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HomeMy WebLinkAboutPermit D05-246 - SOUTHCENTER MALL - BUTTER LONDON - KIOSKBUTTER LONDON 311 SOUTHCENTER MALL EXPIRED 02 -26-06 D05 -246 Z re Ili O 0 co 0. W= J �u W O 2 g �W Z U0 ON 0 F-: 2 U O: LLI Z' ,: Z City G..' Tukwila Departrnent of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 - 431 -3665 Web site: cOukwila.wa.us DEVELOPMENT PERMIT Parcel No.: Address: Suite No: Tenant: Name: Address Owner: 2623049023 311 SOUTHCENTER MALL TUKW BUTTER LONDON LLC 311 SOUTHCENTER MALL, TUKWILA WA 7G SOUTHCENTER LTD 25425 CENTER RIDGE RD, CLEVELAND OH SASHA MUIR 1625 N 52 ST, SEATTLE WA KING RETAIL SOLUTIONS INC PO BOX 21910, EUGENE OR License No: KINGRSI966PA Name: Address: Contact Person: Name: Address: Contractor: Name: Address: Contractoi Permit Number: Issue Date: Permit Expires On: Phone: Steven M. Mullet, Mayor Steve Lancaster, Director DOS -246 08/30/2005 02/26/2006 Phone: 206 - 484 -5558 Phone: 541 - 686 -2848 Expiration Date: 10 /01/2006 DESCRIPTION OF WORK: TENANT IMPROVEMENT - INSTALLATION OF A 72 SQ FT KIOSK (PRE- ASSEMBLED). Value of Construction: $20,000.00 Fees Collected: $661.50 Type of Fire Protection: NONE International Building Code Edition: 2003 Type of Construction: Occupancy per IBC: 0019 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: N Hauling: N Start Time: End Time: Land Altering: N Volumes: Cut 0 C.Y. Fill 0 c.y. Landscape Irrigation: N Moving Oversize Load: N Start Time: End Time: Sanitary Side Sewer: N Sewer Main Extension: N Private: Public: Storm Drainage: N Street Use: N Profit: N Non - Profit: N Water Main Extension: N Private: Public: Water Meter: N Z Z M W UO N0. CO LLJ c� u.. W O LL ¢ �d �w z� �0 z�_ W5 U 0— 0 i}— iw w LL Z U Z. O ~, z doc: IBC - Permit D05 -246 Printed: 08 -30 -2005 f i 1908% City 0. Tukwila Steven M. Mullet, Mayor Departirtent of Comnturtity Developntettt 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: ci.tulnvila.wa.us Steve Lancaster, Director Permit Number DOS -246 Issue Date: 08/30/2005 Permit Expires On: 02/26/2006 Permit Center Authorized Signature: Date: g -05" � - L l PJA fi ll L ' i , 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 constructs nor gerformp of work. I am authorized to sign and obtain this development permit. Signature: Date: - ?o --0,'5 Print Name: 8AS W A ►MBA 112 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. Z i}— W UO 0 CO z. I .- C/) U- w o J U- =. F- O. w ~ w � o oco 13 �- w U U . Z H =. O i— Z doc: IBC- Permit D05 -246 Printed: 08 -30 -2005 I .�� Cit y of Tukwila f9D8 Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 PERMIT CONDITIONS Parcel No.: 2623049023 Permit Number: DOS-246 Address: 311 SOUTHCENTER MALL TUKW Status: ISSUED Suite No: Applied Date: 07/12/2005 Tenant: BUTTER LONDON LLC Issue Date: 08/30/2005 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: Fire retardant treated wood shall have a flame spread of not greater than 25. All materials shall bear identification showing the fire performance rating thereof. Such identification shall be issued by an approved agency having a service for inspection at the factory. 6: There shall be no occupancy of a building until final inspection has been completed and approved by Tukwila building inspector. No exception. 7: All electrical work shall be inspected and approved under a separate permit issued by the Washington State Department of Labor and Industries (206/248- 6630). 8: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of 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. 9: ** *FIRE DEPARTMENT CONDITIONS * ** 10: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the following concerns: 11: The total number of fire extinguishers required for a light hazard occupancy with Class A Ore hazards is calculated at one extinguisher for each 3,000 sq. ft. of area. The extinguisher(s) should be of the "all purpose" (2A, 10 BC) dry chemical type. The travel distance to any extinguisher must be 75' or less. (IFC 906.3) (NFPA 10, 3 -2.1) 12: Fire extinguishers shall not be obstructed or obscured from view. In rooms or areas in which visual obstruction cannot be completely avoided, means shall be provided to indicate the locations of the extinguishers. (IFC 906.6) 13: All electrical work and equipment shall conform strictly to the standards of the National Electrical Code. (NFPA 70) 14: This review limited to speculative tenant space only - special fire permits may be necessary depending on detailed description of intended use. doc: Conditions D05 -246 Printed: 08 -30 -2005 Z w � D UO C O 0 �w w� U - co d =w zF- Z0 �5 U ON o }- wW u. O .z W U= Z �g City of Tukwila 1909 Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 15: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of such condition or violation. 16: These plans were reviewed by Inspector 512. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575 -4407. 1 * *continued on next page ** doc: Conditions D05 -246 Printed: 08 -30 -2005 i s City o f Tukwila 1906 Department of Community Development / 6300 Southcenter BL, Suite 100 i Tukwila, WA 98188 / (206) 431 -3670 I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. i The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local laws 4 regulating construction or the performance of work. I ' i Signature: 4 M Date: Print Name: $-ASH 24 IM U 1 Z Z'% w u� D. UO CO) 0 W= CO) LL. W O' wQ = �W Z O. O N 0 WW I— U LL — — O: Z' U CO O Z dom Conditions D05 -246 Printed: 08 -30 -2005 (u, w CITY OF TUKWILA Community Development Department Public Works Department $ Permit Center 790E 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 w ` TUKWILA Building Permit No. Mechanical Permit No. Public Works Permit No. Project No. use 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 31 King Co Assessor's Tax No.: ��''Ly�04" !yzs Site Address SoLA 11-I C C N T(-V— , SEAT (!_k W . A 0 1* Suite Number: .0e, ! 2 1 Tenant Name: 6& VA-es" Lo N 1( C_ New Tenant: DO .....Yes ❑ ..No Property Owners Name: eVVA i ✓ MailingAddress: LC— W 4 $?f 03 City State Zip CONTACT PERSON Dame: S AS Vi . A /V) U I K Day Telephone: O G 4-s-4 — 5 5 5 ' Mailing Address: (625 52hct $1 • 5E A 77tLC— wA `jg(U-S 1 t City State Zip E -Mail Address: bUV� e✓ v%otlk ► C O v+l Fax Number: 206 -- 2 60 — 2-- 1 9 GENERAL CONTRACTOR INFORMATION - (Mechanical Contractor information on back page) Company Name: V1WQr 'i' A! L ' L— U? 1 dAJJ Mailing Address: 3$$O W (q A y . E'uGt eve—. O 1 4 4-U 2 City State 6 C, Zip Contact rPeerson: O A N C— `r hLS C--#%j Day Telephone: g' 1 — . — E - Mail Address: � ise S - Fax Number: S 4 1 — 6$ 4 — SS a.S Contractor Registration Number: t -C p I K I" 6r D =S 0 6 3 M E Expiration Date: (o f 1/06 * *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance ** ARCHITECT OF RECORD — All plans must be wet stamped by Architect of Record Company Name: Mailing Address: City State Zip Contact Person: Day Telephone: E -Mail Address: Fax Number: ENGINEER OF RECORD — All plans must be wet stamped by Engineer of Record Company Name: Mailing Address: City State Zip Contact Person: Day Telephone: E -Mail Address: Fax Number: q:\ plusticc changesNpennit application (7 -2004) Revised: 6.8 -05 Page ) bh r.(.0 .c v.. w.4.il -� :.5i.. �. {; w � 'r z , `s.4:i -:' 'r` £FiidtF:+�ue' !, t'.tr •.: .�', r ),•r � ..rte C ? �''ti�" ide3�r?it Z �z �W QQD J UO ND J = 1-^ NLL WO LLQ = �W Z H F- O Z U ON 0 F_ WW H - LL O Z U= O Z BUILDING PERMIT INFORMATION — 206 - 431 -3670 Valuation of Project (contractor's bid price): $ 20 t 00 Existing Building Valuation: $ Scope of Work (please provide detailed information): ( yWSI Ar4 t ,pt T t7 N 0 4- 4 SQ i VS 0 5 il< kU _A5CCann L r.0 WITH 1n) SoU rlA C C+QZC -, 2 00A44. Will there be new rack storage? ❑ ..Yes [A ... No If "yes ", see Handout No. for requirements. 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 for 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: Will there be a change in use? ❑ .... Yes ❑ ..No FIRE PROTECTION /HAZARDOUS MATERIALS: ❑.. Sprinklers ❑..Automatic Fire Alarm Compact: If "yes ", explain: hlandicap: ❑..None ❑ ..Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑.. Yes El.. No If "yes ", attach list of materials and storage locations on a separate 8 -1 12 x II paper indicating quantities and Material Safety Data Sheets. q:\Npermits pluskicc changes\permit application (7.2004) Revised: 6.8.05 bb Page 2 Z �z �W JU 0 N 0 CO J f_ N Li. W O LL. N = W Z �_.. H O Z F- W �p O N. 0 I— WW U LL. ~O .Z U N. O Z Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC 1' Floor � 2 M &TA e-- + w co,v ✓t- nK,Ea2 2n Floor 3 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 for 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: Will there be a change in use? ❑ .... Yes ❑ ..No FIRE PROTECTION /HAZARDOUS MATERIALS: ❑.. Sprinklers ❑..Automatic Fire Alarm Compact: If "yes ", explain: hlandicap: ❑..None ❑ ..Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑.. Yes El.. No If "yes ", attach list of materials and storage locations on a separate 8 -1 12 x II paper indicating quantities and Material Safety Data Sheets. q:\Npermits pluskicc changes\permit application (7.2004) Revised: 6.8.05 bb Page 2 Z �z �W JU 0 N 0 CO J f_ N Li. W O LL. N = W Z �_.. H O Z F- W �p O N. 0 I— WW U LL. ~O .Z U N. O Z PUBLIC WORKS PERMIT INFORMATION - 206 - 433 -0179 } Call before you Dig: 1- 800 -424 -5555 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Water District ❑ .. Work in Flood Zone ❑ .. Storm Drainage ❑ ...Total Cut cubic yards ❑ ...Total Fill cubic yards t i 1 r i Scope of Work (please provide detailed information): ❑ ...Tukwila ❑ ... Water District #125 ❑ .. Highline ❑ .. Renton ❑ ...Water Availability Provided Sewer District ❑ ...Tukwila ❑ ... Va1Vue ❑ .. Renton ❑ .. Seattle ❑ ...Sewer Use Certificate ❑ ... Sewer Availability Provided ❑ .. Approved Septic Plans Provided ❑ ...Septic System - For onsite septic system, provide 2 copies of a current septic design approval 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) ❑ .. Geotechnical Report ❑ ...Traffic Impact Analysis ❑ ...Bond ❑ .. Insurance ❑ .. Easement(s) ❑ .. Maintenance Agreement(s) ❑ ... Hold Harmless Proposed Activities (mark boxes that apply): ❑ ...Right -of -way Use - Nonprofit for less than 72 hours ❑ .. Right -of -way Use - Profit for less than 72 hours ❑ ...Right -of -way Use - No Disturbance ❑ .. Right -of -way Use — Potential Disturbance ❑ ...Construction/Excavation/Fill - Right -of -way Non Right -of -way ❑ ...Sanitary Side Sewer El. . Abandon Septic Tank ❑ ...Cap or Remove Utilities ❑ .: Curb Cut ❑ ...Frontage Improvements ❑ .. Pavement Cut ❑ ...Traffic Control El.. Looped Fire Line ❑ ...Backflow Prevention - Fire Protection " Irrigation " Domestic Water " ❑ ...Permanent Water Meter Size... I I WO# _ ❑ ...Temporary Water Meter Size.. WO# _ ❑ ...Water Only Meter Size............ WO# _ ❑ ...Sewer Main Extension ............Public Private ❑ ...Water Main Extension .............Public Private ❑ .. Grease Interceptor ❑ .. Channelization' ❑ .. Trench Excavation ❑ .. Utility Undergrounding ❑ ...Deduct Water Meter Size ........ " a _ tL W . �5 JU 00 CO) 0. W= J H C0 LL W O J LLQ � O �W Z f.. L-- O Z H W 0 U to O E-. W W H U_ O' W Z U C0 ~O H Z FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) ❑ ...Water ❑ ...Sewer ❑ .:.Sewage Treatment Monthly Service Billing to: Name: Mailing Address: Day Telephone: City State Zip Water Meter Refund/Billing: Name: Day Telephone: Mailing Address: City state Zip q:\Npennits plud�cc changma pennit application (7 -2004) Revised: 6 -8-05 Page 3 j bh MECHANICAL PERMIT INFORMATION — 206 - 431 -3670 MECHANICAL CONTRACTOR INFORMATION Company Name: Mailing Address: City state Zip Contact Person: Day Telephone: E -Mail Address: Fax Number: Contractor Registration Number: Expiration Date: * *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance ** Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): Use: Residential: New .... ❑ Commercial: New .... ❑ Fuel Type Electric ..... ❑ Gas .... ❑ Replacement .... ❑ Replacement .... ❑ Other: Indicate type of mechanical work being installed and the quantity below: Unit Type: Qty Unit Type: Qty Unit Type: Qty Boiler/Compressor: Qt Furnace <100K BTU Air Handling Unit >10,000 Fire Damper 0 -3 HP /100,000 BTU CFM Furnace >100K BTU Evaporator Cooler Diffuser 3 -15 HP /500,000 BTU Floor Furnace Ventilation Fan Connected Thermostat 15 -30 HP /1,000,000 BTU to Single Duct Suspended/Wall/Floor Ventilation System Wood/Gas Stove 30 -50 HP /1,750,000 BTU Mounted Heater Appliance Vent Hood and Duct Water Heater 50+ HP /1,750,000 BTU Repair or Addition to Incinerator - Domestic Emergency Heat/Refrig/Cooling Generator System Air Handling Unit Incinerator - Comm/Ind Other Mechanical <I0,000 CFM Equipment 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. f Expiration of Plan Review - Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. 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). 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 O ER O A RIZED AGENT: - I Z-D s Signature: Date: Print Name: SASHA LWM Day Telephone: 2 - 0 (0— 17SVT - 5.5-Vc- Mailing Address: (632S rJ S2^6k Sa- S 6A774—C %J A 9 10 City State Zip Date Application Accepted: Date Application Expires: Staff Ini '31s: q:\tpermils plus\icc changes\permit application (7 -2004) Revised: 6.8.05 rage 4 bh Z �Z '~ W tQQr � JU UO U C0 11.1 J = H N U_ WO �Q U� = W Z F=- F- O Z H- W W U� O� OH W H� LL ..Z W U= O F. Z �g City of Tukwila Y90B 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 s UO C o w= U. w On U- C* d =w z �. H O z F-- 5 �p O� O H WW S u- ~O — Z N 1= _ O F"' Z RECEIPT Parcel No.: 2623049023 Address: 311 SOUTHCENTER MALL TUKW Suite No: Applicant: BUTTER LONDON LLC Permit Number: Status: Applied Date: Issue Date: D05 -246 APPROVED 07/12/2005 Receipt No.: R05 -01283 Payment Amount: 401.50 Initials: BLH Payment Date: 08/30/2005 03:54 PM User ID: ADMIN Balance: $0.00 Payee: BUTTER LONDON LLC TRANSACTION LIST: Type Method Description Amount ---- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - -- Payment Check 1405 401.50 ACCOUNT ITEM LIST: Description Account Code Current Pmts ------------------------ - - - - -- ---------- - - - - -- ------ - - - - -- BUILDING - NONRES 000/322.100 397.00 STATE BUILDING SURCHARGE 000/386.904 4.50 Total: 401.50 6684 08/31 9710 TOTAL 401.50 j doc: Receipt Printed: 08 -30 -2005 J ,�rl1U1. �A City of Tukwila face 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 RECEIPT f Parcel No.: 2623049023 Permit Number: D05 -246 Address: 633 SOUTHCENTER MALL TUKW Status: PENDING Suite No: Applied Date: 07/12/2005 Applicant: BUTTER LONDON LLC Issue Date: Receipt No.: R05 -01008 Payment Amount: 260.00 I Initials: BLH Payment Date: 0711 212005 12:36 PM User ID: ADMIN Balance: $401.50 i , I I Payee: BUTTER LONDON LLC , i TRANSACTION LIST: Type Method Description Amount y -- - - - - -- -- - - - - -- ------ P-------------= - - - - -- ------ - - - - -- } Payment Cash 260.00 j i i ACCOUNT ITEM LIST: Description Account Code Current Pmts BUILDING - NONRES 000/322.100 1.18 i PLAN CHECK - NONRES 000/345.830 258.82 3 Total: 260.00 i. ! .G.:. a I ! tit-7( Ji� doc: Receipt Printed: 07 -12 -2005 Z �W J V' tU 0 N o. U) J !2 O: W s: J u- �. � d = W z �-- t— O z� W U O. O D F-- W W _.. U Z'. co) O z PLAN REVIEW��ROUTING SLIP i ACTIVITY NUMBER D05 -246 DATE: 7 -12 -05 PROJECT NAME: SITE ADDRESS I= SOUTHCENTER MALL X Original Plan Submittal Response to Correction Letter # i Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS ALLG, : -0 !� 6,12 w" q_Z Bui 1 g Division Fire Prevention Public Works Structural ❑ No further Review Required ❑ pllUl tt/l- 1-14 -0 Planning Division Permit Coordinator. DUE DATE: 7-14-05 Not Applicable ❑ Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TOES /THURS RO ING: Please Route M Structural Review Required ❑ REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS Approved ❑ Approved with Conditions Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: DETERMINATION OF COMPLETENESS (Tues., Thurs.) Complete d Incomplete ❑ Comments: Documents/routing slip.doc 2.28 -02 .:a, ,t _�.. _ .i. �.o: .!:d ".C;'r. ��.,ti ;}:,..:.p.., �.. rtitaS ..r<:, -ra.�u „:.�, sj, t, . cc..» tN1s : roia :it ,.��. d. •' ' ''� .� DUE DATE: 8-11-05 Not Approved (attach comments) ❑ z �z � J' W U 00 y0 W J � G7 U. w L L �D = �. w Z WO W U0 0 0� W W �� LL 0 . z . W U= O~ z Look Up a Contractor, Electrician or Plumber License Detail z i Washington State Department of Labor and Industries i 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 i liability insurance. s License Information License KINGRS1966PA Licensee Name KING RETAIL SOLUTIONS INC Licensee Type CONST RUCTION CONT RACTOR UBI 600153094 Ind. Ins. Account Id SECRETARY Business Type CORPORATION Address 1 P 0 BOX 21910 Address 2 City EUGENE County OUT OF STATE State OR Zip 974020413 Phone 5416862848 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 10/1/2004 Expiration Date 10/1/2006 Suspend Date Separation Date Parent Company Previous License KIN G D 11 0 63ME Next License Associated License Business Owner Information Name Role Effective Date Expiration Date LONDAHL, KRIS PRESIDENT 10/01/2004 DEAL, ALAN SECRETARY 10/01/2004 VOLM, WILLIAM VICE PRESIDENT 10/01/2004 Bond Information Bond Company Bond Account Effective Expiration Cancel Impaired Bond Received https:H fortress .wa.gov /lni /bbip /printer.aspx ?License= KINGRSI966PA Page 1 of 2 08/04/2005 z �z "�- W JU U ND co Uj J � (0) LL W 0 O J U? N CY = W H H O Z F— �O 09, W H� LLO .• z W U =: O ~. z F File: DO5 -0246 35mm Drawing #1 -6 F If xAw , v PU9JC COR1. 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