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2010, 04-19 Permit App: 10001060 Tear Off, ReroofSpokane 1 Valley Community Development Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.spokanevalley.org Reroof Construction Permit Application PERMIT NUMBER: 10 — D tP PERMIT FEE: 4C ( q. Commercial N4tesidential 0 SITE ADDRESS: 2_9 ©Zc, q,t ASSESSORS PARCEL NO: Building Owner: cIc\wtGH` Name: ��,n Y. r Name: City: t State:,, Zip:t26 QUO Nr_ Address: Z z ) A/ S --&.t W A'. < !-\ Contractor Lic No����� ir 6,` E1p Date: SO 2,p/0 1 i� State: W_f\ Zip: C City: �1- �� ,� l y / C c0. Phone: 2./2 — C Z 7 / Fax: Contact Person Name: Qom' �xi. r�4 Pho614) Describe the scope of work in detail: Contractor.• � ( rIJ G Ifs tv- \t- 9,a ., ti,___ Name: ��,n Y. r Address: /S l 9 ,�i rte' , ` City: t State:,, Zip:t26 QUO Nr_ 5.p14: 2 / g,....g,....s/Q % Z Fax: Contractor Lic No����� ir 6,` E1p Date: SO 2,p/0 City Business Lic. No: G42—_1,26 1 f7 j^! Tear off Overlay Cost of project: $ 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. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Ownership of resulting development rights granted by any issued permit inure to the property owner. Signature Method of Payment: rrtash ❑ Check ❑ Mastercard ❑ VISA Barpkcard #: Expires: VIN#: Authorized Signature: Date /9-10 REVISED 8/23/2005 Contractors or Tradespeople Printer Friendly Page Page 1 of 1 General/Specialty Contractor A business registered as a construction contractor with LEtI to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name Phone Address Suite/Apt. City State Zip County Business Type Parent Company Bennett Roofing 5092185972 1519 N Magnolia Spokane Wa 99207 Spokane Individual UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602926287 Active BENNER*911K6 Construction Contractor 5/26/2009 5/26/2011 Roofing Unused Business Owner Information Name Role Effective Date Expiration Date Greene, Jerry Michelle Owner 05/26/2009 Amount Bennett, Brian Blair Spouse 05/26/2009 L071003384 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount 1 PLATTE RIVER INS CO CLB2711097 05/26/2009 Until Cancelled $6,000.00 Receive 05/26/: Assignment of Savings Information No records found for the previous 6 year period Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date ATLANTIC CAS L071003384 05/22/2009 05/22/2010 $1,000,000.0005/26/2009 1 INS CO Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 4/19/2010