2006, 08-08 Permit App: 06003096 Plumbing Fixtures fn's /�/1.
Permit Center 14 f4 /' l
11707 E Sprague Ave,Suite 106
SpokanePERMIT NUMBER: 3007
��Valley Spokane Valley,WA 99206
(509)688-0036 F 8-0037
Community Development www.spokanevalley.ora PERMIT FEE: (O 3 —
Plumbing Permit Application n Commercial n Residential
SITE ADDRESS: _ 169.0/ 4.7,/ '—
Building Owner / O bLir 1&Eh be,
Name: /5 l o/ 0, 5 r Phone: Fax:
Address: rGtD City:
State: Zip:ip
:
Contractor ! 1PAct/4149,a C-
Name: afism� „44, S Phone: 5 .o5.0 -?,-,17Fax: Q -4-2_ /g z.j
Address: ft). „" a_ ' toaw City: y' 041/411 State: , Zip:
i
License No: / O 90 -- City Business Lic:
Contact 7t
TG(57�1'
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS G X $6.00 =
2 URINALS X $6.00
3 TUBS 6 X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
AREA,CASE,COIL,TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH ❑CHECK ❑VISA ❑MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
- • iil 36/0/
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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
of account and carry general liability insurance.
License Information
License ALPHAPH958M1
Licensee Name ALPHA PLUMBING Ft HEATING LLC
Licensee Type CONSTRUCTION CONTRACTOR
602516491 Verify Workers Comp Premium..
UBI Status
Ind. Ins. Account 594301
Business Type LIMITED LIABILITY COMPANY
Address 1 3424 N LOCKWOOD RD
Address 2
City SPOKANE VALLEY
County SPOKANE
State WA
Zip 99206
Phone 5095350727
Status ACTIVE
Specialty 1 PLUMBING
Specialty 2 UNUSED
Effective Date 3/13/2006
Expiration Date 3/13/2008
Suspend Date
Separation Date
Parent Company
Previous License ALPHAPH962KM
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=ALPHAPH958M1 8/8/2006
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Business Owner Information
Effective Expiration
Name Role Date Date
THOMAS, SANDRA
JEAN PARTNER/MEMBER 07/21/2005
FORNESS, LORI
MARGARET PARTNER/MEMBER 07/21/2005
THOMAS,
MICHAEL JAMES PARTNER/MEMBER 07/21/2005
FORNESS,
MATHEW JAMES PARTNER/MEMBER 07/21/2005
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
TRAVELERS
CAS & Until
#1 SURETY CO 104606938 03/07/2006 Cancelled $6,000.00 03/13/2006
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
CONTINENTAL
#2 WESTERN CNP244269923 05/23/2006 05/23/2007 $1,000,000.00 05/17/2006
CONTINENTAL
#1 WESTERN CNP002024030 05/23/2005 05/23/2006 $1,000,000.00 02/08/2006 '.
Summons/Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=ALPHAPH958M1 8/8/2006