2004, 12-14 Permit App: 04009390 Residence Project Number: 04009390 Inv: 1 Application Date: 12/14/2004 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE- Contact: GEORGE H WHITE,INC.
NATURAL GAS Address: PO BOX 52
C- S -Z: RTY LAKE,WA 99019-0052
Setbacks: Front 20 Left: 8 Right: 8 Rear: 25 Phon; (509) `91-0429
Group Nam:
Site Information: Project Name:
............................................................
Plat Key: Name: SHELLEY LAKE 04TH ADD PUD District: East
Parcel Number: 45244.3008 Block: 2 Lot: 8
SiteAddress: 16423 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: 9,515 Sq Ft Width: 80 Depth: 129 Right Of Way(ft): 32
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released:By. (CP
'
k:
Plan Review Released Btat t
Approach/Drainage Released By:
L4 it.
Sewer Review Released'B .
Permits:
Operator: K_C Printed By: K_C Print Date: 12/14/2004
Project Number: 04009390 Inv: 1 Application Date: 12/14/2004 Page 2 of 3
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 1905
Building Height 18
Stories 1
Dwelling Units 1
This Application: Total Project:
Description Grp Type Notes Su Ft Valuation Sq Ft Valuation
CARPORT U-1 VB 200 $3,000.00 200 $3,000.00
GARAGE U-1 VB 800 $15,200.00 800 $15,200.00
RESIDENCE R-3 VB 1,905 $142,265.40 1,905 $142,265.40
Totals: 2,905 $160,465.40 2,905 $160,465.40
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,335.35
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $534.14
Permit Total Fees: $1,873.99
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
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 3 NUMBER OF $30.00
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: $108.00
Operator: K_C Printed By: K_C Print Date: 12/14/2004
Project Number: 04009390 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
Plumbing Permit
Contractor: UNKNOWN Firm: UNKNOWN
Address: UNKNOWN Phone: (000)000-0000
UNKNOWN,WA UNKNOWN
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 2 NUMBER OF $12.00
SINKS 4 NUMBER OF $24.00
TUBS 2 NUMBER OF $12.00
DISH WASHERS 1 NUMBER OF $6.00
GARBAGE DISPOSAL 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
FLOOR DRAINS 1 NUMBER OF $6.00
WATER PIPING-DWV 2 NUMBER OF $12.00
Permit Total Fees: $84.00
No
umma
ent ........
Pam S
rv'
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $1,873.99 $1,873.99 $0.00 $1,873.99
Mechanical Permit $108.00 $108.00 $0.00 $108.00
Plumbing Permit $84.00 $84.00 $0.00 $84.00
$2,065.99 $2,065.99 $0.00 $2,065.99
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: 12/14/2004
• • /Ls" L- - '
soryokanOlfe\II
.j Valley 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 1
STREET ADDRESS: 1 ( H 2 3 rA c_ /1-r/�
ASSESSOR'STAX PARCEL NUMBER(S): / 3 X 771
LEGAL DISCRIPTION: 61-- of ECC) C kr 2 Si IC'-e( I
PERMIT DESCRIPTION: -
,- i LDI1 G PERMIT . 0 CHANGE IN USE CIGRADINGa MAN ACACTURED HOME
0-RELOCATION 0-SIGN 0-TENANT 0O11:tlR
r ,
OWNER / APPLICANT INFORMATION _
..i
2OWNER: ' /- , r/J/4 / -I ' I C i 0 APPLICANT: �/ 6-----"PHONE: f 9 I D C/ FAX I FAX: V/� '77 Y� PHONE: FAX:
ADDRESS:tQ X "2/ tis Lk; w11-r 94 6/1 ADDRESS:
CITY,STATE,ZIP - CITY,STATE,ZIP
*CONTRACTOR: S Aryl L 0 ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
/ y
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# (O �v P C N W ! 10e CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: I C 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: /7 G L)
BUILDING HEIGHT TO PEAK: I g / OCCUPANCY GROUP: - 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: X5-4 CONSTRUCTION TYPE: kijo00 r--07147)1L UNFIN BAS HENT:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: FINISHED B MENT:
NUMBER of BEDROOMS: ( CRITICAL AREAS: GARAGE: 5560
,-- -
FLANKING SETBACK: CURRENT PROPERTY SIZE:
IC COVERED DECK:
FRONT SETBACK: 2G / CURRENT PROPERTY USE: pEa: 04 17 0
0 2 0
REAR SETBACK: ,2� - CURRENT SEPTIC USE: S.�Z✓L /
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: O IMPERVIOUS SURFACE AREA:
MECHANICAL PERMIT APPLICATION Community Development Department
Building Division
�
Ll Phone: (509)688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
�'ValFor Inspections,Call(509)688-0054 Spokane Valley, WA 99206
Project Address:
/( i/�3 7-74, n/L Permit Use:
Owner. G -_---c,, I-,/, w/-i /TL C , Phone(Daytime Contact):
Mailing Address: 0 X' 5-2 r_/z, c /r, wA e 9I0/
City State Zip Code
Contractor: C-1- HL-3---/- 7- License#: Phone#:
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 / X $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 / X $10.00 _
13 RANGE / X • $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER / X $10.00 =
16 MISC.FUEL BURNING APPLIANCE /�/ X $10.00 =
17 GAS PIPING(each outlet) I/ 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(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 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 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 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
"l For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
y ? G /4111
Project Address: /6 Permit Use:
Owner.Gam, /4, w!4 07_,---- - (/ Phone(Daytime Contact):
Mailing Address: t(�0 X S-27 L /03, LA-, (4J , 9 &9
' i•
City State Zip Code
Contractor J LCI SC- in<-r , License#: Phone#:
Mailing Address: PO/1/
O C City State Zip Code
_DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00 =
y/
3 TUBS L— X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 = ,
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, L/ X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
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 X 56.00 =
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:
AUTHORIZED SIGNATURE:
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