1998, 06-17 Permit App: 98005345 Blasting for Water Line PROJECT NUMBER= 98005345 APPLICATION DATE= 06/17/98 PAGE= 01
PROJECT NUMBER= 98005345 APPLICATION DATE= 06/17/98 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= S SHELLEY LAKE LN PARCEL#= 45241. 9027
ADDRESS= GREENACRES WA 99016
PERMIT USE= BLASTING FOR WATER LINE JUNE 17 - JULY 3
PLAT#= 005862 PLAT NAME= SHELLEY LAKE
BLOCK= LOT= ZONE= UR-3.5 DIST#= F
AREA= F/A= F WIDTH= DEPTH= R/W= 30
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = VERA
OWNER= HEITMAN, ROBERT PHONE= 509 466 0105
STREET= 22708 N SR HWY
ADDRESS= COLBERT WA 99005
CONTACT NAME= NORTHWEST ROCK CONTRACTOR PHONE NUMBER= 509 993 4492
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
***************************** FIRE SAFETY PMT ******************************
CONTRACTOR= NORTHWEST ROCK CONTRS INC PHONE= 509 465 2608
STREET= 21721 N PANORAMA RD
ADDRESS= COLBERT WA 99005
ITEM DESCRIPTION QUANTITY FEE AMOUNT
EXPLOSIVES Y 35 . 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
FIRE SAFETY PMT 35. 00 . 00 35 . 00
35. 00 . 00 35 . 00
PROCESSED BY: JOHN LARSON
PRINTED BY: JOHN LARSON
******************************** THANK YOU ************************************
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P RODICER ThIS CERTIFICATE
ISSUED AS A MATTER OF INFORM/MDR
THE CERTIFICATE
MOLONEY,O'NEIL.1 ,CORKERY&JONES ONLY AND UPON E
HOLDER THIS t�RTiRCATE DOES NOT AMEND, EXTEND OR
(509) 325-3024 FAX 325-1803 ALTER THE COVERAGE AFFORDED BY RIE POUCIESeaOW.
1206 N LINCOLN #200 COMPANIES AFFORDING COVERAGE
SPOKANE WA 99201 COMPANY
A LEXINGTON INS CO
D COMPANY
NORTHWEST ROCK CONTRACTORS INC a HARTFORD INSURANCE COMPANY
COIBANY
21721 N PANARAMA RD C
COLBERT WA 99005 comport
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His ISTOCERiwY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NDICATED. NOTWITHSTANDING ANY REOUIREI ENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUIENT WIDI RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POUCHES.UMIIS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COTYP(Or NMYRAMCE POI L,WEBER POLICY TIME POLICY EXPIRATION m Ri
LTR DATE asam IYY) DATE ONMIGNYI
OOERAm.LIAMOITY 5353884 6/03/98 6/03/99 GOLISMLAGGIMMTE $2,000,00C
X COMMERCIAL madam.LAsaR( PRODUCTS-COMM*AGS 81,000,00C
CLAIM woe j occult PaRsoNALaYew Kam .1,000,00C
OWNER'S a CONTRACTORS PROT EACH OCCURRENCE .1,000,O O C
FOIE DAMAGE Wry ono.nl s 50,00C
N D gIP wry ow Noon) $
•AUTOYOELETIMMY 52UECJU2195 6/03/98 6/03/99 1,000,00C
X ANY AUTO
ALL OWNED AUTOS MOONY INJURY
SCHEMED AUTOS OW pommy
X HIRED AUTOS MOONY N.RMY
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---• PROPERTY DAMAGE
OA IAD'LIMIJ Y AUTO ONLY-EA ACCIDENT $
_ANY AUTOz....^`n .....r........
OTHEt TFIAN AUTO O�NY:
EACH ACCIDBMR I
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EXCESS LITIMUTY EACH OCCURRENCE $
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OPPICERS ARE: EXGLa.Om.FASE-EA eMPLOYEE .
OTTER
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SPOKANE COUNTY IS NAMED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR.
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MOULD ANY OPTIC ABOVE Mf$CIIMED POLIDMIS EN CANC1LLO EMITS TIE
SPOKANE COUNTY aPMATION Enna TmOIEor. THi HAMA COMM( WILL INMEAVOII TO NM.
ATTN: CAROL FRA Z I ER 30 DAYS saw=Noma To us marmaya HODI Immo To TMS vary,
1026 W BROADWAY BUT FALLOW TO MAL OUCH NaIID=MMU.MOM NO"'LISPTMII ON MINUTE
SPOKANE WA 99260-0170 or ANY Ian UPON TIE OR REPTIrlENTA.TNES.
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At, Department of Labor & Industries
EXPLOSIVE LICENSE
JOHNSON,MARK A.
N 5704'E'ST
SPOKANE,WA 99205-7323
License No.U 17189 Expiration: 06115/1999
Class: CO.SE.TS.WD.
D.L t JOHNSMA415N8 St WA
Depseaaast d Later & ie ow ins
Cardrieterle Regieeseitee Seesoe
PO Boa 44440
Olympia WA 9115O444W
WASHINGTON STATE BANKS ONLY
ASSIE.IMEIHT CAP ACCOUNT
OM TIME DEPOSIT
NOTE TO A
This socwit will sat be released alta ftp TEAR, dtcr the expiration of the Certificate of
Regktratius, provided there are au outstanding sbnaisoss sad complaints flied agalast the deposit
This assignment is for the purpose of folfillisg the tequitemeat of RCW 18.27.040. The mede:_ed dues badny asriV'.
transfer sad sot over veto the truss of %SNOODS ail dens,title and lama in and eo S 640?./Y)
c ____ithom e& std no/103 doilma).of Aocaatt No.tieXpea'-�0 71) m the (bash mac) Liletzkii
1 -�__t n . vtithCaopeter and authority to demand.wand receive said deposit.
and to gi toxipt aid acquittal= therefore, for the res and pawns prescribed b7 said RCW 18.27. laggdesZondithi
Weed siert {back} tan 7`rgisi A n Y
its ooaessioa. and ameauo bold $ IaOCO, OD opdi amkase of ti ie Is led from
the gate of Washington. kis father understood dist bisassignment is s to which may be tendered amt
the (business same) sarihas, ifaet Orx o L and in accordance with the provisions at
RCW 1127. The deposit will be released to the nate of Wallington der 30 days nodes on dammed and with no War
condition d ___
Signed and dared at aidrnvz- . Wa , this j —day of ii4/...
ACCEPTANCE (re be
The mederiptvg bey saw iseeisig s"p"y of aer.sa
se tis Md were es bald Ib finds NM - seibsesed
t dives is sashay by the est el alnii i&
•; Amount lines menet:
3450 iL31o7&. is 6_4029.ce
Naa.rited*ratans 4f. r
PCM.273cse VT:14 cm‘tvokers
704 rsi. "E
+�$
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Spiess& =douched book peewit!
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DEPARTMENT OF LABOR AND INDUSTRIES
REGISTERED AS PROVIDED BY LAW.AS.
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CONST CONT GENERAL
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EFFECTIVE . DATE q
NORTHWEST ROCK CONTRS INC
21721 N PANORAMA RD
SPOKANE WA 99005-9777
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F625-052-000 (8/97)
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