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2005, 07-13 Permit App: 05002473 Roof Cover BUILDING PERMIT APPLICATION WORKSHEET crl�Sokane ������ fy{ ao Valley CommunityDevelopment Department u1� Building Division 11707 E. Sprague Avenue, Suite 106 400 Valley Spokane Valley, WA 99206 ai1eyJ one: (509) 688-0036; Fax: (509) 688-0037 REQUIRED SITE INFORMATION Lti 33(O_ (rc)S Street Address: / Z/ g " 23 "9 5i?0k. v i4)1t 0 6 37 Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: 0,u ,Ijj Z'm 516N asucIL, ❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION ❑ Owner• `pid 1Z,,cQ. 3 ❑ Applicant: /9 .43x 6 u. f v i Phone: 2/o loci G Fax: -. Phone: �7 - 6.ryt, Fax: Address: j biz i 6 23'`° Address: i 63-0 s' j - 13 SPcK e q1 e ? ;S((k vai 1 t--)14 'i c'2.6 City State Zip Code City State Zip Code ❑ Contractor: c) co-/ / c.ub/ r-z_(7. 7/1) ❑ Architect: /25 Phone: Fax: Phone: c35"-- v /51 Fax: g 3o I'?/ Address: Address: rj (,c o z Pia Vic' fro INH 9 9 ze1 City State Zip Code City State Zip Code WA State Contractor License#: Contact: Spokane Valley Bus. Liscense#: Contact PERMIT/BUILDING INFORMATION N HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: //k' 31, MAIN FLOOR TO SQ. FTG:t.i. iP 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: LiZ% OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC ���ipWf " � SYSTEM? MANUFACTURED HOME Width: Length: Year: Pit Set: Manufacturer: RELOCATION Previous Address: Proposed Use: FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth: Tent: Fireworks Display: Blasting: Date/Time: Valuation: Above/Underground Storage Tank Size: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Phone: Fax: Address: City State Zip Inspector: Phone: Fax: Address: City State Zip SPECIAL INSPECTIONS ❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING Firm Name: Phone: Fax: Inspector(s): DISCLAIMER The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. Ownership of resulting development rights granted by any issued/permit ure to the ••e/ er. Print Name �/9.Sii�i "SGL f�II�� Signatur � Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other Bankcard #: Expires: VIN#: Authorized Signature: Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 ti Topic Index I Contact Info W akin c n t uncut cs Search ni t Indo >t�e Home Safety Claims&insurance Workplace Rights Trades Et Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor A business registered as a construction contractor with MI to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment xof account and carry general liability insurance. License Information License MCONSMC965DR Licensee Name A a M CONSTRUCTION Licensee Type CONSTRUCTION CONTRACTOR 602378338 Verify Workers Comp Premium UBI Status Ind. Ins. Account Id Business Type INDIVIDUAL Address 1 10508 E 13TH Address 2 City SPOKANE County SPOKANE State WA Zip 99206 Phone 5I••229259...„., S •tus SUSPENDED 0(0-) Specia . Specialty 2 UNUSED Effective Date 3/19/2004 Expiration Date 3/19/2006 Suspend Date 2/20/2005 Separation Date Parent Company Previous License Next License Associated License Business Owner Information https://fortress.wa.gov/lni/bbip/Detail.aspx?License=MCONSMC965DR 7/20/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2 Name Role Effective Date Expiration Date BAUBLITZ, JASON TODD OWNER 03/19/2004 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date ACCREDITED SURETY & Until #1 CAS CO 10011928 02/20/2004 Cancelled 02/28/2005 $12,000.00 03/19/2004 Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date ATLANTIC CAS INS #2 CO L065003913 03/02/2005 03/02/2006 $500,000.00 03/24/2005 ATLANTIC CAS INS #1 CO L065003126 02/20/2004 02/20/2005 $500,000.00 03/19/2004. Summons/Complaints Information No Matching Information Start a New Search Printer Friendly Version. ;row. About L&I Find a job at L&l ( Information en espanol I Site Feedback r 1-800-547-8367 INDUSIVISS4413014 AND Washington State Dept.of Labor and Industries. Use of this site is subject to the laws of the - state of Washington. Access Agreement I Privacy and security statement I Intended use/external content policy I Visit access.Wa.gov Staff only link https://fortress.wa.gov/lni/bbip/Detail.aspx?License=MCONSMC965DR 7/20/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 Topic Index I Contact Info Search LiDorana Ili r Home Safety Claims 8 Insurance Workplace Rights Trades a Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber 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. License Information License MCONSMC965DR Licensee Name A a M CONSTRUCTION Licensee Type CONSTRUCTION CONTRACTOR 602378338 VerifyYN orkers_Comp Premium UBI Status Ind. Ins. Account 0 Id Business Type INDIVIDUAL Address 1 10508 E 13TH Address 2 City SPOKANE County SPOKANE State WA Zip 99206 Phone 5099229259 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/19/2004 Expiration Date 3/19/2006 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information https://fortress.wa.gov/lni/bbip/Detail.aspx?License=MCONSMC965DR 7/21/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2 Name Role Effective Date Expiration Date BAUBLITZ, JASON TODD OWNER 03/19/2004 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date ACCREDITED SURETY£t Until #2 CAS CO 10011928 03/07/2005 Cancelled $12,000.00 07/21/2005 ACCREDITED SURETY & Until #1 CAS CO 10011928 02/20/2004 Cancelled $12,000.00 03/19/2004 Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date ATLANTIC CAS INS #3 CO L065003126 03/02/2005 03/02/2006 $500,000.00 07/21/2005 ATLANTIC CAS INS #2 CO L065003913 03/02/2005 03/02/2006 $500,000.00 03/24/2005 ATLANTIC CAS INS #1 CO L065003126 02/20/2004 02/20/2005 $500,000.00 03/19/2004 Summons/Complaints Information No Matching Information I Start a New Search Printer Friendly Version About L&I I Find a job at L&I I Informacion en espanol I Site Feedback ,F1,.- I 1-800-547-8367 " ' ' smousrangs -4 ' ©Washington State Dept.of Labor and Industries. Use of this site is subject to the laws of the K,.� II state of Washington. Access Agreement I Privacy and security statement I Intended use/external content policy I Visit access.wa.gov Staff only link https://fortress.wa.gov/lni/bbip/Detail.aspx?License=MCONSMC965DR 7/21/2005