2010, 10-20 Permit App: 10003460 Plumbing Fixtures Permit Center
Stio7ta„e 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: — 3�L p
P 11Q.11 Spokane Valley,WA 99206 l
�0Valley. (509)688-0036 FAX:(509)688-0037 PERMIT FEE: `( �"1- °V
• permitcenter@a,spokanevalley.org
Community Development
Plumbing Permit Application n Commercial )1 Residential
SITE ADDRESS: b 16 r s v,S`A p
Building Owner
Name: SPhone: Fax:lee. ��r>;v� SSS '3�,9 9�
Address: 61 b City: 5 PC. vc)L1 State: Zip:
Contract�orr` I
Name: Gy�/c; �� TNc. Phone:G'oci- 7r-6002. Fax: Soy_ 8i/
ZO"' G1C
Address: i 6-70, C Vg I/4„), City:.spa fly/rev State: w 01 Zip:e. 9.6;--7
License No: Fro L so C )`1i Li Do City Business Lic:
Contact/Project Manager:
Name: Phone:
#OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS(per trap)
Lav/Basins,Bar,Floor,Kitchen,Laundry,Utility,Janitor,Photo,X-ray,Food,
SINKS Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN Area,Case,Coil,Trench,Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN,DRINKING
WATER PIPING/DRAIN-IN WASTE Installation,Alterations,Repair,Reversals
WATER USING DEVICE Ice and/or Coffee maker,hose bib,steamer proofer,carbonator,swamp cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER If Gas,See Mechanical
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS Including traps,vents except kitchen type grease interceptors functioning as fixture traps
REPAIR OR ALTERATION Water piping,drainage or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE Other than atmospheric type vacuum breakers
MEDICAL GAS
INCEPTORS
OCASH 0 CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
SIGNATURE: /✓ 1
CURRENT FEES AVAILABLE AT:http://www.spokanevalley.orq/under the quick links for Forms,Master Fee Schedule.
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/PlumbingPermitApplication040309.doc
Contractors or Tradespeople Printer Friendly Page Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with Lal 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 FOLSOM EXCAVATING INC UBI No. 602058579
Phone 5098911232 Status Active
Address 16701 E Valleyway License No. FOLSOE199400
Suite/Apt. License Type Construction Contractor
City Veradale Effective Date 3/20/2001
State WA Expiration Date 4/20/2012
Zip 99037 Suspend Date
County Spokane Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Effective Expiration
Status
License Name Type Specialty 1 2 Date Date
FOLSOE*033DU FOLSOM
Construction Excavation/Grading Unused 3/31/1997 3/31/2001 Archived
EXCAVATING Contractor
Business Owner Information
Name Role Effective Date Expiration Date
FOLSOM,WENDY S Member 03/20/2001
FOLSOM, KEVIN M President 03/20/2001
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
3 TRAVELERS CAS& 206848519 03/31/2008 Until Cancelled $12,000.0004/15/2008
SURETY CO
2 TRAVELERS CAS ft 206848519 03/19/2002 03/31/2008 $6,000.0003/19/2002
SURETY CO
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
7 Continental CNP251629426 03/31/2010 03/31/2011 $1,000,000.00 02/26/2010
Western Ins Co
6 Continental cnp2516294 03/31/2009 03/31/2010 $1,000,000.00 03/09/2009
Western Ins Co
CONTINENTAL
CNP2516294
-
5 WESTERN 24 03/31/2007 03/31/2009 $1,000,000.00 03/05/2008
GROUP
CONTINENTAL
4 WESTERN CNP2516294 03/31/2006 03/31/2007 $1,000,000.0003/14/2006
INSURANCE
CONTINENTAL
3 WESTERN INS CNP2516294 03/31/2005 03/31/2006 $1,000,000.0003/22/2005
CO
2 AMERICAN 01CG14662110 03/31/2002 03/31/2005 $0.0003/19/2002
STATES INS CO
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
httns://fortress.wa.gov/lni/bbin/Print.asnx 10/20/2010