2010, 04-01 Permit App: 10000883 Tear Off, ReroofSp)"valne
ley.
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www. spokanevallev.org
Reroof Construction
Permit Application
PERMIT NUMBER: It —
PERMIT FEE: ai
Commercial
xi Residential
3
SITE ADDRESS:
/2o9 N.
ASSESSORS PARCEL NO:
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Building Owner: -
Contractor: '
Name: in., t 5 f^ fay n 4,-. —
Name:
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Address: t 2 v g A R I cts I/ `
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Address:
City:S ^ O VC(/QState: c f Zip: . Q
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City: State: Zip:
Phone: c Zt{' — 2 7 3 tax:
Phone:I O (— 3 t O e Fax:
Contractor Lic No: h1 AD Y EMtxp�ate: . j _ 1/ _ % o
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Contact Person . --
City Business Lic. No:
Name:
Phone:
scribe the scope of work in detail: r
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Cost of projec" ""t =$ 6 6 O 0
Tear off
Overlay
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 developme rights granted by any issued permit inure to the property owner.
ci-gna ure � ?— f
Method of Payment:
❑ Cash A Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 6/232005
Contractors or Tradespeople Printer Friendly Page
L•
1'
General/Specialty Contractor
A business registered as a construction contractor with LEI 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 Madek Construction Llc UBI No. 602839512
Phone 5099532835 Status Active
Address Po Box 11764 License No. MADEKCL926MJ
Suite/Apt. License Type Construction Contractor
City Spokane Effective Date 7/11/2008
State Wa Expiration Date 7/11/2010
Zip 99211 Suspend Date
County Spokane Specialty 1 General
Business Type Limited Liability Company Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
Hill, Nina R
Partner/Member
07/11/2008
Bond Information
Page I of I
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
1
CBIC
FC768O
07/10/2008
Until Cancelled
512,000.00
07/11/2008
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
2
UNITED
SPECIALTY INS
IRHOOKBBO8050O1
07/01/2009
07/01/2010
$1,000,000.00
07/15/2009
1
UNITED
SPECIALTY INS
CO
9974460
07/01/2008
07/01/2009
$1,000,000.00
07/11/2008
Summons Complaint Information No unsatisfied complaints on file within prior 6 year period
httns://fortress.wa.eov/lni/bhin/Print_asnx 41112010