2005, 08-03 Permit App 05002694 Vinyl SidingBUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Depa tment
r— Building Division
PtcL4-`i �S 11707 E. Sprague Avenue, Suite 106
alleY 2\ Spokane Valley, WA 99206
• ,✓ Phone: (509) 683-0036; Fax: (509) 688--0037
REQUIRED SITE INFORMATION
Street Address: it I Z S AN) G• n c�
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
1 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: s—c, ON-Q. r ❑
Phone: g e) 1 o? S s Fax:
Address: u 12 3 S o z- W o OA c-
City State Zip Code
0 Contractor: k o_e_ cl� �' S
Phone: / iscc s25 9syfax:
Address: b `-
I)!7 ^v3 )
State Zip Code
City
WA State Contractor License #:
Applicant:
Phone: Fax
Address:
City Ste
Architect:
Phone:
Zp Code
Address:
Fax:
City
Contact:
OSContact:
Spokane Valley Bus. Liscense #:
State
Zip Code
.1(mCO J A` 'I(-!®S PERMIT/BUILDING INPOR 1ATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Nidth: Length: Year. Pit Set:
Manufacturer.
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
-tire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
✓aivation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
'lens Examiner.
kddress:
Phone: Fax:
City State Zip
nspector. Phone: Fax:
ddress:
City
State Zip
SPECIAL INSPECTIONS
IJ BOLTING n CONCRETE
❑ REINFORCEMENT ❑ WELDING
:km Name: Phone: • Fax:
nspector(s):
)ISCLA1MER
Ehe permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
iwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
>roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
2eferenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
'ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
>wnership of resulting development rights granted by any issued permit inure to the property owner.
'rint Name Signature 7
4ethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
Cash ❑ Check ❑ Mastercard 0 VISA ❑ Other
;ankcard #: Expires: VIN#:
authorized Signature:
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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
KDESI**0330S
Licensee Name
K-DESIGNERS
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
601040894 Verify Workers Comp_Piemium_
Status
Ind. Ins. Account
Id
Business Type
CORPORATION
Address 1
2440 GOLD RIVER RD STE 100
Address 2
City
GOLD RIVER
County
OUT OF STATE
State
CA
Zip
95670
Phone
9168537400
Status
ACTIVE
Specialty 1
GENERAL
Specialty 2
UNUSED
Effective Date
9/10/1997
Expiration Date
9/1/2006
Suspend Date
Separation Date
Parent Company
Previous License
JUA_SOEt050BI
Next License
Associated
License
Business Owner Information
https://fortress.wa.gov/lni/bbip/Detail.aspx7License=KDESI**033OS 8/3/2005
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 3
Name
Role
Effective
Date
Expiration
Date
SEARS, FREDRICK
M
01/01/1980
JUDSON, LARRY D
PRESIDENT
09/10/1997
JUDSON, MAHNAZ
F
VICE
PRESIDENT
09/10/1997
08/28/2002
SHAFER, NORMAN
J
01/01/1980
01/01/1980
VIDLOCK, BRIAN
D
01/01/1980
01/01/1980
Bond Information
Bond
Bond
Company
Name
Bond Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
#5
WESTERN
SURETY CO
69580332
10/02/2003
Until
Cancelled
$12,000.00
10/01/2003
#4
STAR INS CO
SA3142939
08/16/2001
Until
Cancelled
10/02/2003
$12,000.00
08/21/2001
#3
USF&G
43013050989987
10/23/1998
Until
Cancelled
08/16/2001
$6,000.00
#2
SAFECO INS
CO
5945619
09/01/1998
Until
Cancelled
08/13/1999
$6,000.00
#1
CONTINENTAL
CASUALTY CO
158473825
09/04/1997
Until
Cancelled
10/21/1998
$6,000.00
Savings Information
No Matching Information
Insurance Information
Insurance
Company Name
Policy
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Amount
Receiv
Date
#7
LANDMARK
AMERICANINS CO
LHA126781
09/01/2004
09/01/2005
$1,000,000.00
08/30/2
#6
GEMINI INS CO
VCGP007197
09/01/2003
09/01/2004
$1,000,000.00
09/16/2
#5
ROYAL SURPLUS
LINES INS CO
K2HA121145
09/01/2002
09/01/2003
$1,000,000.00
08/28/2
#4
ROYAL SURPLUS
LINES INS CO
KZB517898
09/01/2001
09/01/2002
08/31/2
#3
ROYAL SURPLUS
LINES INC CO
KZB515031
09/01/2000
09/01/2001
#2
CREDIT GENERAL
INS CO
AAB100142000
09/01/1999
09/01/2000
#1
TRANSCONTINENTAL
INS CO
C155170757
09/01/1997
09/01/1999
Summons / Complaints Information
https://fort-ess.wa.gov/Ini/bbip/Detail.aspx?License=KDESI* * 033 OS
8/3/2005
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https.//fortress.wa.gov/lni/bbip/Detail.aspx?License=KDESI* *0330S 8/3/2005
e8/02/2805 15:24 8007786785
KDE6lGNERS 5EATTLE
PAGE e2/02
8007786785 PAGF.02
08/02/2005 15:24 8007706785
KDESIGNERS SEATTLE
PAGE 01/02
Fax
•
----_________
0 fES I C. N E t2 S
8647 South 212°' Street
Ph H 253-872-3440.800-S28-95'3•Fad
,Cent WA 98031
800-778.6785
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