2008, 06-20 Permit App: 08002360 Re-roofAgB
Permit Center
S06Wane 1 1703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
,;,OValley& (509)688-0036 FAX: (509)688-0037
www. spokan e vall ey. org
Community Development
Reroof Construction
Permit Application
SITE ADDRESS:/ Q Y/ b C7 • � EW
ASSESSORS PARCEL NO:
Building Owner:
Name.-,-') AJ
Address:
City: State./ / Zip: /
Phone: 5 705 Fax:
Contact Person
Name:
Phone:
PERMIT NUMBER:
PERMIT FEE:
❑ Commercial
❑ Residential
Contractor: Nl ao-k)
Name:
Address:
City: State:
Phone: y YS^�/-i Fax:
Contractor Lic No:,"f UAL P,) A)
Date: r a
City Business Lic. No: ` D ((15 1
Describe the cope of work in detail: Tear off ❑ Overlay
�Pfuc
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 r salting develo ment rights granted by any issued permit inure to the property owner.
Signature 1` Date
Method of Payment:
❑ Cash Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005
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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
UNICORL922DD
Licensee Name
UNICORN ROOFING LLC
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
602809119 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type
LIMITED LIABILITY COMPANY
Address 1
4118 N ASH ST
Address 2
City
SPOKANE
County
SPOKANE
State
WA
Zip
99205
Phone
5099944594
Status
ACTIVE
Specialty 1
ROOFING
Specialty 2
UNUSED
Effective Date
3/4/2008
Expiration Date
3/4/2010
Suspend Date
Separation Date
Parent Company
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=UNICORL922DD 6/20/2008
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Business Owner Information
Effective Expiration
Name Role Date Date
GOLDBERG,
JOSEPH PARTNER/MEMBER 03/04/2008
Bond Information
Savings Information
No Matching Information
Insurance Information
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Bond
Bond
Effective
Expiration
Cancel
Impaired
Received
Insurance
Company
Account
Effective
Expiration
Cancel
Impaired
Bond
Received
Bond
Name
Number
Date
Date
Date
Date
Amount
Date
LINCOLN
#1
GEN INS
PC5199
03/03/2008
Until
$1,000,000.00
03/04/2008
#1
CO
661121739
02/29/2008
Cancelled
$6,000.00
03/04/2008
Savings Information
No Matching Information
Insurance Information
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Summons / Complaints Information
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1-800-547-8367
O Washington State Dept. of Labor and Industries. Use of this site is subject to the taws of the
state of Washington.
Access Agreement I Privacy and security statement I Intended uselexternal content policy I Visit access.wa.gov
Staff only link
littps://fortress.wa.gov/lnl/bbip/Detall.aspx?License=UNICORL922DD 6/20/2008
Company
Policy
Effective
Expiration
Cancel
Impaired
Received
Insurance
Name
Number
Date
Date
Date
Date
Amount
Date
PREFERRED
CONTRACTOR
#1
INS CO
PC5199
03/03/2008
03/03/2009
$1,000,000.00
03/04/2008
Summons / Complaints Information
No Matching Information
Start_a_New Search Prmte.r. Friendly Version
About Lftl 1 Find a job at LEH I Informaci6n en espanot I Site Feedback
1-800-547-8367
O Washington State Dept. of Labor and Industries. Use of this site is subject to the taws of the
state of Washington.
Access Agreement I Privacy and security statement I Intended uselexternal content policy I Visit access.wa.gov
Staff only link
littps://fortress.wa.gov/lnl/bbip/Detall.aspx?License=UNICORL922DD 6/20/2008