HomeMy WebLinkAboutPermit D2000-051 - DW CLOSE - STORAGE RACKSD. W. CLOSE
D2000-051
City of Tukwila
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands:
Contractor
OCCUPANT
OWNER
CONTACT
CONTRACTOR
WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES,
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
734920 -0040
4304 S 131 PL
AWSE
DEVPERM
C /LI
RACKS
001
North:
125
.0 South:
Sewer:
Slopes:
License No: DWCLOC *21305
Construction Valuation: $
PUBLIC WORKS PERMITS: *(Water
Curb Cut /Access /Sidewalk /CSS:
Fire Loop Hydrant:
Flood Control Zone:
Hauling:
Land Altering:
Landscape Irrigation:
Moving Oversized Load:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Print Name:
This permit shall become null and void
180 days from the date of issuance, or
for a period of 180 days from the last
DEVELOPMENT PERMIT
Fire
.0 East:
TUKWILA
N
.00
Permits
Meter
N
N No:
N
Amentremeatecesteram
Permit No:
Status:
Issued:
Expires:
Occupancy:
UBC:
Protection:
.0 West:
Streams:
Phone:
Phone:
D W CLOSE
4304 S 131 PL, TUKWILA WA 98168
NORMED SHAW PTN
P 0 BOX 3644, SEATTLE WA 98124
JOHN RUST
4304 S 131 PL, TUKWILA WA 98168
DW CLOSE COMPANY INC
1701 W GOLF RD STE 1012, ROLLING MEADOWS,
'****************************************************** * * * * * * * * *. * * * * * * * * * * * * * * * * * * * **
Permit Description:
INSTALL SHELVING RACKS
********•********************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Phone:
IL 60008
D2000 -051
ISSUED
03/06/2000
09/02/2000
1997
.0
1
N Start Time: End Time:
N Cut: Fill:
N
N Start Time:
N No:
N Private: N
N
N Private: N .Public: N
Date:
End Time:
, Public: N
(206) 431 -3670
206 -835 -7203
206 - 835 -7203
Listed Separate) Eng. Appr:
Size(in): .00
***************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 43.28
***************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Center Authorized Signature: 4 Date: 3 (e
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 t h i s permit does not presume to give authority to violate or
cancel the provision of any other state or local laws regulating construction
or the performance of work. I am authorized to sign for and obtain this
development permit.
_ \okca o a
if the work is not commenced within
if the work is suspended or abandoned
inspection.
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:CITY OF TUKWILA
Address: 4304 S 131 PL Permit No: 02000-051
Suite:
Tenant: Status: APPROVED
Type: DEVPERM Applied: 02/22/2000
Parcel #: 734920-0040 Issued:
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Permit Conditions:
1. No changes will be made to the plans unless approved by the
Engineer and the Tukwila Building Division.
2 All permits, inspection records, and approved plans shall be
available at the Sob site prior to the .tart of any con-
struction. These :documents are to be maintained and avail-
able until fina1 inspection approval is granted.
3. All construction,tobe done in conformance with approved
plans and requirements of the Uniform Building Code (1997
Edition):-aS Uniform Mechanical Code (1997 Edition),
and Washington State Energy Code (1997 Edition).
4. Validity of Permit. The issuance of a permit or approval 'of
plans“specifications, and Computations shall not be con-
struicCto',be a permit for, or an approval of, any violation,,
of any of the provisions of the building code or of any
other ordinance of the jurisdiction. No permit presuming to
give authority to violate or cancel the ,provisions of this
code'shall be valVd.
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Description of work to be done:
/xAS? S elvi• yJ
Existing use: in Retail ❑ Restaurant ❑ Multi- family Warehouse ❑ Hospital
❑ Church ❑ Manufacturing ❑ Motel /Hotel ❑ Office
❑ School /College /University in Other
Proposed use: ❑ Retail ❑ Restaurant ❑ Multi - family ,Warehouse ❑Hospital
❑ Church ❑ Manufacturing ❑ Motel /Hotel ❑ Office
❑ School /College /University ❑ Other
Will there be a change of use? ❑ yes J "t no
If yes, extent of change: (Attach additional sheet if necessary)
Will there be rack storage? It yes ❑ no
Existing fire protection features: r7i sprinklers ❑ automatic fire alarm ❑ none ❑ other (specify)
Building Square Feet: existing
Area of Construction: (sq. ft.)
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes . no
Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating quantities & Material Safety Data Sheets
Project am / n
AV . (- C.Vo S COQ,
Value of Construction: ¢:.-
Site Address: S , '3/ /L 5.�1
e- J4 ��jj 66 City State/Zip:
Tax 3,f4,2 A —60e/6
,
Propesty Owner:
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Phone:
24 2 yA- .7 - 2,z8 -
Street Address:
4 93o t/ s i3) , 5-e•
City State /Zi :
s-49- 9t /6
Fax #:
'6 . -33)5 .
Contractor:
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Street 2 / S
S.c'A7/42- 4 City S
Fax 2.66 1-se— c35/3a
Architect l
Phone: y 33-R-79 7
Street Address: City State /Zip:
/ 2720 C��.e.�.,)•¢r byr 5 ) -- 98/6e
Fax #:
2.,6 2 y6 - S-3 36 g
Engineer:5,sc / ,
Phone:
Street Address:
x.11 2.2 — ,x4 4 S E
City State /Zip:
State /Zip:
.0,a7" &+s ,r031
Fax #:City
Fax #:
Contact Person.
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Ph .2.06 8 S- 7.203
Street Address:
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Fax #:
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CITY OF TUh UVILA
Permit Center
6300 Southcenter Blvd., Suite 100, Tukwila, WA 98188
(206) 431 -3670
Commercial / Multi - Family Tenant Improvement / Alteration Permit Application
Project Number::'
Permit Number:
Application and plans must be complete In order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
APPLICANT; REQUEST.FOR PUBLIC. W. ORKS:SITE1CIVILPLAN.REVIEW..OF THE FOI LOWIN
(Addit)onal:reviews may be ' determined by the Public Works Department)
❑ Channelization /Striping ❑ Curb cut/Access /Sidewalk in Flood Control Zone ❑ Hauling
❑ Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Land Altering 0 Cut cubic yds. 0 Fill cubic yds. ❑ Landscape Irrigation
❑ Sanitary Side Sewer #: ❑ Sewer Main Extension 0 Private 0 Public
❑ Storm Drainage ❑ Street Use ❑ Water Main Extension 0 Private 0 Public
❑ Water Meter /Exempt #: Size(s): 0 Deduct 0 Water Only
❑ Water Meter /Permanent # Size(s):
❑ Water Meter Temp # Size(s): Est. quantity: gal Schedule:
J O Miscellaneous /Z- ,,7�#D
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. The building official may extend the time for action by the applicant for a period not exceeding 180 days upon written request by
the applicant as defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once.
Da�plic�a�ted:
D lica
2 x»
Appl alio tgItlals)
PLEASE SIGN BACK OF APPLICATION FORM
CTPERMIT.DOC 1/29/97
BUILDING OWNER OR ■ •
. OR/ZED AGENT:
Signatu - • '�
-
Date: •
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Print nal
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ALL COMMERCIAL/MULTI -F.'LY TENANT IMPROVEMENT /AL RATION PERMIT APPLICATIONS
MUST BE SUBMITTED WITH THE FOLLOWING:
• ALLORAWINGS TO BE STAMPED BY WASHINGTON STATE LICENSED ARCHITECT,
STRUCTURAL ENGINEER OR CIVIL ENGINEER
D ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
• BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
■/A SUBMITTED
❑ ❑ Complete Legal Description
❑ ❑ Metro: Non - Residential Sewer Use Certification if there is a change in the amount of plumbing fixtures
(Form H -13). Business Declaration required (Form H -10).
Four (4) sets of working drawings (five(5) sets for structural work), which include :
❑ ❑ Site Plan (including existing fire hydrant location(s)
1. North arrow and scale
2. Property lines, dimensions, setbacks, names of adjacent roads, any proposed or existing easements
3. Parking Analysis of existing and proposed capacity; proposed stalls with dimensions
4. Location of driveways, parking, loading & service areas
5. Recycle collection location and area calculations (change of use only)
6. Location and screening of outdoor storage (change of use only)
7. Limits of clearing /grading with existing and proposed topography at 2' intervals extending 5' beyond property's
boundaries
8. Identify location of sensitive area slopes 20% or greater, wetlands, watercourses and their buffers (change of
use only)
' 9. Identify location and size of existing trees that are located in sensitive areas and buffer (TMC 18.45.040), of
those, identify by size and species which are to be removed and saved
10. Landscape plan with irrigation and existing trees to be saved by size and species (exterior changes or change
of use only)
11. Location and gross floor area of existing structure with dimensions and setback
12. Lowest finished floor elevation (if in flood control zone)
13. See Public Works Checklist for detailed civil /site plan information required for Public Works Review (Form H-
9).
❑ ❑ Floor plan: show location of tenant space with proposed use of each room labeled
❑ ❑ Overall building floor plan with adjacent tenant use; identify tenant space use and location of storage of
any hazardous materials; dimensions of proposed tenant space.
❑ ❑ Vicinity Map showing location of site
Rack Storage: If adding new racks or altering existing rack storage, provide a floor plan identifying rack
layout and all exit doors. Show dimensions of aisles, include dimensions of height, length, and width of
rack. Structural calculations are required for rack storage eight feet and over.
❑ ❑ Indicate proposed construction of tenant space or addition and walls being demolished
❑ ❑ Construction details
❑ ❑ Sprinkler details - details of sprinkler hangers, specifically penetrations in structure, i.e., roof; size of
water supply to sprinkler vault with documentation from contractor stating supply line will meet or
exceed sprinkler system design criteria as identified by the Fire Department.
❑ ❑ Washington State Non - Residential Energy Code Data shall be noted on the construction drawings.
❑ ❑ SEPA Checklist - if intensification of use (check with Planning Department for thresholds).
❑ ❑ Attach plans, reports or other documentation required to comply with Sensitive Area Ordinance or other
land use or SEPA decisions.
❑ ❑ Food service establishments require two (2) sets of stamped approved plans by the Seattle -King County
Department of Public Health prior to submitting for building permit application. The Department of
Public Health is located at 201 Smith Tower, Seattle, WA or call (206) 296 -4787. (Form H -5)
❑ ❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If no
contractor has been selected at time of application a copy of this license will be required before the
permit is issued OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal
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.
CTPERMIT.DOC 1/29/97
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2.000- 05 1
CITY OF TUKWILA. WA
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TRANSMIT Numbur: R9000237 Amount: tt 0 / 2 2 00 1 0 0 9
Payment. Method: CMCN Notition: D 4 CLOL:L [nit: WP.R
• • - • • • - • - • - • _ • 1. • • • - • - • • ^ I - • • ^ • • .• • • - • • - • • • . • - • - • • - • • - - • • _ . • - -• - • • . • . • r
'Pei-Mit No: D2000-051 Type: DEVPERM DEVELOPMENT PERMIT
Parcel Not 734920-0040
5itsAdOres3t 4304 S 131 PL
Totil 41.2O
This. Ntvment 43.28 Tutail ALL Pints: 43.2S
Balance: .00
kk+A***Wls.**A**.Asi*****A*
Account . Description Amount
• 000/322.10.0 BUILDING - MGNRES 23.50
:.. 000/3.45 .830 PLAN CHECg - NONRES 15.21
. 000/ SIVE BUILDING SUPCNARGE 4.50
11-.AOSMil
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1858 02/24 9717 :TelTA
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Type of Inspection: 1 1 r
Merti- cira-ho» C 1-4 In -c
Special instructions:
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INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
Approved per applicable codes.
COMMENTS:
' INSPECTION RECORD
Retain a copy with permit
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PERMIT NO.
(206)431 -3670
0 Corrections required prior to approval.
El $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No:
Date:
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Date cal ed• -
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Date wan5 / /0 ix . .
Addr
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Special instructions:
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Phone: 01,./03
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98
p$NOMMINMMEMSEMessmtwo OIMI$taMaGnti.
par
PERMIT NO.
06)431-3670
VrAPproved per applicable aides. Li Corrections required prior to approval.
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14vic,
E=I $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No:
Date:
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City of Tukwila
Fire Department
Project Name i)14). 1 .L-o5e
TUKWILA FIRE DEPARTM
FINAL APPROVAL FO
Address . S • /3 / J
Retain current inspection schedule
1 Needs shift inspection
Sprinklers:
Fire Alarm: 4/
Hood & Duct: 4/
Halon: Ai
Monitor:
Pre -Fire: ti/
Permits:
Authorized Signature
;INALAPP.FRM Rev. 2/19/98
X Approved without correction notice
Approved with correction notice issued
John W. Rants, Mayor
Thomas P. Keefe, Fire Chief
P mit No. l/, e ) ''" e9 //
Suite #
�) � .3/9 j /
Date
T.F.D. Form F.P. 85
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575.4404 • Fax (206) 575-4439
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i rreial Information
r .To Build On
Lnginoor ng • Consulting • Tooting
March 14, 2001
742 -00056
Mr. Allen Olson
Hoffrita;t Construction
1200 Westlake Ave. N.
Seattle WA 98109
Subject.
We have completed the requested special inspections on the subject project. Our final report, dated
Decenlb :a 1, 2000 is numbered FR 9629.
WORTS. REQUIRED
Reinforced Concrete Inspection 3000 /4000psi
Epoxy I3olting Inspection
SoilsBackfill Compaction
Structural Steel Visual Welding /Bolting
Name
Project Address 12 ateway Drive, Tukwilla, WA
Permit Number
Reinforced Masonry Inspection
To the best of our knowledge, all work inspected conformed to approved plans, specifications, UBC, and
related codes, and/or verbal or written instructions from the Engineer of Record.
Sincerely,
Professional Services Industries, Inc.
Russell S. Bodge
District Manager
Cc: ' City of Tukwilla
Professional Service Industries, Inc. • 10025 South Tacoma Way, aH1 • Tacoma, WA 98499 • Phone 253/589 -1804 • Fax 253/589-2136
ZO'd ZZ:OT TOOZ VT jeW
MCI Switching Center
WORKED INSPECTED
Reinforced Concrete Inspection 3000 /4000psi
Epoxy Bolting Inspection
Soils/Backfill Compaction
Structural Steel Visual Welding/Bolting
Reinforced Masonry Inspection
92TZ- 68G- 2SZ:XPd
ISd
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D2000 - 051 DATE: 2 -22 -2000
PROJECT NAME: D W CLOSE
XX Original Plan Submittal
Response to Incomplete Letter #
Response to Correction Letter # _ Revision # _ After Permit Is Issued
DEPARTMENTS:
Building Division
Z-4
Public Works
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Fire Prevention
Niue "4-2:5
Structural
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete Fr Incomplete
Comments:
TUES /THURS ROUTING:
Please Route Fr Structural Review Required
APPROVALS OR CORRECTIONS: (ten days)
Approved
Approved
\PRROUTE.DOC
5/99
Approved with Conditions
Approved with Conditions
CORRECTION DETERMINATION: DUE DATE
Planning Division
Permit Coordinator
Not Applicable
No further Review Required
DUE DATE: 2 -24 -2000
REVIEWER'S INITIALS: DATE:
DUE DATE 3 -23 -2000
Not Approved (attach comments)
Not Approved (attach comments)
REVIEWER'S INITIALS: DATE:
REVIEWER'S INITIALS: DATE:
Ir
DEPARTMENTS:
Building Division
Public Works
Please Route
Approved
\PRROUTE.DOC
5/99
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D2000 -051 DATE: 2 -22 -2000
PROJECT NAME: D W CLOSE
XX Original Plan Submittal
Response to Incomplete Letter #
Response to Correction Letter # Revision # _ After Permit Is Issued
TUES /THURS ROUTING:
APPROVALS OR CORRECTIONS: (ten days)
Fire Prevention
Structural
n Structural Review Required
Approved with Conditions
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 2 -24 -2000
Complete Incomplete n Not Applicable
Comments:
No further Review Required
REVIEWER'S INITIALS: 'u- DATE:
DUE DATE 3-23-2000
Not Approved (attach comments)
REVIEWER'S INITIALS: 1 61 'k_ DATE: 21 2 2 7
CORRECTION DETERMINATION: DUE DATE
Approved n Approved with Conditions
Not Approved (attach comments)
REVIEWER'S INITIALS: DATE:
Please Route
ACTIVITY NUMBER: D2000 -051 DATE: 2 -22 -2000
PROJECT NAME: D W CLOSE
XX Original Plan Submittal Response to Incomplete Letter # _
Response to Correction Letter # _ Revision # _ After Permit Is Issued
DEPARTMENTS:
Building Division
Public Works
\PRROUTE.DOC
5/99
PLAN REVIEW /ROUTING SLIP
n
n
TUES /THURS ROUTING:
Fire Prevention
Structural
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete ri Incomplete
Structural Review Required
Approved ( 1 Approved with Conditions
n
APPROVALS OR CORRECTIONS: (ten days)
Approved 1 1 Approved with Conditions
REVIEWER'S INITIALS: I
Planning Division
Permit Coordinator
DUE DATE: 2 -24 -2000
Not Applicable
Comments:
No further Review Required ri
REVIEWER'S INITIALS: DATE:
DUE DATE 3-23-2000
Not Approved (attach comments) n
DATE: a -00
CORRECTION DETERMINATION: DUE DATE
Not Approved (attach comments)
REVIEWER'S INITIALS: DATE:
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Dear Sir:
City of Tukwila
Fire Department Thomas P. Keefe, Fire Chief
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Re: Rack at D.W. Close Company - 4304 South 131st Place
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February 25, 2000
Fire Department Review
Control 0)2000 -051 .
(511)
The attached set of building plans have been reviewed by
The Fire Prevention Bureau and are acceptable with the
following concerns:
1. Storage may not be closer than 36 inches in all
directions to ceiling - hung "Space or Unit" heaters. (UFC
1109.2)
Storage may not be closer than 18 inches below
sprinkler heads. (NFPA 13, 4 -2.5 and NFPA 231.5 -1)
2. In double row racks with heights of storage up to and
including 25', an average nominal 6" transverse flue space
between loads or at rack uprights shall be maintained.
(NFPA 231C 4 -3.1)
Maintain minimum 6" longitudinal flue space between
back to back racks. (NFPA 231C)
3. Where storage height exceeds 15 feet and ceiling
sprinklers only are installed, fire protection by one of
the following methods is required for steel building
columns located within racks: (a) one -hour fire proofing,
(b) sidewall sprinkler at the 15 foot elevation of the
column, (c) ceiling sprinkler density minimums as
determined by the Tukwila Fire Prevention Bureau. (NFPA
231C, 3 -2.3)
4. Aisles leading to required exits shall be provided
from all portions of buildings. Aisles located within an
accessible route of travel shall also comply with the
Building Code requirements for accessibility. (UFC 1204.1)
John W. Rants, Mayor
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575-4404 • Fax (206) 5754439
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City of Tukwila
Fire Department
Page number 2
5. Depending on the classification of the commodity being
stored and the size of the storage area, smoke vents and
curtain boards may be required by Table 81 -A of the Uniform
Fire Code. Contact the Tukwila Fire Prevention Bureau for
further information.
6. Depending on the classification of the commodity being
stored and the storage height, in -rack sprinklers may be
required per N.F.P.A. 231C. Contact the Tukwila Fire
Prevention Bureau for further information.
7. Refrain from blocking sprinkler coverage with
shelving. NFPA standard #13 states that any shelving or
decks in excess of 4 feet in width will require
installation of sprinklers thereunder.
8. High -piled combustible storage is combustible
materials in closely packed piles more than 12 feet in
height or combustible materials on pallets or in racks more
than 12 feet in height. For certain special- hazard
commodities such as rubber tires, plastics, some flammable
liquids, idle pallets, etc., the critical pile height may
be as low as 6 feet. (UFC article 2, sec. 209 -H)
Contact The Tukwila Fire Prevention Bureau to witness all
required inspections and tests. (UFC 10.503) (City
Ordinance #1742)
This review limited to speculative tenant space only -
special fire permits may be necessary depending on detailed
description of intended use.
Any overlooked hazardous condition and /or violation of the
adopted Fire or Building Codes does not imply approval of
such condition or violation.
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575 • Fax (206) 5754439
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City of Tukwila
Fire Department Thomas P. Keefe, Fire Chief
Page number 3
Yours truly,
The Tukwila Fire Prevention Bureau
cc: TFD file
ncd
John W. Rants, Mayor
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 5754404 • Fax (206) 5754439
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F625. 052.000 (8/97)
Detach And DispIa ■ Certificate
DEPARTMENT OF LABOR AND INDUSTRIES
REGISTERED._AS,.,PROVIDED. BY . LAW AS
CONST''`CONT G
RE GIST ' #; EXP DATE
CCO1 DWCLOC *21305 09/30/2000
EFFECTIVE DATE 09/25/1979
D W CLOSE COMPANY INC
1701 W GOLF RD STE 1012
ROLLING MEADOWS IL 60008
Detach And Display Certificate
L G
REGISTERED AS PROVIDED BY LAW AS Please Remove
CONST CONT GENERAL And Sign
REGIST. # EXP. DATE Identification
CCO1 DWCLOC *21305 09/30/2000 Card Before
EFFECTIVE DATE 09/25/1979
Placing In
D W CLOSE COMPANY INC Billfold
1701 W GOLF RD STE 1012
,ROLLING MEADOWS IL 60008
tgnature
Issued by DEPARTMENT OF LABOR AND INDUSTRIES
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