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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