLEY LAKE LN
SPOKANE VALLEY WA 99206
Description: NEW RESIDENCE W/ATTACHED GARAGE - NATURAL GAS
Subdivision:
Owner: CLIFF SCHMITZ CONSTRUCTION
Applicant: CLIFF SCHMITZ CONSTRUCTION
Address:
Contractor:
Address:
Lot: Blk: Parcel No:
CLIFFORD SCHMITZ CONSTRUCTION
16520 E SECRETARIAT LN
VERADALE WA 99037 -
Phone: (509) 999-773
K- "773
Phone: (509) 922-4297
Lic No: CLIFFSC104RF
Applied:
Issued:
Expires:
Zoning:
09/24/2003
03/22/2004
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
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
SHOWERS (PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
TYPE II HOOD
sfr
143748
21
65 X 58
1
3
25
61
5
5
r-3
5-w
1
75 X 143
no
no
3
3
1
5
1
1
1
1
3
1
1
1
3
3
1
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SHOWERS
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
Total Calculated:
Deposits/Receipts:
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Building
Planning
Public Works
Initials / Date
496.06
1,240.15
4.50
18.00
18.00
6.00
30.00
6.00
6.00
6.00
6.00
18.00
15.00
10.00
10.00
3.00
30.00
1,922.71
0.00
//Awe -6 (4pLe -
REVIEWED FOR CODE COMPLIANCE
SPAKA l VALE ! 13�ILI NG�f?IVI ION
Sri()lane
doonalley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
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:
612,1 s. S let J4k.e fe
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRI PTI ON: L BL K 141.1 -al/ /NNe PQ 11 -fl' 0-00
PERMIT DESCRIPTION: 2S \ AL
UILDING PERMIT
DRELOCATION
®CHANGE IN USE D GRADING
[I SIGN Q TENANT
CI MANUFACTURED HOME
0 OTHER
i
OWNER / APPLICANT INFORMATION
I
® OWNER:
PHONE: FAX:
ADDRESS:
E
//!! PP SCAM
I _ - CITY,STATE, ZIP
CONTRACTOR: C L t 5 (QCT M (T Z. Lb/1S
PHONE: egg -2'133 FAX:8f I- q /
'
ADDRESS: 1(d�"Z� �s S L�-�� 41
UeAZACKYu 4`903 1 CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # EL 1 %'i'RP
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
'
BUILDING HEIGHT TO PEAK: C(
BUILDING DIMENSIONS: tt
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
Z-,9
REAR SETBACK: t‘ 2 11
LEFT SETBACK: rD ,
RIGHT SETBACK:
5%
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:_-
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: j'1
2N0 FLOOR SQ FT:e�'f
UNFIN BASEMENT: 11
1 lS
FINISHED BASEMENT: -e-
GARAGE: I Z$
COVERED DECK:
DECK: 4 /00
0 BOLTING
FIRM NAME:
INSPECTOR(S):
0 CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
i
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
IF YES: COUNTY ® CITY
DATE:
STAFF:
METHOD OF PAYMENT:
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
ETHOD 0
CASH
Spocrr� <>�
t al
Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
509-688-0037 - Fax
Spokane Valley, WA 99206
PROJECTPERMIT
ADDRESS: g 0, S 5 J J/
USE:
OWNER: r(
PHONE (Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: 0-1 01044 S p Laugl A) G
LICENSE #:
MAILING ADDRESS:
PHONE #:
WATER CLOSET, BIDETS
(street) (city/state) (LJf)
PLUMBING FIXTURES
ATE: EXPIRES:
NNKCARD NUMBER:
JTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
?.-
X
$6
-
2
URINALS
X
$6
-
3
TUBS
�j
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
}
X
$6
-
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
9,
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
1
)
X
$6
-
8
GARBAGE DISPOSAL
I
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
f
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,
SWAMI' COOLER
3
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
86
-
20
MISC. PLUMBING FDCI'URE
X
$6
-
'PAYMENT
S 414.st;
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
■ CHECK • ■
�._.__.__..
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
NNKCARD NUMBER:
JTHORIZED SIGNATURE:
SSuukane
,1 .#Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
509-688-0037 - Fax
Spokane Valley, WA 99206
METHOD OF PA
❑ CASH ❑ C
DESCRIPTION OF WORK
PROJECT, t9 Z f
ADDR
ADDRESS, 1
.
`4G l'1 i
�
PERMIT
USE:
OWNER:
1
FUEL BURNING APPLIANCE
PHONE (Daytime Contact):
MAILING ADDRESS:
X
515
(street)
(city/state) (ZIP)
CONTRACTOR: Q' ` ,( ,
/c i_kfn d,J i Aki4TULZ
LICENSE #:
MAILING ADDRESS:
X
$19
PHONE #:
(street)
UNLISTED APPLIANCE (ADDITIONAL FEE)
(city/state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR < 100,000
1
X
515
-
2
FUEL BURNING APPLIANCE
> 100,000
X
$19
-
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- OR <400,000
X
$50
-
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
5100
=
5
USED APPLIANCE (WSEC min. AFUE rating)
- or < 400,000
X
$50
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
$100
-
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
$57
-
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
C
X
$IO
-
13
RANGE
-
X
510
-
14
DRYER
-
X
$10
-
15
FUEL BURNING WATER HEATER
-
!
X
810
-
16
MISC FUEL BURNING APPL
-
X
510
-
17
GAS PIPING (ea. Outlet)
-
A
X
51
-
18
DUCT SYSTEMS
-
X
510
-
19
VENTILATING FANS
-
1
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
S50
-
24
TYPE II HOOD
-
1
X
510
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIR CONDMONER
3-15 TON
X
820
-
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
$10
-
31
WOOD OR PELLET STOVE/INSERT
-
X
510
-
32
WOOD STOVE - FREE STANDING
-
X
525
=
TIENT
VISA;wrap',:~'
•--, asp ......
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
Site Information
Project Information
Site Address: 921 S SHELLEY LAKE LN
VERADALE, WA 99037
Parcel Number: 45245.9155
Subdivision:
Block: 1 Lot: 9
Zoning: UNK Unknown
Owner: CLIFF SCHMITZ CONST
Address: 16520 E SECRETARIAT
VERADALE, WA 99037
Building Inspector: BOBBY STONE
Water Dist:
Project Number: 03006894 Inv: 1 Issue Date: 9/23/2003
Permit Use: SEWER CONNECTION - SHELLEY LAKE 4TH
Applicant: CL]FF SCHMITZ CONSTRUCTION
16520 E. SECRETARIAT
VERADALE, WA 99037 Phone: (509) 922-4297
Contact: CL11.1. SCHMITZ CONSTRUCTION
16520 E. SECRETARIAT
VERADALE, WA 99037 Phone: (509) 922-4297
Setbacks - Front: Left: Right: Rear:
Group Name:
Project Name:
Permits
Sewer Connection Permit
Contractor: FOLSOM EXCAVATING INC License #: FOLSOEI994DO
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
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
NO 1'U hD. 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.
$15.00
$100.00
Payment Summary
Total Fees AmountPaid AmountOwing
$100.00 $100.00
$0.00
Tran Date
9/23/2003
Processed By: BURRIS, ROBIN
Printed By: HINTZ, FAITH Page 1 of 1
Receipt # Payment Amt
6052 $100.00
PERMIT
Cee
4 -
S. t Z
APPRc
APPROVED BY
)91t`1Z
9s -1v
sl.e Ileo lake lane