2005, 04-05 Permit App: 05001072 Residence Project Number: 05001072 Inv: 1 Application Date: 04/05/2005 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 GARAGE- Contact: GEORGE H WHITE,INC.
NATURAL GAS Address: PO BOX 52
C-S-Z: LIBERTY LAKE,WA 99019-0052
Setbacks:Front 20 Left: 8 Right: 8 Rear: 30 Phone: (509)991-0429
Group Name:
Site Information: Project Name:
Plat Key: Name: SHELLEY LAKE 04TH ADD PUD District: East
Parcel Number: 45244.3010 Block: 2 Lot: 10
SiteAddress: 16505 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: 8,727 Sq Ft Width: 80 Depth: 108 Right Of Way(ft): 32
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released By: {
�;J� .
Plan Review Released By:
Sewer Review Released By: /(J `
Permits: ��
Operator: K_C Printed By: K_C Print Date: 04/05/2005
Project Number: 05001072 Inv: 1 Application Date: 04/05/2005 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 2830
Building Height 24
Stories 2
Dwelling Units 1
This Application: Total Project:
Description Grp Type Notes Su Ft Valuation Sq Ft Valuation
2ND FLOOR R-3 VB 1,264 $94,395.52 1,264 $94,395.52
CARPORT U-1 VB 144 $2,160.00 144 $2,160.00
GARAGE U-1 VB 560 $10,640.00 560 $10,640.00
RESIDENCE R-3 VB 1,566 $116,948.88 1,566 $116,948.88
Totals: 3,534 $224,144.40 3,534 $224,144.40
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,693.75
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $677.50
Permit Total Fees: $2,375.75
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
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 5 NUMBER OF $50.00
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: K_C Printed By: K_C Print Date: 04/05/2005
Project Number: 05001072 Inv: 1 Application Date: 04/05/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Plumbing Permit
Contractor: PRECISE MECHANICAL Firm: PRECISE MECHANICAL
Address: 1310 S AVALON CT Phone: (509)922-9666
SPOKANE WA 99216
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 3 NUMBER OF $18.00
SINKS 6 NUMBER OF $36.00
SHOWERS 2 NUMBER OF $12.00
TUBS 1 NUMBER OF $6.00
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 USING DEVICES 1 NUMBER OF $6.00
Permit Total Fees: $102.00
Notes: .
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $2,375.75 $2,375.75 $0.00 $2,375.75
Mechanical Permit $128.00 $128.00 $0.00 $128.00
Plumbing Permit $102.00 $102.00 $0.00 $102.00
$2,605.75 $2,605.75 $0.00 $2,605.75
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: K_C Printed By: K_C Print Date: 04/05/2005
SOOrYlian";\111 \L
1lrE CCS [ - `�1 E '` `A
-� D PERMIT APPLICATION WORK SHEET
- -SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
❑ �� 11707East Sprague Ave Ste 106
❑ Spokane Valley, WA 99206
U 0 0 Phone:(509)6880036 Fax:(509)688-0037
IREQUIRED SITE INFORMATION 1
STREET ADDRESS: I `F'S 6 AVE,
ASSESSOR'S TAX PARCEL NUMBER(S):
LOT I 0 �at..t< " r} : - -1 1 --
LEGAL DISCRIPTION: I
PERMIT DESCRIPTION: N1 -''.1.,,--' i- <_..
&BUILDING PERMIT ElCHANGE IN USE a GRADING a MANUFACTURED HOME
C}RELOCATION 0-SIGN ®-TENANT CI-OTHER
OWNER / APPLICANT INFORMATION
IR OWNER: 6 LV i 9 , I T .. .,.31V r- ® APPLICANT: �ft v I.:"—
PHONE:
PHONE: / J 1- o t/ C1 FAX: U 1— ! PHONE: FAX:
ADDRESS: u 0 Y S� -,. ADDRESS:
4 ). e, ori e „ -, TY,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR: ARCHITECT: C,JI' )
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# 6 e''')fr 6 P (
O re--
CONTACT: (:_`'P L--
PERMIT/BUILDING INFORMATION 1
COST OF.PROJECT: / /`%0, 6 0 30%SLOPES ON PROPERTY: ' ~ MAIN FLOOR SQ FT: / 4' 4
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS:‘,/7Y C CONSTRUCTION TYPE:\i\j 1)1 Ce 16- UNFIN BASEMENT: -42--
,..7
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:�
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: - �^``
FLANKING SETBACK: CURRENT PROPERTY SIZE:5702 I COVERED DECK:
FRONT SETBACK: ,.f"0 ! CURRENT PROPERTY USE: O 'f DECK:
REAR SETBACK: -2 CURRENT SEPTIC USE: -
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: S 1 IMPERVIOUS SURFACE AREA: 2 / 06, 5 g (—t i
MANUFACTURED HOME
Width: Length:
Manufacturer: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: - _
�� er: # of Heads: Fire Alarm:
Tent: Fireworks Dis is Paint Booth:
p y: --- Blasting: Date/Time:
Valuation:
Above/Underground Storage Tank Size:
. WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address: Phone: Fax:
Inspector: City State
Address: Phone: - Zip
Fax:
City- State Zip
SPECIAL INSPECTIONS
0 BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm N=rne.
Inspector(s): Phone: Fax:
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
Signature
Method of Payment: (Faxed permit applications will only be accepted with major bank
❑ Cash - ! card)
Check ❑ Mastercard
0 VISA 0 Other
Bankcard#:
Expires: 4 VIN#:
Authorized Signature: , . :; "
PLUMBING PERMIT APPLICATION
~
Sr*)rkaEl\+ City of Spokane Valley Community'Development Department
BuildingDivision
T 'Je 11707 E. Sprague Avenue, Suite 106
`,IJ' YSpokane Valley, WA 99206
4,0•016
Phone: (509)688-0036;Fax: (509)688-0037
• FOR INSPECTIONS, CALL(509)688-0054
Project Address: ,/ Permit Use:
Owner: &r ', , LA-) } /IC .X11/ (' Phone (Daytime Contact): 7/-0 9
Mailing Address: X07{ Cp I WS C k , k-J 4 1 e I
_ C State Zip Code
P
� �/C� a 1 �� tee �'Y*. �! IRS
Contractor. V R L C l a= -' License#: Phone#:
Mailing Address: City State Zip Code
#OF TOTAL
_DESCRIPTION OF WORK UNITS X COST AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X 66.00 =
2 URINALS X $6.00 =
3 TUBS / X $6.00 =
�'
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAVSIBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, / X $6.00 =
JANITOR,PHOTO,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, / X $6.00
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE A a R COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK ISA 0 MASTERCARD PROCESSING FEE $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: 4/ _ ,Pf
MECHANICAL PERMIT APPLICATION
•
Sonaia,ne\lialk, City of Spokane Valley Community Development Department
Buildin Site ion
11707 E. Sprague Avenue, Suite 106
4,V
11ey Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
7771�% 7771FOR INSPECTIONS,CALL(509)688-0054
Project Address: • / �' Permit Use: �_ r�1��
Owner: ( , /1- rte)1-11 'r, C e Phone (Daytime Contact): /
Mailing Address: ( &T/ S9 �"-Lf °''A' 9 ./ >
State Zip Code
Contractor: -,5't CC 1-9 L° T ,' License#: City
Phone#:
Mailing Address: City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK ,
UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / _X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X _ $19.00 =
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 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X
USED APPLIANCE(WSEC min.AFUE More than 400,000 X $100.00 =
6 rating)
7 BOILER/REFRIGERATION _ 1-100M BTU X , $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00
9 BOILER/REFRIGERAT1ON 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATIO. More than 1,750M BTU X $95.00 =
/
12 GAS LOG,GAS INS6T,GAS FIREPLACE°''A
X $1000
___-
13 RANGE / X $10.00 =
14 DRYERX _ $10.00 , _
15 FUEL BURNING WATER HEATER A t ,. / X $10.00 =
16 MISC.FUEL BURNING APPLIANCE c� X $1.00 =X $10.00 =
/
17 GAS PIPING(each outlet)
16 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 =
a•
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $19.00 =
22 EVAPORATIVE COOLERS / X $10.00
23 TYPE t HOODX $50.00 =
24 TYPE II HOODX $10.00 ,=
25 HEAT PUMP/AIR CONDITIONER 0-3 TON 1 X $12.00 =
26 AIR CONDITIONER3-15 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 TANKX $10.00 , =
31 WOOD OR PELLET STOVE/INSERT X $10.00 ,=
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL ,
0 CASH 0 CHECK (VISA 0 MC
DATE: PROCESSING FEE $35.00
EXPIRES:
CARD#: TOTAL PERMIT FEE DUE:AUTHORIZED SIGNATURE: /'
ADOAE$S TI '
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___ COMMENTS
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his site plan is being 4ubmitted for the purpose
obtaining a building pe it_and is a true and cora
t representation of the proposal. Aft known props
s
a lines/dimensions,curb Boss,structures and easemei
•.7I have been identified. so Indicated are wetlarn
bodies of r, steep elopes or other critical are
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