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HomeMy WebLinkAboutPermit D2000-079 - DEJA VU CLUB - REPLACED FIRE DAMAGED SHEDDEJA VU FIRE DAMAGE D2000-079 City of Tukwila Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 DEVELOPMENT PERMIT WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL. PERIOD EXPIRES, APPLICANT IS PROCEEDING AT THEIR OWN RISK. Parcel No: 004100 -0516 Permit No: D2000 -079 Address: 15011 TUKWILA INTERNATIONAL BL Status: ISSUED Suite No: Issued: 03/10/2000 Location: Expires: 09/06/2000 Category: AOT Type: DEVPERM Zoning: Const Type: V -N Occupancy: Gas /Elec.: UBC: 1997 Units: 001 Fire Protection: NONE Setbacks: North: .0 South: .0 East: .0 West: .0 Water: N/A Sewer: N/A Wetlands: Slopes: N Streams: Contractor License No: OCCUPANT DEJA VU CLUB Phone: 15011 PACIFIC HY S, TUKWILA WA 98168 OWNER KANG HE,E YEAL +SEE LEE z 1550 ALKI AV SW, SEATTLE WA 98116 1 CONTACT TOM VANCE Phone: 206 -824 -7176 w 22513 MARINE VIEW DR, #204, DES MOINES WA 98198 6 k***k*********• k***-*** kk*******' k*******• k**• k* k**• k** k****•k• k** * *k**•k * **•kk *k•k*•k** *•k*k* *** UO Permit Description: 10 REPLACE FIRE DAMAGED SHED w = **•k•k**•k**• k******•k• kk************• k***' k**• k*******• k******* k* •k** * **•k ** **•k **k** * * *k** * *k ** -J1-.. Construction Valuation: $ 5,000.00 w u- PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: w Curb Cut /Access /Sidewalk /CSS: N Fire Loop Hydrant: N No: Size(in): .00 u.j. Flood Control Zone: N Da Hauling: N Start Time: End Time: H = . Land Altering: N Cut: Fill: ?F--? Landscape Irrigation: N Moving Oversized Load: N Start Time: End Time: Ill uj; Sanitary Side Sewer: N No: 00 Sewer Main Extension: N Private: N Public: N 0(0 Storm Drainage: N p 1-` ' Street Use: N w w. Water Main Extension: N Private: N Public: N ��? 1 ******************** * ** * * * * * * * * * ** * * * * *** ** * ** *** ** **** * * * * * * ** * * * * * * * *•k * * * *•k* *•k * ** u. t TOTAL DEVELOPMENT. PERMIT FEES: $ 188.06 z. * *** * * ****** * * * ** ************** k**********• k****************** * * *•*•k* * * * **•k * *•k *•k *•k *•k* *; V fl) I-- _ O~ Permit Center Authorized Signature: I hereby certify that I have read and examined t1'i'is 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. ovis1 ance mit The grantin cancel the or the perfor developme Signa Print Name: his permit does not presume to give authority to violate or n of any other state or local laws regulating construction f work. I m authorized to sign for and obtain this B d • Date : 6 o' 7 e4*+p 1 iw�e�vxx nefNm; rags� 34V•S Ater. +.ss.»:.w• �+, w,,,;=• , (206) 431 -3670 Date: U f ) 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 CITY OF TUI(WILA Address: 15011 TUKWILA INTERNATIONAL BL Suite: Tenant: Type: DEVPERM Parcel #: 004100 -0516 Permit No: D2000 -0 Status: ISSUED Applied: 03/07/2000 Issued: 03/10/2000 ::l•• * *.k*•*** *•**• k• k*•*** k**** *•A*kk*•*•*•*•kk *** **;** **k* - 4k1A*1.* *•* * *** .* * *kk•k•k•* Permit Conditions: 1. No changes will be made to the plans unless approved by the Engineer and the Tukwila '2. All permits, inspection records, and: approved plans sha l l be available at the job site prior to the start of any con - struction. These 'documents are to be maintained and avail- able until final inspection ;approval is granted: 3. Electrical permitsshall;be obtained through the Washington State Div-ision of and Industries and. all electrical wort; Will : inspected by 'that, agency (248 -6630) 4. Plumbing permits shall' be obtained through the Seattle King County , Department of Public Plumbing will be inspected::by that :agency,, `. including all gas piping (29(- 722: ?, 5. All work shall be under separate permit issued by the C?ity of Tukwila,. Ali c onstruction to be done /in conformance with approved plans and requirements of the Uniform ;Building Code (1997 Fdsi_tion) as amended, Uniform Mechanical Code (1997 Edition), an:d;'Washingti n State Energy Code. (19,97. Edition) . Val'idity.., Perin The issuance of a permit or approval plans, specifications, and computations shall not be con str.ued to be :a permit for, or an approval of, any violation of 'airy ` the of the building code or of any other ord ir ance of the jurisdiction. No permit presuming to give; :authority "to violate or cancel the provisions of this l l be valid. z 1 re w U 0 0 wi J � 2 u. w u_ ? I- al z 1 _ Zo w UQ O -: w Z u Z ~ . 0 _ w U 2. 0 F- z Descri c tion of work to be done: PL AC .1 ,-- b 1 #c&cV.) - 1 Existing use: ❑ Retail ❑ Restaurant ❑ Multi- family ❑ Warehouse ❑Hospital ❑ Church ❑ Manufacturing ❑ Motel /Hotel ❑ Office ❑ School /College /University MOther Proposed use: ❑ Retail ❑ Restaurant ❑ Multi- family ❑ Warehouse CI Hospital ❑ Church ❑ Manufacturing ❑ Motel /Hotel ❑ Office ❑ School /College /University 171 Other Will there be a change of use? ❑ yes A no If yes, extent of change: Existing fire protection features: ❑ sprinklers ❑ automatic fire alarm Opone ❑ other (specify) Building Square Feet: existing new Area of Construction: 3Z5r 5 Will there be storage of flammable /combustible hazardous material in the building? Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating ❑ yes no quantities & Material Safety Data Sheets Project Name enant: t e 74 ?# �c 0-&-119- �1 c� Value of Constructio Site Ad ss: /5 # /G Ii 0. - 7 se) — role — et i , - City State /Zip: Is; T I �� -` � - D I L Property Owner: Phone: --1 re- y 1'I -T41-1 Street Address:, 1556 ik - SV City State /Zip: i- c6 L ( t, Fax #: A1 5 r, Contractor: ` r — }�t 1 V2vl Cs2, Cott-OA- Phone: 2 Cam, S24 — 7f 7 ' Street Addres : 22(3 Ma-0 /1-C U t e ._ Ptol t--+t City State /Zip: UJA 9SW,V Fax #: 2d6 8 z4 —2.6 Architect: v f D 4` SC Phone: ZbG tP 22- 7856 Street Address: City State /Zip: 3' (S Z) A- -ETc� \i-A ? Fax #: 2G Gz2 - I v Engineer: P4,- Phone: / Street Address: IJi City State /Zip: Fax #: Contact Person: \ 1 Phone: 7-- 024 - 71 7 to ( c, vti �I �� Street Address: Z- 1 A-41:12rlup , v f' Dz. City State /Zip: Fax #: 20 1 4 , 84 — - CITY OF TWe WILA Permit Center 6300 Southcenter Blvd., Suite 100, Tukwila, WA 98188 (206) 431 -3670 NCPERMIT.DOC 1/29/97 New Commercial / Addition / Multi - Family Permit Application Application and plans must be complete In order to be accepted for plan review. Applications will not be accepted through the mail or facsimile. PPLICANT REQUEST FOR PUBLIC,WORKS SITE/CIVIL PLAN REVIEW:;OF THE •(Addlbonal, rev /ews'may'be, deter itlneOEb'y {the Public:.W,orks;Departinerit)�,,. `; 4 k� �2 ❑ Channelization /Striping ❑ Curb cut/Access /Sidewalk ❑ Fire Loop /Hydrant (main to vault) #: Size(s): ❑ Flood Control Zone ❑ Hauling ❑ Land Altering 0 Cut cubic yds. 0 Fill cubic yds. ❑ Moving an Oversized Load: Start Time: End Time: in 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: ❑ Miscellaneous 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. Daticaac to : d D llexp : Applicat (initials) PLEASE SIGN BACK OF APPLICATION FORM BOIL ING • WN • R OR AUTHORIZED GE ', ,, Date: 0 S g .� - y� ,,.,„„ , i` Print- ea l 1 0 F-41 V-P Q201 C.–R..— .Pie ° - '= 7l"1 * ? 3 c �G��I'� 1 rl V( S'J7 S'S-z Ci tale /zi 1 oItk. , A- 9V)1c:19 ALL NEW COMMERCIAL/ADDITION/1W I- FAMILY PERMIT APPLICATIONS MU : E SUBMITTED WITH THE FOLLOWING: O RI c.� fto�L,p 't"s. Tp 4E STAMPED BY WASHINGTON STATE LICENSED ARCHITECT, STRUCTURAL ENGINEER OR CIVIL GIN ,. > ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED N/A SUBMITTED ❑ ❑ Copy of recorded Legal Description from King County ❑ ❑ Certificate of water /fire flow availability (Form H -11a). Contact the Public Works Department (206) 433- 0179 for servicing district. ❑ ❑ Certificate of sewer availability (Form H -11). Contact the Public Works Department (206) 433 -0179 for servicing district. ❑ ❑ 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). Five (5) sets of working drawings, which include : ❑ ❑ Site Plan 1. North arrow and scale. 2. Existing and proposed utilities and existing hydrant location(s). 3. Property lines, dimensions, setbacks, names of adjacent roads, any proposed or existing easements. 4. Parking Analysis of existing and proposed capacity; proposed stalls with dimensions. 5. Location of driveways, parking, loading & service areas, with parking calculations & location & type of dump - ster recycling screening. 6. Location and screening of outdoor storage. 7. Limits of clearing /grading with existing & proposed topography at 2' intervals extending 5' beyond property's boundaries, erosion control measures & three buffer protection measures. 8. Identify location of sensitive areas slopes 20% or greater, wetlands, watercourses and their buffers (TMC 18.45.040). 9. Identify location and size of existing trees, note by size and species those to be maintained and those to be removed. 10. Landscape plan with irrigation: Existing trees to be saved by size and species. Proposed: Include size, species, location and spacing. Location of service areas and vault with proposed screening. 11. Location of high water mark of the Green /Duwamish River if site is located within 200' of the high water mark. 12. Lowest finished floor elevation (if flood control zone permit required). 13. Civil plans to include 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. 14. See Public Works Checklist for detailed civil /site plan information required for Public Works Review (Form H -9). ❑ ❑ 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 ". Bullding,Owner/Autliorized Agent 11 the appllcaif is other than the owner,'registered archlfect/englrieer, or con ash(ngta notarized letterfrom: the property. owneratithorizing:the agent.to.sutimlt this: permit.appllcation.and.oblaln the permit will, be' required` as; part o%thIs stibmlttal: ❑ Vicinity Map showing location of site ❑ Building Elevations (Include dimensions of all building facades and major architectural elements) ❑ Mechanical Drawings ❑ Structural Drawings (detail of sprinkler hangers, pipe, duct & vent penetrations in structure) ❑ Architectural drawings ❑ Specifications (if separate document) ❑ Structural Calculations ❑ Sprinkler structural calculations indicating load of water - filled sprinkler piping ❑ Height Analysis ❑ Soils Report stamped by Washington State licensed Geotechnical Engineer ❑ Topographical and BoundarySurvey ❑ Tree Coverage Analysis (Multifamily only ) ❑ Washington State Energy Code Data and Non - Residential Energy Code Compliance Form H -7 ❑ Completed Land Use Applications if not previously submitted (i.e. SEPA, BAR, Variance, Shoreline or Tree permit) ❑ 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 Pub- lic Health is located at 201 Smith Tower, Seattle, WA or call (206) 296 -4787. (Form H -5) I HERE PENAL Y CERTI OF PER NCPERMIT.DOC 1/29/97 THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER URY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. �r�e' �e1�' rk�, 1�' iTM1 "1R!ttt'9M!rYp!KAA"N�7.MAtimnu. wan»• ceT,,. rt. e......,+- ..- o.�,,.a- ..n..,,.,..w..,,,�. ,...- ,.�.<, 7 z wl re Th . , . 1- iiD ), 00 .0 colli WI _1I ***************************,.”,*A******* ************************* 0 u_ CITY OF TUKWILA, WA -1)2,UUU— 0 TRANSMIT IL I 0 ************************************** ************************* 2 g=1 TRANSMIT Number: R9800246 Amount: 188.06 03/07/00 15:07 u.< Payment Method: CASH Notation: TOM VANCE Init: WER n E a Permit No: D2000-079 Type: DEVPERM DEVELOPMENT PERMIT i zi- Site Address: 15011 PACIFIC HY S Total Fees: 188.06 This Payment 188.06 Total ALL Pmts: 188.06 :ED III ui DO Balance: .00 OF- 41 lw 1 - , . z w w c) — — i 1 .... 1... o z If Account Code Description Amount 000/322.100 BUILDING - NONRES 111.25 .:000/345.830 PLAN CHECK - NONRES 72.31 000/386.904 . STATE BUILDING SURCHARGE 4.50 2215.03/08 9717 TOTAL 188.06 t SlawvAimv..1'.,,4ti•A:spcvd •i:thr t1/4.,-A•4 Prg(5L Vi Type . s 8 ectio : r ' Address: I cp t t ' TOKUJILA Date call/ 00 Special instructions: D a t ef/ g co ...c11 P.m. Re uester: Phpne: INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit r - Approved per applicable codes. PERMIT NO. (206)431-3670 Corrections required prior to approval. COMMENTS: at Dat 5? 09 ri $4 .00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No: Date: r iSakihotisk - • - :44.144:11 . - thtir4640A0a, • 4■Vddr. 'g 2 1_2 cew 00 (0 0 .J CO IL w 0 gr u_< 1— III Z 0 0. Z 1— W w D 0 1 _ Lu z 0 c° 01- clt o�ect: Type.offtspection: ss: _____ 15011 ( l i/14 la ( Date called:: U0 ` IUD .. � Special instructions: B ' vn ( C� Date rl: (�} 0 j a.m p.m. Requesw , w Phone ch_q _ - C l_/ I INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 Approved per applicable codes. INSPECTION RECORD Retain a copy with permit PERMIT NO. (206)431 -3670 Corrections required prior to approval. COMMENTS: efe..- TO Mc- ON ELe-c- `rte -(C4-- Fe- bbtvPCc( . S A-Prge,v-5 ©-' 3/ZS(o& $4 .00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. Receipt No: Date: Z CL 2 V 00, to co cm J W0 0. W z I- O z n. D o. 0 �': w W` U o lj z' W = O H- z • ct: T i pe � s ' bem A dr ��` � fir-{ �� Date called: l/ 3 r7 / UV Special instructions: Date wanted: nn a.m. Requester: Phoag:„ !_ _ ^77iO 9 7 INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 pproved per applicable codes. Corrections required prior to approval. COMMENTS: Date :; zo n $47.00 REINSPECTION FEE REQUIRED. Prior to inspectio , fe must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No: Date: • �" Ya�"vn' 'Lt ' ' ' i. 1. c.' x, .' +::.�i.:t.E PERMIT NO. (206)431 -3670 VK u. '• !dam" fA . , i ? i tifd n YiuYwstk. IAA 'AMA t z H H J U 0 0 CO o. W = W O. • Q � LL ?. co a. H Z O. .2 W n. ON o =W U ti C.) ( 22 O I- z Projec-E �� - (-{ Ct Type of Ip_s�tion !t-� Addre (' ( ._..- w (}fir, ( Date call M Special instructions: (L,' ` Date wan 1 16(� t (.J�J i r p.m. Request Phonec _g INSPECTION NO. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 tl � PERMIT NO. 6)41 -3670 „r V ® Approved per applicable codes. El Corrections required prior to approval. COMMENTS: , c72Lro- .. w4-ic. eD inAedeem exie e to /_7V 0 must b $47.00 REINSPECTION FEE REQUIRED. Prior to i n p ection fee must b e paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. Receipt No: Date: i1 ,:;.i:'Ka� Ei;; . >:ti4:AShcr:t. 1../APx':12;$0i ti'ia:4�'«�.uS.n' m�..� • rpi. k�sen i�xrec<.. • r ' , zz F Z re w U W • w J F w • 0 2 g J' LL Q ' co 2 = _ z � t— O • z w w U , O tn 0 1- ww w z U F , O Project: D 6 Ni L-) Type of-Inspection: 1 i k.--C k lc 10.- R ,l, I vl Address: • 1501 1 - Tu . I! Date called: Special instructions: ..e Date wanted. --,Ca.m. \ ')-• 1 p.m. Requesteg Phonr e21.4 ...7717 I • INSPECTION NO. r INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 P .1 PERMIT NO. Approved per applicable codes. 0 Corrections required prior to approval. COMMENTS: $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid (206)431-3670 at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No: Date: IONMEENNEMSMEMERVOWY1 AIY3fr. AvA 'IN z re w 0 0 w WI g -71 u. < S. a LU Z I— 0 Z W w 0 m 0 0 I— W u j I it- . z c.) .C 0 COMMENTS: Type of Inspection: Ik) V6 97647707t1 ci4E. i= r.ae-.c. htivagcnakt Date called: Special instructions: Date red;/ 0 n16o/T i ov ei 1€e 1 Gavee 4,e tti Ex... x-2 rt»P Fc G-c 7X'(cA4. ,e-w4. rz) MO $6" et A- ce.i> - .vlr EJ4A‘. WI Cdt.IC, m s c.g8 I ,077•</47 ,(orr ; 9 - e.47 . //eA (TG,m77D.c1 ,e r-e *'t Ok- TV r-_640%./6.-- C(M-41: GvooD A AldSP,Ccaety. Project: 1 VI Type of Inspection: Ik) V6 97647707t1 Address: 7/ /Afrc t5o -- ist.vp, Date called: Special instructions: Date red;/ 0 a.m. p.m. Re nester: MO Phone: INSPECTION NO. I k t 14 e., r INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 n Approved per applicable codes. , ❑ Corrections required prior to approval. El $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. Receipt No: Date: Yi PERMIT NO. (206)431 -3670 .;1.14i?`a;+ , c s . ' it lFikSiaiS'�: z W r4 00 W • u w }} g J LL ?. d . w ` Z H. Zo w U • co O co • 1- w V u. ai U = O 1- z Sprinklers: h Fire Alarm: ,c/ Hood & Duct: p/ Halon: /1 Monitor: /' Pre -Fire: Xi Permits: 1 l FINALAPP.FRM Needs shift inspection TUKWILA FIRE DEPARTMENT FINAL APPROVAL FORM Project Name P t_ j A U IA L a. Q Address 1 c o/ l 124r. h% . 5 Retain current inspection schedule Approved without correction notice Approved with correction notice issued < . -; / . Authorized Signature rv�.4*4" i+ � r :4Na .,��... City of Tukwila John W. Rants, Mayor Fire Department Thomas P. Keefe, Fire Chief Permit No. T.F.D. Form F.P. 85 1 Z _ 0o G� l Suite # Date Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575 -4404 • Fax. (206) 5754439 �"W::: « a.. a_._ ..fer.i.'u:.l�u"5:+�:..::i.�1J� Lii..b....[ll.l:.i. >':� . •.:��i.l.Imri wl u5 .:.1.'w.C+t...�1N✓..- ..rf�a.a.t z w 6 00 U o J = H cn u_ . w g Q = d . � w z �. � z � w U • 0 O D . o wW u' O w Z O z ACTIVITY NUMBER: D2000 -079 PROJECT NAME: DEIA VU FIRE DAMAGE SITE ADDRESS: 15011 PACIFIC HIGHWAY S XX Original Plan Submittal DEPARTMENTS: BuPlding Division WG �i 104 Pubaic orks III 4 Approved DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Response to Correction Letter # Revision # TUES /THURS ROUTING: Please Route REVIEWER'S INITIALS: PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP Fire Preiention /1 41 Structural Incomplete Structural Review Required APPROVALS OR CORRECTIONS: (ten days) Approved with Conditions Comments: REVIEWER'S INITIALS: CORRECTION DETERMINATION: \PRROUTE.DOC 5/99 Approved REVIEWER'S INITIALS: Approved with Conditions DATE: 3 -7 -2000 Response to Incomplete Letter # ma n n After Permit Is Issued Plann D ivision Permit Coordinator DUE DATE:3-9-2000 Not Applicable No further Review Required DATE: DUE DATE 4 -6 -2000 e Not Approved (attach comments) DATE: DUE DATE Not Approved (attach comments) DATE: �: ' • • .._ �' Signature REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST. # EXP. DATE " ; CCO1 TWVANC *223QM' 11/1.4/2000 EFFECTIVE DATE. . 11/14/1978: T W VAN COMPANY_ 22513 1 I IEW .R DES MOI ES W I 9098 111 «C111/ . , "i•i is tE,K ia'. • Issued by DEPARTMENT OF LABOR AND INDUSTRIES • z W QQ ' 2 00 W = w u-? = W 1 z wI- w U u) O - 0H ww L I O w z