The URL can be used to link to this page

Home My WebLink AboutPermit D11-250 - TRUDY'S TAVERN - DEMOLITIONTRUDY'S TAVERN DEMO 15037 TUKWILA INTERNATIONAL BL Di 1-250 City oilkukwila • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.TukwilaWA.gov DEVELOPMENT PERMIT Parcel No.: 0041000493 • Permit Number: D11-250 Address: 15037 TUKWILA INTERNATIONAL BL TUKW Issue Date: 08/22/2011 Suite No: Permit Expires On: 02/18/2012 Project Name: TRUDY'S TAVERN DEMOLITION Owner: Name: HAWLEY ENTERPRISES INC Address: PO BOX 1002 , ENUMCLAW WA 98022 Contact Person: Name: CHRIS TONKIN Address: 3300 MAPLE VALLEY HY , RENTON WA 98058 Contractor: Name: WILCOX CONSTRUCTION INC Address: 123 4TH AVE N , EDMONDS, WA 98020 Contractor License No: WILCOC*194Q0 Phone: 206 -255 -3633 Phone: 425 774 -4185 Expiration Date: 12/10/2011 DESCRIPTION OF WORK: DEMOLISH TRUDY'S TAVERN AND REMOVE ALL RUBBLE FROM SITE. REMOVE THE CONCRETE FOUNDATION AND SLAB. REMOVE THE UNDERGROUND HEATING OIL STORAGE TANK. FILL HOLE LEFT FROM SLAB WITH STRUCTURAL FILL AND OVERLAY ASPHALT AT A LATER POINT IN TIME. PPUBLIC WORKS ACTIVITIES INCLUDE EROSION CONTROL AND GRADING (FILL HOLE AFTER TANK REMOVAL). PROJECT IN VALLEY VIEW SEWER DISTRICT AND WATER DISTRICT #125. Value of Construction: $12,000.00 Fees Collected: $801.05 Type of Fire Protection: NONE International Building Code Edition: 2009 Type of Construction: V -B Occupancy per IBC: 0004 Electrical Service Provided by: SEATTLE CITY LIGHT * *continued on next page ** doc: IBC -7/10 D11-250 Printed: 08 -22 -2011 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Flood Control Zone: Hauling: N Land Altering: Y Landscape Irrigation: Moving Oversize Load: Number: 0 Size (Inches): 0 Start Time: Volumes: Cut 10 c.y. End Time: Fill 15 c.y. Start Time: End Time: Sanitary Side Sewer: Sewer Main Extension: Private: Public: Storm Drainage: Street Use: Profit: N Non - Profit: N Water Main Extension: Private: Public: Water Meter: Permit Center Authorized Signature: N Date: C .4-4'2 4( l I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the performance of work. I am authorized to sign and obtain this development permit and agree to the conditions attached to this permit. Signature: Print Name: \LW AbNITP.J Date: O/72,4/ This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PERMIT CONDITIONS: 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 4: All construction shall be done in conformance with the approved plans and the requirements of the International Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code. 5: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 6: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, doc: IBC -7/10 D11-250 Printed: 08 -22 -2011 any violation of any of the provisions of the ' Mg code or of any other ordinances of the of Tukwila. Permits presuming to give authority to violate or ca the provisions of the code or other ordinan f the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. 7: ** *FIRE DEPARTMENT CONDITIONS * ** 8: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the following concerns: 9: The removal of underground flammable /combustible liquid storage tanks requires a separate fire department permit for each tank. Permits can be obtained from the fire prevention office at 444 Andover Park East, Tukwila, WA 98188. 206 - 575 -4407. 10: Accumulation of combustible waste material is prohibited during the demolition phase of this project. Remove and properly dispose of all waste material prior to the close of the working day and as often throughout the day as needed. 11: Contact The Tukwila Fire Prevention Bureau to witness all required inspections and tests. (City Ordinances #2050 and #2051) 12: Any overlooked hazardous condition and/or violation of the adopted Fire or Building Codes does not imply approval of such condition or violation. 13: These plans were reviewed by Inspector 511. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575 -4407. 14: PUBLIC WORKS 15: Contractor shall notify Public Works Project Inspector at (206)433 -0179 of commencement and completion of work at least 24 hours in advance. 16: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation off -site or into existing drainage facilities. 17: The site shall have permanent erosion control measures in place as soon as possible after final grading has been completed and prior to the Final Inspection. 18: Any material spilled onto any street shall be cleaned up immediately. 19: Sanitary sewer capping shall be performed per Valley View Sewer District CAPPING PERMIT # 6847. 20: Disconnection or capping of water service shall be coordinated with Water District #125. doc: IBC -7/10 D11-250 Printed: 08 -22 -2011 CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.aov Building Permit No. p t 1- ).5-0 Mechanical Permit No. Plumbing/Gas Permit No. Public Works Permit No. Project No. (For office use only)_ Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** SITE LOCATION Site Address: 15037 Tukwila International Blvd. Tenant Name: Trudy's Tavern King Co Assessor's Tax No.: 0041000690 Suite Number: Floor: New Tenant: ❑ Yes ❑ ..No Property Owners Name: HAWLEY ENTERPRISES INC Mailing Address: P.O. Box 1002 Enumclaw City 98022 State Zip CONTACT PERSON — who do we contact when your permit is ready to be issued Name: Chris Tonkin Mailing Address: 3300 Maple Valley Hwy. E -Mail Address: chris @tacotimenw.com Day Telephone: (206) 255 -3633 Renton City State Fax Number: (425) 228 -8226 WA 98058 Zip GENERAL CONTRACTOR INFORMATION — (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: Wilcox Construction Mailing Address: 234 5th Avenue South Contact Person: Paul Carter E -Mail Address: Pcarter @wilcoxconstruction.com Contractor Registration Number: WILCOC 194Q0 Edmonds City Day Telephone: 98020 State Zip (206) 817 -1254 Fax Number: (425) 774 -4187 Expiration Date: 12/10/2011 ARCHITECT OF RECORD — All plans must be stamped by Architect of Record Company Name: Howard Kimura Mailing Address: PO Box 59415 Contact Person: Howard Kimura Renton 98058 E -Mail Address: hgkimura @comcast.net City State Day Telephone: (425) 271 -1875 Fax Number: (425) 271 -2383 Zip ENGINEER OF RECORD — All plans must be stamped by Engineer of Record Company Name: Blueline Group, Inc. Mailing Address: 25 Central WAy Contact Person: Geoff Tamble E -Mail Address: 9tamble @thebluelinegroup.com HAApplications\Forms- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh Kirkland City State Day Telephone: (425) 216 -4051 Fax Number: (425) 216 -4052 98033 Zip Page 1 of 6 BUILDING PERMIT INFORMATION — 206 -431 -3670 Valuation of Project (contractor's bid price): $ 12,000.00 Existing Building Valuation: $ 1,000.00 Scope of Work (please provide detailed information): Demolish Trudy's Tavern and remove all rubble from site. Remove the concrete foundation and slab. Remove the underground Heating Oil storage tank. Fill hole left from slab with structural fill and overlay asphalt at a later point in time. Will there be new rack storage? ❑ Yes m.. No If yes, a separate permit and plan submittal will be required. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION /HAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm m None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes m No If 'yes', attach list of materials and storage locations on a separate 8 -1 /2 "x 11 " paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Fonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 Existing Interior Remodel Addition to Existing Structure New Type of ` Construction per IBC Type of Occupancy per IBC 1$` Floor 3,096 VB A2 2nd Floor 3 *d Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION /HAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm m None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes m No If 'yes', attach list of materials and storage locations on a separate 8 -1 /2 "x 11 " paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Fonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 PUBLIC WORKS PERMIT INFORMATION - 206- 433 -0179 Scope of Work (please provide detailed information): Demolish Trudy's Tavern. The information requested below is included with our application for our building permit. Call before you Dig: 1- 800 - 424 -5555 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Water District VI ...Tukwila ❑ ...Water District #125 ❑ ...Water Availability Provided Sewer District ❑ ...Tukwila ❑ ...Sewer Use Certificate ❑ .. Highline 0... Valley View ❑ .. Renton ❑...Sewer Availability Provided ❑ .. Renton ❑ .. Seattle Septic System: ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. Submitted with Application (mark boxes which apply): ❑ ...Civil Plans (Maximum Paper Size — 22" x 34 ") ❑ ...Technical Information Report (Storm Drainage) ❑ ...Bond ❑ .. Insurance ❑ .. Easement(s) Proposed Activities (mark boxes that apply): ❑ ...Right -of -way Use - Nonprofit for less than 72 hours ❑ ...Right -of -way Use - No Disturbance ❑ ...Construction /Excavation/Fill - Right -of -way ❑ Non Right -of -way ❑ 0 ...Total Cut 10 cubic yards m ...Total Fill 15 cubic yards ❑ .. Geotechnical Report ❑ .. Maintenance Agreement(s) ❑...Traffic Impact Analysis ❑ ...Hold Harmless — (SAO) ❑ ...Hold Harmless — (ROW) ❑ .. Right -of -way Use - Profit for less than 72 hours ❑ .. Right -of -way Use — Potential Disturbance ❑ .. Work in Flood Zone ❑ .. Storm Drainage ❑ ...Sanitary Side Sewer ❑ .. Abandon Septic Tank ❑ .. Grease Interceptor VI ...Cap or Remove Utilities ❑ .. Curb Cut ❑ .. Channelization ❑ ...Frontage Improvements ❑ .. Pavement Cut ❑ .. Trench Excavation ❑ ...Traffic Control ❑ .. Looped Fire Line ❑ .. Utility Undergrounding ❑ ...Backflow Prevention - Fire Protection Irrigation Domestic Water 71 ❑ ...Permanent Water Meter Size... WO # ❑ ...Temporary Water Meter Size .. WO # ❑ ...Water Only Meter Size WO # ❑ ...Deduct Water Meter Size ❑ ...Sewer Main Extension Public ❑ Private ❑ ❑ ...Water Main Extension Public ❑ Private ❑ FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) ❑ ...Water ❑ ...Sewer ❑ ...Sewage Treatment Monthly Service Billing to: Name: Day Telephone: Mailing Address: City State Zip Water Meter Refund /Billing: Name: Mailing Address: Day Telephone: City State Zip H:\Applications\Forms - Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh Page 3 of 6 PERMIT APPLICATION NOTES - Applicable to all permits in this application Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. Building and Mechanical Permit The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). Plumbing Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing Code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNERAR AUTHOBIZiD AGENT: Signature: Print Name: Mailing Address: -??7c2(> An44 f'12 lo" <, /f.P) Date Application Accepted: 7 Date: -7 I %✓ /° // Day Telephone: 2°6 55 - 3 G 33 r2�N ✓� La Pc 0S City State Zip Date Application Expires: Staff Initials: H: \Applications\Forms- Applications On Line \2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh af Page 6 of 6 • • r"-- City of Tukwila ZDepartment of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.TukwilaWA.gov RECEIPT Parcel No.: 0041000493 Permit Number: D11 -250 Address: 15037 TUKWILA INTERNATIONAL BL TUKW Status: APPROVED Suite No: Applied Date: 07/25/2011 Applicant: TRUDY'S TAVERN DEMOLITION Issue Date: Receipt No.: R11 -01823 Initials: User ID: LAW 1632 Payment Amount: $595.00 Payment Date: 08/22/2011 12:26 PM Balance: $0.00 Payee: TACO TIME TRANSACTION LIST: Type Method Descriptio Amount Payment Check 601506 595.00 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts BUILDING - NONRES PW BASE APPLICATION FEE PW LAND ALT PERMIT FEE STATE BUILDING SURCHARGE 000.322.100 000.322.100 000.342.400 640.237.114 Total: $595.00 317.00 250.00 23.50 4.50 doc: Receiot -06 Printed: 08 -22 -2011 • 1 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http://www.TukwilaWA.gov RECEIPT Parcel No.: 0041000493 Permit Number: D11-250 Address: 15037 TUKWILA INTERNATIONAL BL TUKW Status: PENDING Suite No: Applied Date: 07/25/2011 Applicant: TRUDY'S TAVERN DEMOLITION Issue Date: Receipt No.: R11 -01562 Payment Amount: $206.05 Initials: WER Payment Date: 07/25/2011 11:07 AM User ID: 1655 Balance: $321.50 Payee: TACO TIME TRANSACTION LIST: Type Method Descriptio Amount Payment Check 601495 206.05 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts PLAN CHECK - NONRES 000.345.830 206.05 Total: $206.05 doc: Receiot -06 Printed: 07 -25 -2011 INSPECTION NO. INSPECTION RECORD Retain a copy with permit 0I( -2..�D PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 0 (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: �.. .J- ( tZl� £ 14 ■k1AJ Type of Inspectio �: ,�i A !3J' I J •'� Address: J�0 T�s Date Called: Special Instructions: 2r z. Date Wanted • r Z�c '!r aa.m.. t tv Requester: Phone No/: CC G �.e, G ' 2(� —v `�0S Approved per applicable codes. 0 Corrections required prior to approval. 'COMMENTS: tlnP - ,AA:rTf • n..QD Inspec ;br: n REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Pr I r v S i 4au� Type sp vire - c_oiks`r oEha Address: 1 D 0- l TIE. Date Called: --- Special Instructions: 0 )11 _.s._. 3_ O // ca" Jf 1 1 ,----- Date wante— — 0 ,., p.m. RequRtx:( ` W : (60K Phone Phone 24D (11 — 8 q 2-- &S( Approved per applicable codes. E Corrections required prior to approval. COMMENTS: Insp 1� Date:Q y „ t REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. ii\� V 0 Approved per applicable codes. INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 INSPECTION RECORD Retain a copy with permit pt i -asv PERMIT NO. Project: ��® v Type of n�s _ectn: r _ \ Address: /SD 3 ---ii 3 Date Called: 1% ad111 Special Instructions: )0v,A.6 \ 1 \ lc.�.... Date Wanted: % a.m., v r�3 ii p.m. Req ster: Q e ✓, G, Phon No: _ LA Corrections required prior to approval. COMMENTS: — F ,:.J — Ga /1Sf7u k ur, 4o sf-atf- r ovnel; -c(y on %ui(a(; - liSC.. -fra re,,1uin fel place,. Rrodegi Inspector: TS Date: que(l p $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must'be paid at 6300 Southcenter Blvd., Suite 100. Call to sche. ule reinspection. Receipt No.: J 'Date: l,:•. f• •-fl REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. , PERMIT NO. -Z-1) • : CITY OF TUKWILA BUILDING DIVISION .6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: ; o, f + �A ' l Type of Inspection: Pw Date Called: on yo-E---Oram° o cok t Ad r 1 1 Special Instructions: Date Wanted:. 0110 1 ` ` t p.m. Requester vAtE w( w i lit 1\ l A' it . Phone No: /"t`C vs._ egfsi LI Approved per applicable codes. ElCorrections required prior to approval. COMMENTS: Pa---con caoduct:ed offac f;i a.icd 'Inspector: /75 Date: Iwo ( INSPECTION NUMBER INSPECTION RECORD Retain a copy with permit - ,v-- cs'c PERMIT NUMBERS CITY OF TUKWILA FIRE DEPARTMENT 444 Andover Park East, Tukwila, Wa. 98188 206 -575 -4407 Projects: "-17W- 5 (Thh �1'it-1 1\ Tye of Inspection: livl b Fire Alarm: Contact Person: Address: -- 3-7 —Z T— (` Suite #: Special Instructions: Phone No.: )< Approved per applicable codes. I I Corrections required prior to approval. COMMENTS: ®� Needs Shift Inspection: Sprinklers: Fire Alarm: Hood & Duct: Monitor: Pre -Fire: Permits: Occupancy Type: Inspector: AA , .S9 Date: ?46:/// Hrs.: n $100.00 REINSPECTION FEE REQUIRED. You will receive an invoice from the City of Tukwila Finance Department. Call to schedule a reinspection. Billing Address Attn: Company _Name: Address: City: State: 1 Zip: Word /Inspection Record Form.Doc 6/11/10 T.F.D. Form F.P. 113 FILE COPY Permit No. 11- .?-..S'0% Ply" rp'view approval is subject to errors and omissions. of cc istri lction documents does not authorize 11-t: -,c ;Ilion of any adopted code or ordinance. Bece pt u:,pproved iris: so Copy and conditions is acknowledged. By Gate. Vz.z/ C.t tv Of Tu BUiW.:. _i G D 1 I 1 1 20 10 0 20 r20' pATW/BA95 OF BEARINGS - BASIS OF EARDRS 61700646E ICON[ WE REST LOX OF QUARTER OF SECTION 22. 1VP. 23N. ROE 1E.. W.N. Pry AKIN 40 MO@d(TM OATUIR MAD 63/91 10NCM OAT(RE: NAN) 66 WW1 05 7 RN • 336.06 E 16' CEP N • 331.9' E 184' CIO 5 - 332.3' (POS9611 ABANDONED) REVISIONS Po C',anpe s shall he made to the scope .i cf work without prior approval of ukv'/?ia building Division. BOUNDARY ilVTO - Olt' ' ':I ....0 r'; ly I'tJ'''ude ad�itional plan review tees. j FARO IEBAR AND CAP -ODES 2353T CSC MOM AID Ix REST OF PROPERTY CORER ..,ig NORTH FAQ OF 4'- WALL 6 0T 5 + SHED CONFER 0.1 NORM W PROPERTY 101 pT PROPERTY LINE 1 EN(.3 APPROVED • 336.41 E 6' COJCE N - 331.1 (CENTER CHANNEL) SHED CORNER 0.2' NORM 00 PROPERTY UE it /iii / 41 NE CORNER OF WALL 6 TIN PROR]ETY 141E 5964 0466 RN = 06.35 E 0' CD40 WS 6' CON[ E. 5E • 3314' (CENTER 0151810) ORIDNG COWAN 41 NORTH FACE 00 WALL ON PROPERTY EWE OW:NC CORNER 01' NORTH OF PROPERTY UNE These plans have been reviewed by the Public Works Department for conformance with current City standards. Acceptance is subject to errors and nmiSSinns which do not authorize violations of adopted standards or ordinances. The responsibi ay for the adequac.• of the design rests totally wit i the designer. Additions, deletions or revisions then drawings after this date 4F 11 void tE is a tance and will require a resub' ittal of re ised drawing for subsequent approv NEF,E:ggLacceptance is s /bject to field t by 6035 A ¢ °Ft'1m. 'c Works u ilities inspector Date: _ - F5UN0 RERAN AND CAP 'CRONES 21537' OY 0009 510 17' EST OF PROPERTY COVER 1 -5TORY CONCRETE TARP �� STRUCTURE Y E 4'N W- 3317 4078 OL/0AIER TUR002 ELBOW) 2 -01CR7 00700 STRUCTURE CD 75 14 E 12' CONC N • 339.4' 112- CO405 • 331.4' E 84' COIC NE • 332.3 SOUTH FACE OF BUILDING 03 NORTH OF PROPERTY EWE / so. NO EASEMENT O TITLE REPORT PDX UIUIES Ne changes can be made. to th Om1ATR1O 1110410160 DA NO 6103 attn 7=1 • g $J without approval from th C SQUARE CONCRETE MONWENT PI: CAS 009 065' INTERSECTION E SOUTH IM7H STREET ANO 46TH A arming Division of DCD 3100308 267.90' 0919 46 00 AS YT NAG NAIL N *578451 AT NE 05445 REY BANN P4RRNC EDT. (S CORNER OF 971) 12' SO4 F GREEN UO+LSW° ANDY . 504+48 00 FACE Cr EXTRUDED" CURB IN ER921FNNN Q� S ` b��. WALLA _ i -••lE Rev d OEYATT0O 333.14' TOE b': SET AND WASHER '.9765 CONTROL' N ASPI1!LT CORNER 04 O0 F 0 911 ` ELEVATION 337.67 LEGEND FOUND SECTION CORNER Li POUR oUAR108 CORNER O FOUND 1100004T N CASE O MAO R70R A9D CM AS NOTED 0 SET 9E4060.04 o SANITARY 5C1101 MAONOE o A SANITARY SEVER OEM OUT ® 57001 GRAN WAVLE ❑ CATER BASIN DRAW ED RATER METER D( RATER 5ACYE SV a SHUT OFF VALVE CI FIRE HIWRMT 0577,0 FIRE OEPARLE TIT CONNECTOR P0002 VAULT • SIGNAL VALT m UOR VAULT STREET IICHT UTILITY POE W/ L9R • T8*4457 REEK - GIY ANCNGR )7 AREA LIGHT O PED PEDESTRIAN SRRAL POST 9 POERR 441745 • CAS WW1 m OAS VALVE BOLLARD JZ 904 SS SS SD 4P DP 07 0E7! 01300710/4 OF 16.261044 SAR7ARY SERER UE 510!44 DRAIN WE OVERHEAD POWER UIE OVERHEAD POYOR AID TF]ECOONUNICATION5 WATER UJE CAS LANE POWER ME 1pE00010JCATON5 LIME 49860 OPTICS UE CHAIN 164 FENCE 0E WOOD 40441E 1OE 33 . 3201 329.4' E I2 cam N - 331.3 E IT COPE 5 • 331.3 Co 27 RN- .44 E 17 CVNC N - 3305' E 12' CON0 5 - 330.5' CR =CRETE WALL BR OELM WAIL ETD ECRU= CONCRETE OIR9 PA RAMIID AREA ROI ROOF 01E3140110 41'6 DOBIL NEE WE STRIPE BUTTONS WB 9891 WOE WE STRIPE BUTTONS 0.78 008945 201018 WE SWIPE BU1RM ▪ UE 00808490 n 001E 04NR RASP 45 . ;4 DATE CONCRETE PAWNS ASPHALT PAY9NE BU407455 } SPOT EIEVA7IN+ B7 4P Rv. 117 DIN. 332.1' 117 N5 • 332C' EEL ADS W. 330.3 u CO 066 RIO • 334... 1 12' CON[ M . 330.1• 1 12' CON0 5 - 30.45. CB 35 PoY - 332.10 E 6' 055 • 330.6' +47 03 #74T3 IE RBI CON[ E • 331.09' .329.7' 4 o • 51110 551,64 145 mu • 337.49 E 6N. 5 -3284' (CENTER CHANNEL) REVIEWED FOR CODE COMPLIANCE ■ ROVED AUG 17 2011 City of Tukwila BUILDING DIVISION P1 l2 f3 N (5 46 DC WEST 00 MOH FAQ OF OlRO 02' NORTH Q PROPERTY LSE +�4 V ,4" wan SmP53 1q1 CF CU FAQ 18 432 • .5 CF CURB CE 185 RN- 3]21 L.,.. 6 PROPERTY 11E E IT CON[ W . 330.1' :4:5' E 144 AOSE - 329.9' +� 19M'A' SD O9 RY - 331.96' 6 16'CONCON[ GNE - - ]29.7' 32s.9' CORRECTIO E LT R# 10 EASEMENT N 175E REPORT FOR Ul11711ES RA #7120 PoY • 335]6 E 12' COJCN .330.45 1 12' COHC 5 - 329.9' HM 6 12' N N • 329.7' E 12' 045.329.7' 6 0' 603 W - 329.7 33210 / BOUNDARY & TOPOGRAPHIC SURVEY OF TUKWILA SITE 1111113.1NE 25 CENTRAL WAY. ANTE 400 Hma ma% WA 96033 RECivEr AUG 1 2011 PERMIT ENTER SW 1/4, NW 1/4, SEC.22, TWP.23N., RGE. 4E, W.M. CITY OF TUKWII.A, KING COUNTY, WASHINGTON %ow Axis S0FVry .Y' M047040q 131302 NE 126tfi ERILAN 1, WA 96034 133_ 425123 -940 FAX 425123-8700 -solomapAama 108 N0. 10080 DATE 10/10/10 DRAW HY AWG SCALE 1 - =20 MOOED EV TJO SHED' 20F2 AdflifERICALIV Asbestos - Lead - Mold - Demolition Taco Time Chris Tonkin Cell Phone: 206 -255 -3633 Email: chris@tacotimenw.com P.O Box 81006 Seattle, WA 98108 -1005 Phones (200)297-0740 Fu (208) 287 -0753 August 5, 2011 RECEIVED AUG 18Z011 TUKWILA PUBLIC WORKS Re: Asbestos Abatement Services at: Trudy's Tavem located at: DEMO 15037 Tukwila International Blvd Tukwila, WA 98188M11-357 PROPOSAL AND CONTRACT American Environmental Construction, LLC proposes to furnish all materials and perform all labor necessary to complete the following: Notifications 1. File (A) Notification to Perform an Asbestos Project with the Puget Sound Clean Air Agency (PSCAA) and (B) Notice of Intent to Remove or Encapsulate Asbestos with the Washington State Department of Labor and Industries (WSDLI), as required. The WSDLI will require a 10 -day wait after notification before work can begin. Scope 2. Remove and properly dispose of approximately 1,700 square feet of painted asbestos containing textured ceiling material from the main area. Work area will be enclosed in HEPA filtered negative pressure containments requiring the work spaces to be empty of all contents prior to our arrival on site. After removal of the asbestos and entire enclosure we will perform clearance air monitoring and provide results to the owner to indicate the space is safe for re- occupancy and future remodel work. Asbestos Abatement Price: $ 5,985.00 Puget Sound Clean Air Agency Notification $210.00 Asbestos Abatement and PSCAA total price: $6,195.00 Plus Applicable Tax PLEASE NOTE: This bid EXCLUDES the Puget Sound Clean Air Agency Notification for the demolition of the structure(s) referenced above. The Demolition Contractor, General Contractor, or Owner must apply separately for the Puget Sound Clean Air Agency Notification to demolish the structure(s). Clarifications: 3. The following clarifications are applicable: • Any items that have NOT been removed from the structure prior to our work crew arriving on -site will be considered as non- salvagedlwaste items and will be treated accordingly or salvaged by ourselves. CORRECTION RECEIVED AUG 12 2011 Dt� -2 PERMIT C NTER Page 2 August 5, 2011 15037 Tukwila International Blvd Tukwila, WA 98188_M11 -357 TonkinChris- TacoTime15037 • If demolition of the structure is required to access the asbestos containing materials, the demolition debris will be placed to one side for disposal by others. This bid EXCLUDES the removal of demolition debris from site unless altemate arrangements have been made prior to the execution of this Contract. • This bid EXCLUDES site security of the building and /or property from unauthorized entry. • Water and power to be supplied by the Owner unless altemate arrangements have been made. Please tell us whether water and power will be available at the time of our work. • If any additional suspect materials (such as floor tile, sheet vinyl flooring, unknown boiler pipe/fitting insulation, heat ducts etc.) not noted in the Good Faith Asbestos Survev are discovered during the abatement process, the removal of those items will be considered a "change in condition". The cost of removal of those materials will be invoiced on a change order basis. • Quality Assurance 3. Quality Assurance: • Supervision of work and air monitoring service will be provided. Abatement design and a written completion report including: air monitoring records, disposal certificate, PSCAA notification(s) (if applied for) and other relevant documents will be provided upon request. • All work performed to comply with existing Federal, State and Local regulations and in a substantial and workmanlike manner according to generally accepted industry standard work practices. General Conditions 4. Payment to be made immediately upon receipt of invoice unless previous arrangements have been made as stated herein: within 15 days of invoice Interest will be charged at the rate of 1.5% per month on any outstanding amount over 30 days from the date of the invoice. This proposal includes insurance per our standard policy limits. G/L @ $2M, OCC @ $2M Agg, Auto @ $1M. Increased limits are available at a premium. Proposal and Contract price effective for sixty (60) days. If you find the above Proposal and Contract acceptable, please complete and sign the attached form where indicated and return to American Environmental Construction, LLC either by fax at (206) 522 -4099 or mailed to P.O. Box 81005, Seattle, WA 98108. Respectfully submitted, American Environmental Construction, LLC Mike Fonseca— Project Estimator Page 3 August 5, 2011 15037 Tukwila International Blvd Tukwila, WA 98188_M11 -357 TonkinChris- TacoTime15037 ACCEPTANCE If accepted, please fill -in the form below, sign the agreement and return to American Environmental Construction LLC. When would you like to schedule the job? alt 12-od Demolition Start Date? 1.1 Address of the building IS 0177 Tt&V -w,It., i k;, Iv,) n 4 nc, 1.2 City (,‘1 -1i; ).\ State W A zip 8521 i 8 1.3 Age of the building Size (SFT) Number of Floors it- 4(0 1 zo,,j 3, i ov 5 C- 2.1 Client's Name For Resale? CLc�s �' 11 A'o 2.2 Billing Address 33 JV AiLitett L4112, 1-1•1' 2.3 Billing City Ze,.-\-0•. State WA zip 1$U 5 2.4 Client phone number 2J)(7, e).55 -3 63 Client fax number yes aaSg - aaa C 3.1 Owner's name (if different from the Client) 3.2 Owner's address 3.3 City State zip 3.4 Owner phone number Owner fax number 4.1 Site contact name & telephone number. (The person we will call to schedule the job and let us into the premises. Name: • i c• el 1c..., Phone faib L 3-05— 3 63 3 Cell: If mulfple bids are quoted in this Proposal, PLEASE INDICATE WHICH BIDS ARE ACCEPTED: You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal. Should the undersign default on any obligation incurred under this agreement and American Environmental Construction LLC refers this account to his attomey for collection and /or legal action, the undersigned agrees as follows: to pay the principal due, attorney fees and all costs of any nature incurred by American Environmental Construction LLC to pursue the delinquent obligation. Delinquent accounts will be accessed at the rate of 1 -1/2% per month (18% per year). ACCEPTED this day of By: gnature 20 i/ Print Name CITY FORM NO t ,912 ADOPTED BY DIVISION OF MUNICIPAL CORPORATIONS. Date CITY OF TUKWILA TREASURER'S RECEIPT (261 6i47/-7/ 20 1/ yua Received o 61'1 'L `t i ( -1i '16 /IA( Ofib FOR �� r // t~ 1 .. 47338 BY // 4 {iyt DEPT: --- -Dollars, TOTAL OLYMPIC PRINTERS, INC. WHITE • Finance Dept. CANARY • Customer PINK . File VIORATAC. TOWARD ARE TERFhUMVAIENT.", :iH::Pt;'BL;FIfr. 3460 S. 148th St., Suite 100 • P.O. BOX 69550 • TUKWILA, WA 98168 • (206) 242 -3236 RECEIPT N9 5592 Date N r 20 2 I Received From C`li rr` s / Address / S n _a '7 7":72 13 %2� 1c- G1,. Z l C/A 4 -2 8/ 6z, 5 acv c'~ 4-7 '�— `�`� o Dollars $ od' For ��r� wS r �^ -��-- - 6 Pc/2 (7o) L# 1Co -- d� ACCOUNT HOW PAID ACCOUNT CASH AMT. PAID 70 19,e2. CHECK BADUECE ORDER '2 By /,/ ryinvvou LIauaavuvII pscleanair.org Puget Sound Clean Air Agency Notification Case #: 201102112 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for Inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid ;210.00 Credit Card Transaction # VTIF7C5A0C46 Transaction Date 08/05/11 Owner's Name Project Street Address aty Contact Person Mailing Address Chris Tonkin 15037 Tukwila International Blvd Tukwila Chris Tonkin 3300 Maple Valley Hwy Renton, WA 98058 Phone Zip Phone (206) 255-3633 jo b# 11368 98188 (206) 255-3633 This project Includes asbestos removal. Project Size linear feet / 1700 square feet Project Start Date 08/18/11 Completion Date 08/31/11 Asbestos will be removed by a licensed asbestos abatement contractor Contractor American Environmental Construction, LLC Contractor Job # 11368 Contact Linda Lightfoot Phone (206) 267 -0746 Malting Address P.O. Box 81005 Seattle, WA 98108 -1005 (1) I certify that the Information I have provided Is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single - family residence that Includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there Is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History Loa Out If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https: / /secure.pscleanair.org /Asbestos /Approved.aspx 8/5/2011 August 3, 2011 • City of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director Chris Tonkin 3300 Maple Valley Hy Renton, WA 98058 RE: Correction Letter #1 Development Permit Application Number D11 -250 Trudy's Tavern Demolition —15037 Tukwila International BI Dear Mr. Tonkin, This letter is to inform you of corrections that must be addressed before your development permit can be approved. All correction requests from each department must be addressed at the same time and reflected on your drawings. I have enclosed comments from the Public Works Department. At this time the Building, Fire and Planning Departments have no comments. Public Works Department: Joanna Spencer at 206 431 -2440 if you have questions regarding the attached comments. Please address the attached comments in an itemized format with applicable revised plans, specifications, and /or other documentation. The City requires that four (4) sets of revised plans, specifications and /or other documentation be resubmitted with the appropriate revision block. In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany every resubmittal. I have enclosed one for your convenience. Corrections /revisions must be made in person and will not be accepted through the mail or by a messenger service. If you have any questions, please contact me at (206) 431 -3670. Sincerely, <1:),L6 Bill Rambo Permit Technician encl File No. D11 -250 W:\Permit Center\Correction Letters \2011\D11 -250 Correction Letter #1.doc 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665 PUBLIC WORKS DEPARTMENT COMMENTS DATE: August 2, 2011 PROJECT: Trudy's Tavern Demo 15037 Tukwila International Blvd PERMIT NO: D11-250 PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the following comments. 1) Please submit copies the following permits or approvals: a) Sanitary sewer capping from Valley View Sewer District, contact Mr. Dana Dick at ( 206) 242 -3236 b) Underground storage tank removal from Tukwila Fire Department, contact Alan Metzler at (206)575 -4404. c) Asbestos/Demolition from Puget Sound Clean Air Agency. W:Other /Joanna /D11- 250inc • E T • PLAN REVIEW /ROUTING SLIP icy ACTIVITY NUMBER: D11 -250 DATE: 08 -12 -11 PROJECT NAME: TRUDY'S TAVERN DEMOLITION SITE ADDRESS: 15037 TUKWILA INTERNATIONAL BL Original Plan Submittal Response to Incomplete Letter # X Response to Correction Letter # 1 Revision #' After Permit Issued DEPARTMENTS: Building Division AWL Public Works Fire Prevention Structural Planning Division l l Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 08-16-11 Complete N Incomplete ❑ Comments: Not Applicable Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUESITHURS ROUTING: Please Route Structural Review Required No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved Approved with Conditions Notation: REVIEWER'S INITIALS: DATE: DUE DATE: 09- 13-11 Not Approved (attach comments) I I Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents/routing slip.doc 2 -28 -02 ItE V • PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D11 -250 DATE: 07 -25 -11 PROJECT NAME: TRUDY'S TAVERN DEMOLITION SITE ADDRESS: 15037 TUKWILA INTERNATIONAL BL X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: ulldinp C ivisio 1U& u Works NA AO Fire Prevention Structural fns IrP tit .7A -lI Planning Division ❑ Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete ❑ DUE DATE: 07-26-11 Not Applicable n Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS ROUTING: Please Route N- Structural Review Required ❑ No further Review Required ❑ REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 08-23-11 Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) KA Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only (� j CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW Staff Initials: VW\ Documents /routing slip.doc 2 -28-02 • City of Tukwila • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa. us Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: [ ! °� /go (/ Plan Check/Permit Number: D11-250 ❑ Response to Incomplete Letter # ® Response to Correction Letter # 1 ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: Trudy's Tavern Demolition Project Address: 15037 Tukwila International Bl rr -3Contact Person: (L ,', / D n (� A Phone Number: b l� 55 6 2 > Summary of Revision: 4..i.-e-- ,,i c /4•101/441 7 P ' r z o40(� w e- k co ■ !'-c. r %),- y Se L)-e/ ( c Y') Pe•.- . ; -I / Unvle,:gidvi -.i Sfo ?ogre. -ic, 0lc (C w,ow,1 P ei•r. o,r.t 1-4., (0 + F( t -CO, hpt.'l.r. +:�-- U ie1.-- ,iwI 0 $ Aq).(4)40S . :1- (.,vi c,IS,3n (kJ,o� e:.0- f.,r t I',�.;J 1Io T71)41 c.--,' (1.4-- A. Ily(rty, L 9 (4:J V'01 ��ii� cr..ny 11.t.-14cc f J tt / J J iv +-L p11� 1 1, In -I- T `luvC 14 c 14..(4) (l) toeer,,eS , Sheet Number(s): "Cloud" or highlight all areas of revision includin: date of re PERMIT CENTER Received at the City of Tukwila Permit Center by: 'r Ca—Entered in Permits Plus on t/- RECEIVED WV OF TUKWILA AUG.j22011 \applications \forms- applications on line\revision submittal Created: 8 -13 -2004 Revised: Contractors or Tradespeople liter Friendly Page 1 General /Specialty Contractor A business registered as a construction contractor with L&I 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 WILCOX CONSTRUCTION INC UBI No. 319007592 Phone 4257744185 Status Active Address 234 5Th Ave South License No. WILCOC'194Q0 Suite /Apt. License Type Construction Contractor City Edmonds Effective Date 11/20/1981 State WA Expiration Date 12/10/2011 Zip 98020 Suspend Date County Snohomish Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status WILCOAE376NOWILCOX, Al ELSWORTH DBA Construction Contractor General Unused 8/20/1963 12/1/1981 Archived Business Owner Information Name Role Effective Date Expiration Date LESSARD, MATTHEW J President 11/15/2010 Bond Amount HOLOBAUGH, TRENT L Secretary 11/15/2010 SV4713 CARTER, PAUL F Vice President 11/15/2010 WILCOX, ROBERT EUGENE President 11/20/1981 11/15/2010 LESSARD, MATTHEW J Secretary 11/21/2005 11/15/2010 LESSARD, JAMES MICHAEL Vice President 11/20/1981 11/21/2005 WILCOX, A E DTC0526D7304PHX10 01/01/1980 01/01/1980 WILCOX, LAURA 01/01/1980 01/01/1980 OLDS, HOWARD A Secretary 01/01/1980 01/01/1980 Bond Information Page 1 of 2 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 7 TRAVELERS CAS E STY CO OF AMER SV4713 12/01/2005 Until Cancelled $12,000.0009/26 /2005 6 ST PAUL FIRE & MARINE INS CO SV4713 12/01/2002 12/01/2005 $12,000.0010/31 /2002 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 20 Charter Oak Fire Ins Co DTC0526D7304C0F11 06/01/2011 06/01/2012 $1,000,000.00 06/08/2011 19 Phoenix Insurance Company, The DTC0526D7304C0F11 06/01/2011 06/01/2012 $1,000,000.00 05/31/2011 18 THE PHOENIX INS CO DTC0526D7304PHX10 06/01/2010 06/01/2011 $1,000,000.00 06/01/2010 17 TRAVELERS PROPERTY CAS INS CO DTC0526D7304IND07 06/01/2005 06/01/2010 $1,000,000.00 05 /22/2009 https://fortress.wa.gov/lni/bbip/Print.aspx 08/22/2011 F625- 052 -000 (8/97) DEPARTMENT OF LABOR AND INDUSTRIES REGISTERED AS PROVIDED BY LAW AS CONST CONTR GENERAL WILCOX CONSTRUCTION INC 234 5TH AVE SOUTH EDMONDS WA 98020 Detach And Display Certificate REGISTERED AS PROVIDED BY LAW AS CONST CONTR GENERAL REGIST. # EXP. DATE CCOI WILCOC*194Q0 12/10/2011 EFFECTIVE DATE 11/20/1981 WILCOX CONSTRUCTION INC 234 5TH AVE SOUTH EDMONDS WA 98020 Signaturc Issued by DEPARTMENT OF LABOR AND INDUSTRIES F625.052.000 (8/97) Please Remove And Sign Identification Card Before Placing In B illfold