2005, 08-18 Permit App: 05003003 Residence Project Number: 05003003 Inv: 1 Application Date: 08/18/2005 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED-GAS Contact: GEORGE H.WHITE INC
Address: BOX 52
C-S-Z: LIBERTY LAKE,WA 99019
Setbacks:Front 16 Left: 8 Right: 7 Rear: 15 Phone: (509)255-5000
Group Name:
Site Information: Project Name:
Plat Key: Name: SHELLEY LAKE 4TH ADD PUD District: East
Parcel Number: 45243.3201 Block: 4 Lot: 1
SiteAddress: 16215 E 9TH 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: 8,939 Sq Ft Width: 112 Depth: 58 Right Of Way(ft): 16
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released By:
Originally Released: 08/18/2005 By: cjjanssen
Plan Review Released By:
Originally Released: 08/18/2005 By: TMELBOU
Approach/Drainage Released By: 1
PRIVATE LANE
Originally Released: 08/18/2005 By: cjjanssen
Operator: CJJ Printed By: CJJ Print Date: 08/18/2005
•
Project Number: 05003003 Inv: I Application Date: 08/18/2005 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Sewer Review Released By
SEWER PERMIT#05005992
Originally Released: 08/18/2005 By: cjjanssen
Permits:
Building Permit
Contractor: GEORGE H WHITE CONST Firm: GEORGE HARVARD WHITE CON
Address: 0 BOX 52 Phone: (509)921-9752
LIBERTY LAKE,WA 99019
This Application: Total Project:
Description Grp Type Notes Si Ft Valuation SQ Ft Valuation
DECK R-3 VB 140 $2,100.00 140 $2,100.00
GARAGE U-1 VB 828 $15,732.00 828 $15,732.00
RESIDENCE R-3 VB 1,757 $131,212.76 1,757 $131,212.76
Totals: 2,725 $149,044.76 2,725 $149,044.76
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,273.75
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $509.50
Permit Total Fees: $1,787.75
Mechanical Permit
Contractor: S&R HEATING Firm: S&R HEATING,INC
Address: 15501 N YALE RD Phone: (509)467-3960
MEAD,WA 99021
Item Description Units Unit Desc Fee Amount
DUCT SYSTEMS 1 NUMBER OF $10.00
GAS WATER HEATER 1 NUMBER OF $10.00
GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00
GAS PIPING 4 #OF UNITS $4.00
HEAT PUMP OR A/C 0-3 TONS 1 NUMBER OF $12.00
VENTILATING FANS 4 NUMBER OF $40.00
CLOTHES DRYER 1 NUMBER OF $10.00
RANGE 1 NUMBER OF $10.00
GAS LOG OR GAS INSERT 1 NUMBER OF $10.00
HOOD-TYPE II 1 NUMBER OF $10.00
Permit Total Fees: $128.00
Operator: CJJ Printed By: CJJ Print Date: 08/18/2005
Project Number: 05003003 Inv: 1 Application Date: 08/18/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Plumbing Permit
Contractor: PRECISE CONSTRUCTION Firm: PRECISE CONSTRUCTION
Address: 602 S SHELLEY LAKE LN Phone: (509)218-1718
VERADALE,WA 99037
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 2 NUMBER OF $12.00
SINKS 5 NUMBER OF $30.00
SHOWERS 1 NUMBER OF $6.00
TUBS 1 NUMBER OF $6.00
DISH WASHERS 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
FLOOR DRAINS 1 NUMBER OF $6.00
WATER USING DEVICES 1 NUMBER OF $6.00
Permit Total Fees: $78.00
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $1,787.75 $1,787.75 $0.00 $1,787.75
Mechanical Permit $128.00 $128.00 $0.00 $128.00
Plumbing Permit $78.00 $78.00 $0.00 $78.00
$1,993.75 $1,993.75 $0.00 $1,993.75
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: CJJ Printed By: CJJ Print Date: 08/18/2005
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4„,•••"alleY7 ,c; c , , ) PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT •
BUILDING DIVISION
11707•East Sprague Ave Ste 106
\\ O Spokane Valley, WA 99206.
• o •61La Phone:(509)688-0036 Fax:(509)688-0037
IREQUIRED SITE INFORMATION
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STREET ADDRESS: 1 ( 1
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ASSESSOR'S TAX PARCEL NUMBER(S1: .."' " rt ''.?'I) (( nr.‘ i
LEGAL DISCRIPTION: L- IOC: 7 -
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PERMIT DESCRIPTION: t'411.'.) CR L ...c .
bilumpoG PERMIT . a-CHANGE IN USE El GRADING 1]MANUFACTURED HOME
0RELOCATION - 0-SIGN 0-TENANT 0OilitIR
1.. , OWNER / APPLICANT INFORMATION ...........1-
DOWNER: 6C-0- 1 \'"A`i 14 1 f F 0 APPLICANT: cilltr‘A 1.---
PHONE: 99 f- 61-72- FAX: V 1- CI-77 G PHONE: FAX:
ADDRESS: tOY ,, LI 4 .' 1 1"*JIC‘ 6:100IfCi ADDRESS:
CITY,STATE,ZIP ..:---- CITY,STATE,ZIP
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CI CONTRACTOR: SftrfilL. ARCHITECT: trec
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PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP_ crrr,STATE,ZIP
WA ST CONTRACTOR LICENSE*CUT C1,--'\ u309 r E CONTACT: (f+FO 96L- q'e (- e 0.2.. 4:1
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PERMIT/BUILDING INFORMATION
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COST Of PROJECT: (4- 0/ 60 10 30°/0 SLOPES ON PROPERTY:- :7-' MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK:;20 1 OCCUPANCY GROUP: 2ND FLOOR SQ FT: el<
BUILDING DIMENSIONS: ,ie.;' y CONSTRUCTION TYPE:tki 6 661,) rre'le-UNFIN BASEMENT: _
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NUMBER OF STORIES: STRUCTURES ON PROPERTY: '- FINISHED BASEMENT: -0_1_____
• NUMBER of BEDROOMS: 2 CRITICAL AREAS: GARAGE: .24-er g-Z-
FLANKING SETBACK: CURRENT PROPERTY SIZE: S93 ) -0---
COVERED DECK:---
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FRONT SETBACK: i . ° CURRENT PROPERTY USE:
REAR SETBACK: 1‘ I CURRENT SEPTIC USE: ---.6)
LEFT SETBACK: . LI/
CURRENT WELL USE:
RIGHT SETBACK: `-' ' ' IMPERVIOUS SURFACE AREA:97 Co
MECHANICAL PERMIT APPLICATION Community Development Department
ill I, 11E Building Division
Phone: (509)688-0036; FAX: (509)688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections,Call (509)688-0054 Spokane Valley, WA 99206
Project Address: 110 2! 5 - Permit Use:
Owner. CDL O , v-1,.. ‘,....iv>. 1 1 Lt.: i"y`r' r . Phone(Daytime Contact):
Mailing Address: r.,„6 ^;K 45 2 4. €k °, 4. ° # ,
5 _
Contractor. City
_ License#: Phone#: State Zip Code
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 t X $1200 =
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 $60.00 =
12 GA$LOG,GAS INS ,GAS FIREPLACE\J j X $10.00 =
i
13 t RAN1 X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER 1 X $10.00 =
16 MISC.FUEL BURNING APPLIANCE _ � X ,. $10.00
17 GAS PIPING(each outlet) 7 X $1.00 =
18 DUCT SYSTEMS / X $10.00 =
19 VENTILATING FANS 471 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 COOLERSX $10.00 - , =
23 TYPE I HOOD X $50.00 , =
24 TYPE II HOOD _ // X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $1200 =
26 AIR CONDONER 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: SUBTOTAL
0 CASH 0 CHECK VISA 0 MC DATE PROCESSING FEE r $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
c',
PLUMBING PERMIT APPLICATION Commtinity Development Department
*kaliAtiti Building Division
nePhone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
doovalley
Project Address: I C f C "S ° t'
' ''L Permit Use:
Owner. 6L---0, H , '.' 14 I re" ' ( a Phone(Daytime Contact):
Mailing Address:)3P ) 5"),,, 'i-1,6, 4`1\1 \1'14, 99619
City State Zip Code
Contractor. P!a (ft: cdiv,sr. License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 2 X $6.00 =
2 URINALS X $6.00 =
3 TUBS - X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL.ON-SITE BUILT r X $6.00 =
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, "� X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT 7"
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 =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER.SUMP PUMP X $6.00 =
ICE AN/OR COFFEE.MAKER,HOSE BIB,
16 WATER USING DEVICE "" STEAMER ,1 X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
VACUUM BREAKER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS. X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
0 CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
(:„......-------.i
AUTHORIZED SIGNATURE:
1 1 2.3 2'
1
1 V21 43-
I ANC
SCALE= 1" 2O' -O'
16215 9th Lane
Lot 1 Block 4
Shelley Lake 4th
8939 Sq. Ft,
2876 Impervious
George H. White, Inc.
(509) 921-9752
Box 52
Liberty Lake, WA
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