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2006, 10-12 Permit App: 06004088 Tear Off, ReroofSfokane 11 Valley Community Development Permit Center 11707 E Sprague Ave, Suite 106 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.spokanevallev.om.com Reroof Construction Permit Application SITE ADDRESS 4d18 6, (o --k aQe ASSESSORS PARCEL NO: 1,11 :moo -,>.v.■. .r4) ❑ Commercial residential 69 , rvlaha,1 LEGAL DESCRIPTION: -Bu dia- o. ne - - - _ ___ - _ Name: i CVo, c C1Q', Address: Li q 18 E. 6 -0Cl, k 0 V, City: L) . \).a\\{ j Zip: ` I Phone: /4,(12- - q oa \ Fax: ontact 1 ersoi Name: 1 '(1 Q p ( ` C� Phone: (6-C9) 43 `I - 1, 7 Cont �.acto _ _ Name: IOC et\f‘W C5, C lTtc nl EtO Address: Alq I ( C L d,u.0.. al ka. au,_ City: p n Qf p Zip: 9902 ON Phone: La ti- 67 (, Fax: Lic No: 13CR1 Ho f* p. Date: 63 - 6)3 - D7 City Business Lic No: 32 LIZ() / 5I 1 D 4 1 Describe the scope of work in detail: ` Tear off ? Overlay t Icer 0© • t '�\ s‘c��� \��C psi 004,(poo) 6n \c 1 p \\-).so oo d, -f (AC_ J off. c d -Q oi Y- t e c. .0`. f' r oOYYl 1&k ;.\ C9Jatad1 (1�3eL 1/ Lo evc r Cost of project e--)(1/€-"'a)p4 a-fA� � y �� r c01 r c -' $yny 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. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Ownership of resultingelopment rights granted by any issued permit inure to the property owner. Signature„ �' Date Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash Bankcard #: Authorized Signature: REVISED 8/23/2005 ❑ Check El Mastercard ❑ VISA ❑ Other Expires: VIN#: Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 ndustrles Topic Index f Contact Info Search Home Safety Claims & Insurance Workplace Rights Trades & Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer Friendly Version General/Specialty Contractor A business registered as a construction contractor with L&I 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. License Information License NORTHC*950DH Licensee Name NORTHWEST CONTRACTOR Licensee Type CONSTRUCTION CONTRACTOR UBI 602480752 VeruWorkers Comp Premium Status Ind. Ins. Account Id Business Type INDIVIDUAL Address 1 2911 E COLUMBIA AVE Address 2 City SPOKANE County SPOKANE State WA Zip 99208 Phone 5094846726 Status ACTIVE Specialty 1 ROOFING Specialty 2 CARPENTRY/FRAMING Effective Date 3/8/2005 Expiration Date 3/8/2007 Suspend Date Separation Date Parent Company Previous License Next License Associated License https://fortress.wa.gov/lni/bbip/Detail.aspx?License=NORTHC*950DH 10/12/2006 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2 Business Owner Information Name Role Effective Date Expiration Date FIRSOV, MICHAEL OWNER 03/08/2005 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date #2 PLATTE RIVER INS CO 41063775 03/03/2006 Until Cancelled $6,000.00 03/06/2006 #1 ACCREDITED SURETY It CAS CO 10025990 03/07/2005 Until Cancelled 03/07/2006 $6,000.00 03/08/2005 Savings Information No Matching Information Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date #3 CENTURY INS CO CCP408530 03/03/2006 03/03/2007 $300,000.00 03/07/2006 #2 CENTURY SURETY CO CCP396645 03/03/2006 03/03/2007 $300,000.00 03/06/2006 #1 SCOTTSDALE INS CO 248785389 03/07/2005 03/07/2006 $300,000.00 03/08/2005 Summons / Complaints Information No Matching Information Start a New Search Printer Friendly Version About L&I I Find a job at LEtI1 Informacion en espanol I Site Feedback 1 1-800-547-8367 Washington State Dept. of Labor and Industries. Use of this site is subject to the laws of the state of Washington. Access Agreement 1 Privacy and security statement 1 Intended use/external content policy 1 Staff only link Visit access.wa.aov https://fortress.wa.gov/lni/bbip/Detail.aspx?License=NORTHC*950DH 10/12/2006