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2000, 09-18 Permit App: 00008333 Blasting for Driveway Project Number: 00008333 Inv: 1 Application Date: 09/18/2000 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: BLASTING FOR DRIVEWAY FOR FUTURE Contact: MARK JOHNSON/NORTHWEST HOME(9/19/00 THRU 11/19/00) Address: 21721 N PANORAMA RD C-S-Z: COLBERT WA 99005 Setbacks: Front Left: Right: Rear: Phone: (509)993-4492 Group Name: Site Information: Project Name: Plat Key: 999999 Name: RANGE District: F Parcel Number: 45245.9141 Block: Lot: SiteAddress: 300 S SHELLEY LAKE (BLC Owner: Name: BRITT JR,CHARLES W/SCHM VERADALE,WA USA 9903 Address: 4927 N PASADENA LN D-1 Location::VER SPOKANE,WA 99212 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 20.17 Acres Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Department Review ?/„/„,-,,BUILDING Critical Area Review Released By: DX �� -•14elc1=Reasons: /LA,- v,r+2�5:�"U`c _Aal iLf i BUILDING Special Reviews J --gelensed By: 1 •r%' T v� JLt �' �I �y -WtS Hold Reasons: 31 -f i✓z5� " _ J 7 Permit Conditions: 9 /y o0 Permits: 1 PZA/a� " --- __._. .„,A” Fire Safety Permit Contractor: NORTHWEST ROCK CONTRS INC Firm: NORTHWEST ROCK CONTRS INC Address: 21721 N PANORAMA RD Phone: (509)465-2608 COLBERT,WA 99005 Item Description Units Unit Desc Fee Amount EXPLOSIVES 1 Y OR BLANK $35.00 Permit Total Fees: $35.00 Project Number: 00008333 Inv: 1 Application Date: 09/18/2000 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Operator: JAS Printed By: JAS Print Date: 09/18/2000 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Fire Safety Permit $35.00 $35.00 $0.00 $35.00 $35.00 $35.00 $0.00 $35.00 Notes: s APPLICATION INFORMATION What is the JOB SITE address? ASSESSOR'S tax parcel number? \k6k(CLOkkei Legal despNpti=n it appears ay):prgier�(dgeflci OWNE or CUPANT l DC S ' Lt ' Phone � ��c r3g7� Mailing a dress City,state Zip Who should we contact regarding this project? 1 Phone Mark A. Johnson (Blasting Contractor) 465-2608 (Cell #993-4492) What work is being done under this permit? Blasting - Lone nspector district Property size Hight of way Width 2 m Dater district a m Building Building height #of stories Contractor (Blasting) Dimensions TOTAL SQUARE FOOTAGE Northwest Rock Contractors, Inc. WA State Contractor license# Matn floor area Unfinished basement area NORTHRC099DE Mailing address 21721 N. Panorama Road 2nd Moor area Finished basement area Colbert, Washington 99005 ArchitecUEngineer Garage area Size of decks,etc. What is the heat source? Whet is the cost of your project? Manufactured Home Sign Width: Length: Whet is the square footage of How high is the sign? the sign face? Year: Make: installer Contractor We State Contractor license# We State Contractor license# Mailing address Mailing address Relocation Fire Safety Previous address Fire Sprinkler_ Tent_ Paint booth_ Fire Alarm_ Fireworks display_ VALUE Contractor Contractor WA State Contractor license# WA State Contractor license# Mailing address Mailing address Fuel Storage Tanks Swimming Pool (Circle one) Above-ground Underground Size/gallons Private Contents of tank(s) Size!gallons Public/semi-private Contractor Contractor Wa State Contractor license# WA State Contractor license# Mailing address Mailing address COMPLETE ALL APPLICABLE INFORMATION Spokane County does not discriminate on the basis of disability in the admission to,or treatment or employment in,its programs or activities. ACORD,� I RTIFI AT > F I BI ITY INS RA.:.: N DATE 9/18/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MOLONEY 0'NEILL CORKERY&JONES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (509) 325-3024 FAX 325-1803 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1206 N LINCOLN #200 COMPANIES AFFORDING COVERAGE SPOKANE WA 99201 1 COMPANY A EMPIRE INDEMNITY INS CO INSURED i COMPANY NORTHWEST ROCK CONTRACTORS INC B HARTFORD INSURANCE COMPANY COMPANY 21721 N PANARAMA RD C COLBERT WA 99005 I COMPANY I I D COVERAGES.. >..::::...... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITSLTR DATE(MM/DD/YY) DATE(MM/DD/YY) A ! GENERAL LIABILITY C L 3 0 1 9 1 9 6/03/00 6/03/01 GENERAL AGGREGATE $2, 0 0 0, 0 0 0 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 0 0 0, 0 0 0 CLAIMS MADE I X I OCCUR PERSONAL&ADV INJURY $1, 0 0 0, 0 0 0 lOWNER'S&CONTRACTOR'S PROT I EACH OCCURRENCE $1, 0 0 0, 0 0 0 FIRE DAMAGE(Any one fire) $ 50, 000 MED EXP(Any one person) $ 5, 000 B AUTOMOBILEUABIUTY 52UECJU2195 6/03/00 6/03/01 --, I COMBINED SINGLE LIMIT _1, 000, 000 X I ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ ©HIRED AUTOS BODILY INJURY $ IXNON-OWNEDNON-OWNED AUTOS 1 (Per accident) ---�'i ------- -- 11 PROPERTY DAMAGE $ GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ 1 ANY AUTO I OTHER THAN AUTO ONLY: ', EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY SII I EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ �''I OTHER THAN UMBRELLA FORM $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE --d, OFFICERS ARE: I II EXCL EL DISEASE-EA EMPLOYEE $ OTHER i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS SPOKANE COUNTY IS NAMED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE SPOKANE COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1026 W BROADWAY BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY SPOKANE WA 99260-0170 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. •UTHORIZED R -: - • - -- Mic -e1.-R. '.chnurr CH A . .. ... .... . Parcel: 45245.9141 Owner: BRITT JR,CHARLES W/SCHMITT,MARGARET A CoOwner: Owner Address - T 4927 N PASADENA LN D-1 SPOKANE WA 99212 .... . 1Pir .„.,‘; .4,...':!..--- - _ .1_ Site Address .-,.. i 1.. .___. --- ___.--,,L,- 0 ADDRESS UNKNOWN VERADALE j ~ Legal Description ed 24-25-44THATPTN OF THESW1/4 OF THENE1/4&THENW1/4 OFTHES111.1111111 .1 s-! �u" ,•I�;, IN SEC 24,TWN 25 N,RGE 44 E,W.M.,COUNTY OF SPOKANE, i_f .,,.,,� +� �L STATE OF WASHINGTON,DAF BEG AT THE NE COR OF THE SD SW 1/4 41 ` Iiiiiii . —` 7 OF THE NE1/4;TH N 89DEG 17MIN 15SDS W,A DIST OF 234.82FT; ® tribra e'+y�' y ' THS 39DEG 27MIN 30SDS W,433.65FT;THS 43DEG 09MIN 41SDS r%; i J! ,K;' ,.'''.','; :':1Ii... Iw W,195.69FT;THS 51 DEG 47MIN 38SDS W,121.44FT;THS 19DEG Atli% y � 1 ,.,,, ail ..}.- 04MIN 05SDS W,123.25FT;THS 06DEG 39MIN 21SDS W,143.11FT; ."'•" 121E Virdra#411,/4,•?, .' , TH S 15DEG 40MIN 34SDS E,148.00FT;TH S 29DEG 18MIN 16SDS nglat �' E,163.40FT;TH S 40DEG 36MIN 47SDS E,102.38FT;TH S 37DEG 4 � 39MIN 33SDS E,65 45FT;TH S 38DEG 37MIN 21SDS E,116.18FT; 7/.4444 ~ r �) Al Pl L rTH S 12DEG 53MIN 43SDS E,92.54FT;TH S 30DEG 27MIN 38SDS E, 50.65FT,TH S 75DEG 50MIN 56SDS E,65.75FT;TH S 87DEG 24MIN {i} � — v 55SDS E,86.41FT;TH S 75DEG 52MIN 51 SDS E,76.90FT;TH Sv g'11' ir ;: ' 47DEG 34MIN 24SDS E,40.41 FT;THS 87DEG 46MIN 55SDS E, ' ,' -j�* '"---< _______*1,-.,--,4t-� 105.09FT;THS 56DEG 05MIN 17SDS E,41.39FT;THS 77DEG , 1 evils ""•" 16MIN 41SDS E,50.74FT TO A PT ON THE ELY LN OF THE NW1/4 OF THE SE1/4 LYG 216.63FT S OF THE NE COR OF SD NW1/4 OF THE v `1 ' SE1/4;TH NLY ALG SD ELY LN AND THE ELY LN OF THE SW1/4 OF "' � I co THE NE1/4 TO THE POB. iiIIIIIf.�� Notice: This is not a legal document. Data depicted on this map is general&subject to constant revision. It is intended for reference use only. Legal documents should be obtained from the appropriate agency. E Department of Labor&Industries EXPLOSIVE LICENSE � NORTHWEST ROCK CONTRACTORS INC, 21721 N PANARAMA RD COLBERT,WA 99005-9777 License No. P 20033 Expiration: 06/15/2001 Class: D.L.#: JOHNSMA415N6 St: WA 'Ft Department of Labor&Industries <, tv EXPLOSIVE LICENSE JOHNSON,MARK A. 21721 N PANARAMA RD COLBERT,WA 99005-9777 License No.U 17189 Expiration: 06/15/2001 Class: CO.SE.TS.WD. D.L.#: JOHNSMA415N6 St: WA A