2003, 05-29 Permit App: BD03-528 Residence City of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT
T APPLICATION
Box 1 OWNER4-/119521/ Cp/?$7 MG. JOB LOCATION 99,4C /Y
OWNER'S ADDRESS pD /POy. CITYS ntiONE_109 3 9 8,6
"30792
DESCRIBE JOB (�'j f7 S772JGT S f#6(..8" F fm 1 L'-f / -S]V Y)f
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. l/
BOX 2 CONTRACTOR'S NAME /4%1OSE`1 exit)ST. I Nom. PHONED? 9 3 4 ZO
CONTRACTOR'S ADDRESS po !3 Q 1( 3o-? 9 CITY 5,4l_9- ?E
CONTRACTOR'S REG.# L 1 tJ OSC. 1 044pOliiEXPIRATION DATE A216 C '3
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT ( Co/QEST-1W PHONE g ?9 3 y Zo
ADDRESS P0$O% 30782. CITY Sp0)c.ene ZIP 99
BOX 4 SEWER AVAILABILITYCfrt oP 5 OKhnt WATER AVAILABILITY C4-r'-f op SiooiG,4ne-
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION$
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTIO Ig (I W f
tl l�
MAY 292 3
(IF NECESSARY, PLE SUBMIT A SEPARAT: • ..E WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER
UOUP1E l
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOORa%h'/ 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED / DECK / GARAGE 7 f� /
CARPORT / TOTAL /°(,y / HEIGHT TO PEAK OF BUILDING /2- FT.
BOX 8 (✓) SINGLE FAMILY ) ( try
NX SCONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ( ) NG STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE----' '? SQ. FT.
BOX 9 PLUMBING FIXTURESIncludin rough-ins)
( 9 MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS, in
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL. \.
BOX 10 Water Service meter size(if known) / Also see BOX 4
BOX 11 Septic Tank—Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
BOX 12 Street use may require a" Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFORM T E WORK FOR WHICH APPLICATION IS MADE.
OWNER/AGENT 'uC.
PYP J DATE /03 (OVER)
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard Expiration Date
Print the name of the Holder Signature
OFFICE USE ONLY- PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS; FRONT SIDE . REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT'kPPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPIARTMENT APPROVAL DISAPPROVAL DATE
L
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @
BUILDING SQ. FT.
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES 'I AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Sml( 11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
410 V11 Spokane Valley, WA 99206 509-688-0037-Fax
alley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: e(gos"G /
USE:
OWNER:1,-in 71 n PHONE
V>� �Q//s� �/�� (Daytime Contact):
MAILING ADDRESS: die 29 Y�
PI 13n x 3e?q Z S PO tan, t/ig qa z 3
(street) (city/state)
(ZIP)
CONTRACTOR: LICENSE>t:
MAILING ADDRESS: PHONE#:
(street) (city/state)
(ZIP)
DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE •OR<100,000
2 FUEL BURNING APPLIANCEX 519 •
>1�'000 X119
3 UNLISTED APPLIANCE(ADDITIONAL FEE) •OR<400,000 -
X $50 •
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000
5 USED APPLIANCE X 5100 •
(WSEC min.AFUE rating) •or<400,000 X $50 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400000 •
X $100 •
7 BOILER/REFRIGERATION _
1-100M BTU X 515
•
8 BOILER/REFRIGERATION 101•500M BTU
9 BOILER/REFR1GERATION X S •
501•I,000M BTU X S3939
10 BOILER/REFRIGERATION 1001-1,750M BTU •
11 BOILER/REFRIGERATION X 557 •
�1750M BTU X 595
•
12 GAS LOG,GAS INSERT,CAS FIREPLACE
13 RANGE X $10
— X $10 •
14 DRYER — X 510
•
15 FUEL BURNING WATER HEATER
X 10
16 MISC.FUEL BURNING APPL. •
X S10 • -
$ •
17 GAS PIPING(ea.Outlet) A
X Sl
18 DUCT SYSTEMS —— -
X 110 - —
19 VENTILATING FANS X $10
20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM ?IF
X 512 •
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM FFFF X 519
22 EVAPORATIVE COOLERS — X $10
23 TYPE I HOOD •
— X $50 •
24 TYPE I1 HOOD -• ( X $10
•
25 HEAT PUMP/AIR CONDITIONER 0.3 TON X 512
26 AIR CONDITIONER 3-15 TON _ X _ S20 ••
27 AIR CONDITIONER 15-30 TON X 525
28 AIR CONDMONER 30.50 TON X $35 •
•
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 •
SUBTOTAL:
METHOD OF PAYMENT
PLUS PROCESSING FEE: $35.00
VISA' t i; #--„...,. TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK 1::] 0 L....._ ,'Z;
DATE: EXPIRES:
BAN KCARD NUMBER:
:A.UTHOR.7ZF:D SIGNATURE:
• a7Vlr 11707 East Sprague Avenue, Suite 106 509-688-0036- Phone
Spokane Spokane Valley, WA 99206 509-688-0037- Fax '
.Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT rg,s-- � PERMIT
ADDRESS: (./ / V USE:
OWNER:,l,oS /_n 5 r I� PHONE(Daytime Contact): � �3�
MAILING ADDRESS"( `-�/,
PO 19o- 3&)q a Sonne_. ul4- el9z z 3
(street) (city/state) (ZIP)
CONT$�CTt f is ,/1 r,D �S LICENSE#:
MAILING11.•��,AD1�4 el3I PHONE 0:ci`07'Li
Veracca6 l,'a g4o -7
(street) (city/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
I TOILETS WATER CLOSET,BIDETS 2 X so -
2 URINALS X $6 -
3 TUBS 2 X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 -
5 SINKS LA VS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 3 X $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER / X $6 -
7 CLOTHES WASHER / X $6 -
8 GARBAGE DISPOSAL 1 X $6 -
9 WATER SOFTENER X $6
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X so -
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 -
12 FOUNTAINS,DRINKING X so -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS x $6 -
REVERSAL s
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, 3 X $6 -
SWAMP COOLER //
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 $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL: 7
METHOD OF PAYMENT ``fib
YIS( 'Cgs- PLUS PROCESSING FEE: $35.00
❑ C.'.SH E CHECK ❑ 0 '.__..._=_'` _
TOTAL PERMIT FEE DUE:
D.,.TE. EXPIRES:
BANKC?.RD NUMBER.
,'.UT IORJZED SIGNATURE
City of SPOKANE VALLEY .
Building, Fire and Public Works Fees Receipt
App[icant/Business ', l - . ,�.
Project Name - •'• L,._ iv Permit No. 5 2�
Site Address - .. Date -,z9
Please Receipt the Following:
Check Number . , ( 3
Payer's Name i Receipt Number c�
Address P e , . � �j 14 . . t
i4ra. City --c) Zip 9 Z23
BUILDING DEPARTMENT
001.059.322.10.01 Building Permit $
•
•001.059.322.10.02 Plumbing Permit $
001.059.322.10.03 Grading Permit $
. 001.05p.322,1Q.04 Mechanical Permit $
e01=039.322.10:06 bemolition Permit $
001.059.322.90.01 Misc. Permits and Fees $
.
001.059.345.83.01 Plans Check Fee
001.059.345.83.03 Energy plans checkfee . $ 3 t� 3' SS i �� 35
001.059.342.40:02' SPECIAL Inspections $ O
001.059.237.10.98 Bonds / Deposits $
$
001.059.237.10.02 WSBCC Surcharge *
. FIRE DEPARTMENT #
001.059.322.10,07 Plans check. fee �*
001.059.322.10.08 Sprinkler plans check $
$
001.059.322.10.09 F. A. Plans check •
$
001.059.322.10.10 Misc. plans check
$
001.059,322.10.11 Fire Alarm inspections
$
001.0.59.322.10.12 Sprinkler inspections
$
001.059.322.10.13 Misc. Inspections
$
001.059.321.30.00 Fireworks Permit
$
001.059.342.40.01 UFC permit fees
$
001.059.237.10.99 Bonds / Deposit **
OTHER: $
PUBLIC WORKS •
001.059.322.40.00 Right of Way $
. 001.059.342.40.03 Special Inspections $
001.059.237.1 0.99 Bonds/Deposits (cash)** $
' TOTAL AMOUNT DUE $ 5-4s ,__5------
-4 — �r—�
s w. J
To be s
* sent to Wash. State Building Code Council quarterly.
# 65% of figure to be sent to the Fire Department Quarterly, except bonds etc.
** Liability Insurance verification may also be required.
s-vrecpt .
Call 24 hours before inspection required
Sfitiane
Phone 509.688-0036 Fax 509.688-0037
dos Valley
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # PW 03-,2,7`j
APPROACH PERMIT
APPLICATION
Location of property_ 4cj h,�" (4 4.-1,...._
(Address/Parcel #, if available)
Applicant Name Lir c,es 0 v..s -fin
Address _ ('i 9 Z Phone 5??9 3 4 za
Contractor's Name
Address Phone
Contractor's Reg# Expires
PROJECT DESCRIPTION (Provide site sketch)
XResidential Driveway I 1 Commercial/Industrial Driveway
Existing Curb & Gutter I I Rural Road Section
Culvert Installation Sidewalk Repair/Construction
Other conditions
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the City.
SPECIAL CONDITIONS:
PERMIT FEE $ Ins•ection Fee$
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Si.nature
Fees Paid$ 02,sex7 Date I
D !nit II*. .11-
LICENSE DETAIL INFORMATION Form Page 1 of 2
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia,WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration#or License LINDSCI0660W
Name LINDSEY CONSTRUCTION INC
Address P 0 BOX 30792
Address
City SPOKANE
State WA
Zip 99223
Phone Number 5098793420
Effective Date 9/16/1994
Expiration Date 8/22/2003
Registration Status ACTIVE
Type CONSTRUCTION CONTRACTOR
Entity CORPORATION
Specialty Code GENERAL
Other Specialties
UBI Number 601562128
* * *VIEW CROSS REFERENCE FILE FOR THIS LICENSE* *
* * *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* * *
* * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION * * *
'CHECK*CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* * *
* * *VIEW CONTRACTOR INSURANCE INFORMATION * * *
New inquiry by CITY, NAME , PRINCIPAL OWNER NAME , LICENSE , UBI
NUMBER,check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction
Compliance Home Page
https://wws2.wa.gov/lni/bbip/TF2Form.asp?license=LINDSCI066OW 5/29/03
Application#: Gg. 24,3 aG"
• CERTIFICATE OF EXEMPTION
C of E August , 2002 "G"
Spokane County Division of Planning
1026 W.Broadway.Ave.
Spokane,WA. 99260
Existing ''parent"tax parcel number(s) .35233 1401
Site address or frontage road name 14th..,AVp
Public road ®Private road D Private driveway 0 Auditors-recording-#: .-...
Legal description - Section 23 Township 25 Rarige
Block '14, Woodland
..._. ... .
Terrace Addition. Volume "I" of PlPlats, P.16
Lot 9 plus W 4.1 feet of Lot 10
•
continued on back
Total existing acreage g New property size q0307p
Current zoning 112.3,s�' Comprehensive Plan category Ldi.,
(work) 370-5893
Name of applicant Mike Shuler Phone Number (home)
Mailingaddress
P. 0. Box 1207
City Davenport State WA Zip 99122
I certify that I as owner or authorized agent have examined this document and state that the information-contained in
it and submitted by me or my agent to compile said document is true and correct,and authorize Spokane County to
proceed with processing. In addition, I have read and understand the provisions contained herein and agree to
comply with them. I understand that the issuance of this exemption is not intended.to.verify.that..adequate
provisions have been made for drainage ways,potable water supplies, roads and sanitary wastes. Any subsequent
approval based on this exemption shall not be construed to give authority to violate or cancel the provisions of any
state or local law.
Applicant Date
Staff Use Only
This Certificate of Exemption issued pursuant to section a .,jt{]_ /Ce, of the Subdivision ..
Ordinance for Spokane County and RCW 58.17. The Certificate of Exemption is intended to
indicate if the property as described is exempt from the State andLocal Subdivisionlaws-which
regulate the sale, lease or transfer of ownership of property and is subject,to the following
conditions and/or findings:
1. NOTICE TO PURCHASER-This piece of property may not have appropriate provisions for potable water
supplies(drinking;water),sanitary wastes(septic tank or sewer), drainage ways,streets or read,alleys or.
other public ways. Spokane County is not responsible for making provisions for the above-stated items. If
this property is served by a private road,Spokane County is not responsible for improving or maintaining
said private road.
2. For property created via this exemption,the applicant shall file a Segregation-Application with the County
Assessor prior to the issuance of a building permit.
3. This Certificate of:Exemption is for and shall run with the land,and shall be applicable to the applicant,
owner,heirs,successors or assigns.
4. The use of this property must conform to the Zoning Code
5. The following conditions shall also apply continued on back
The re ired information has been submitted to the County Engineer.
By Date
Division of Engineering
APPROVED 0 DENIED �
By /' Date d2-
ision of Planni
RELATED FILES: •
Receipt#: 642a)1440
Proposed Plot Plan
4905 East 14th Ave.
Spokane Valley, Wash.
Parcel "G" of Spokane County Certificate of Exemption# CE-283-02
Block 14, Woodland Terrace Add. Vol. "I" of plats, p. 16, L. 9 plus W. 4.1 ft of L 10
SCALE 1:20 I SEWER AND WATER PROVIDED BY CITY OF SPOKANE
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APPROVEC �. - __