2006, 10-18 Permit App: 06004171 ReroofS 36kane
Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.or2.com
Reroof Construction
Permit Application
SITE ADDRESS �97v
PER1�T!r4sI•JM .
RMITE
❑ Commercial
El -Residential
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
uding o'ne
Name: LI ftiO1.6\\ S t D'\moi I l
Address: t �Z7
City: c) —)4,0i >� )S� Zip:
I Phone: /, 2g 7/
Contaiet,Pe%son,.
Name: S z , /Lik`k\L'e)
Phone: g/6/ -7/(-2,2(c'
Describe the scope of work in detail:
,00 acor: _(
Name:
Address:.0%far 'S Ri
City:
Phone: ,2%Z- YY�/ Fax:
Lic No: Exp. Date:
City Business Lic No:
L --Tear off 0 Overlay
)eKif\.*
) NLV
Cost of project
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 resulting development rights granted by any issued permit inure to the property owner.
�}
�� .�/��i Date �`U(C1
Signature
Method of Payment: (Faxed per it applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard in --VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8123/2005
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`General/Specialty Contractor
A business registered as a construction contractor with LW to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
Id account and carry general liability insurance.
License Information
License
ABSOLPROO6D8
Licensee Name
ABSOLUTE PAINTING Et ROOFING
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
602024526 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type
INDIVIDUAL
Address 1
14813 E RICH
Address 2
City
SPOKANE
County
SPOKANE
State
WA
Zip
99216
Phone
5092164621
Status
ACTIVE
Specialty 1
PAINTING/WALLCOVERING
Specialty 2
ROOFING
Effective Date
3/28/2000
Expiration Date
3/27/2007
Suspend Date
Separation Date
Parent Company
Previous License
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License
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=ABSOLPR006D8 10/18/2006
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Business Owner Information
Name
Role 1 Effective Date 1 Expiration Date
BERGLAND, MIKE OWNER 01/01/1980
Bond
Information
,Bond
Bond
Company
Name
Bond
Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
£'#4
OLD
REPUBLIC
INS CO
YLI247407
05/17/2004
Until
Cancelled
$500,000.00
09/29/2006
$6,000.00
05/26/2004
#3
GULF INS
CO
B34220698
03/27/2002
Until
Cancelled
04/15/2004
07/05/2006
$6,000.00
03/27/2002
#2
GRANITE
STATE
INS CO
243486
03/27/2001
Until
Cancelled
04/09/2002
05/04/2006
$4,000.00
03/28/2001
#1
GRANITE
STATE
INS CO
243486
03/27/2000
Until
Cancelled
$300,000.00
05/04/2006
$6,000.00
AMERICAN
STATES
INS CO
Savings Information
No Matching Information
Insurance Information
Insurance
Company
Name
Policy
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Amount
Received
Date
FIRST
MERCURY
INS CO
FMIL001740
06/30/2006
06/30/2007
$500,000.00
09/29/2006
#8
FIRST
MERCURY
INS CO
2181376
06/30/2006
06/30/2007
$500,000.00
07/05/2006
#7
AMERICAN
STATES
INS CO
01CG0107006
03/27/2006
03/27/2007
$300,000.00
05/04/2006
#6
AMERICAN
STATES
INS CO
01CG0107005
03/27/2005
03/27/2006
$300,000.00
05/04/2006
#5
AMERICAN
STATES
INS CO
01CG0107004
03/27/2004
03/27/2005
$600,000.00
05/26/2004
#4
AMERICAN
STATES
INS CO
01CG0107003
03/27/2003
03/27/2004
$300,000.00
03/24/2003
#3
AMERICAN
STATES
INS CO
01CG0107002
03/27/2002
03/27/2003
$300,000.00
03/27/2002
#2
AMERICAN
STATES
INS CO
TBA
03/27/2001
03/27/2002
03/28/2001
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10/18/2006
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INS CO
TBA
f Summons / Complaints Information
03/27/2000
03/27/2001
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