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Home My WebLink AboutPermit B92-0420 - LITRAS RESIDENCE - FIRE DAMAGE REMOVALThis record contains information which is exempt from public disclosure pursuant to the Washington State Public Records Act, Chapter 42.56 RCW as identified on the Digital Records Exemption Log shown below. B92 -0420 Litras, Diana 4418 South 146th Street RECORDS DIGITAL D- ) EXEMPTIO THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION Page # tode Exemption = Brief Explanatory DeSctiptiop �t�tutel ule The Privacy Act of 1974 evinces Congress' intent that Personal Information — social security numbers are a private concern. As such, individuals' social security numbers are Social Security Numbers redacted to protect those individuals' privacy pursuant 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. to 5 U.S.C. sec. 552(a), and are also exempt from 552(a); RCW 552(a); RCW disclosure under section 42.56.070(1) of the 42.56.070(1) 42.56.070(1) Washington State Public Records Act, which exempts under the PRA records or information exempt or prohibited from disclosure under any other statute. Redactions contain Credit card numbers, debit card Personal Information — numbers, electronic check numbers, credit expiration 5, 17 DR2 Financial Information — dates, or bank or other financial account numbers, RCW RCW 42.56.230(4 5) which are exempt from disclosure pursuant to RCW 42.56.230(5) 42.56.230(5), except when disclosure is expressly required by or governed by other law. u 1 bI MJL rno) M E M O R A N D U M DATE: February 1, 1993 TO: Kim Hart /Finance FROM: Denise Millard /Permit Coordinator SUBJECT: Bond refund for Permit #B92 -0420 Litras Please refund $2,000.00 deposited with the City for a demolition bond on permit B92 -0420 by John Litras. Please see attached receipt. Please send to Department of Community Development, applicant will come in to pick up. Thank Youi1111 CITY OF TUKWILA TREASURER'S CHECK '6200 SOUTHCENTER BLVD. PH. 206-433-1800 TUKWILA; 8188 CITY OF TU 19 -10 30 1250 gfio-t/ro BANK TUKWILA.ANOOVER PARK BRANCH 161 ANDOVER PARK E. P.O. BOX I39923 SEATTLE. WASHINGTON 9919E14923 U.9. BANK OP WASHINGTON. NATIONAL ASSOCIATION ru C 1T,,, 1 .* gw+j • ��l � �t� • r • r .. �.. Y .'. t. Y�.z. 1 i Ocaezarv. ` t City of Thkyyili Community. Development / Public Works • 6300 Southcenter Boulevard, Suite 100 Permit No: B92 -0420 Type: B -DEMO Category: RES Address: 4418 S 146 ST Location: Parcel #: 004000 -0426 Wetlands: Water Dist: N/A Units: 001 Contractor License No:RONSBI222QC Signature: Print Name: The grantingf this permit or cancel the provi"s,i.ons of, constructi'� or',.the pe_rfo obtain this��u'i �•ing\ perm DEMOLITION PERMIT Slopes: Sewer Dist: N/A Buildings: 001 REMOVE: REMNANTS OF FIRE DAMAGED RESIDENCE. Investigation Fee:. Total Permit Fee: 5,.650: (206) 431 -3670 Tukwila, Washington 98188 Status: ISSUED Issued: 12 /07/1992 Expires: 06/05/1993 TENANT LITRAS DIANA L " ,_ Phone: 206 246 -3996 4418 S 146TH ST, ;';SEATTLE "WA98168= OWNER LITRAS DIANA L' Phone: 206 246 -3996 4418 S 146TH ST, .SEATTLE 'WA 98168 CONTACT MARKUS JOHN Phone: 206 432 -4730 27412 RETREAT-KANASKAT RD SE, RAVENSDALE, WA 98051 CONTRACTOR RONS BULLDOZING INC. Phone:`:.' 206 432 -0537 P.O:`'BOX 67, RAVENSDALE, WA. 98051 ********************************************** * * * * * * * * * * * * ** * * * * * * * * * *k * * ** Permit Description: Valuation: Demol iti/on Fe'e.: .30..00 Cash �.�,Bond: .. 2;000. 00. Bond ;Number: CASHIER - CK- *********.********** * * * * * * * * * * * * * * * * * * * * * * * ** .00 2,030.00 Permit Center`Autho,rized Signature Date I hereby;..cert,ify. that I have read and ex amined this` permit and'know -`the same to be ;;true and correct. All provisions ;'of law :and..`ordi,n`ance.s" : governing this work will be complied with, whet,herecified.herein or not does not presume to` gi.v;e: authority to violate ny other `state or "local laws `rega,ting ce of work. I am_ .authori ze;d to ;si;gn for an This permit shall become null and void °`1f` 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 NO. CONTACTED DATE READY DATE NOTIFIED -� ((�� ^ -l� BY: (init.) PERMIT EXPIRES 2nd NOTIFICATION BY: (init.) AMOUNT OWING �' .00 3RD NOTIFICATION BY: (snit.) -- ,, ,, PLAN CHECK NUMBER INSTRUCTIONS TO STAFF • Contacts with applicants or requests for information should be summarized in writing by staff so that any time the status of the project may be ascertained. • Plan corrections shall be completed and approved prior to sending on to the next department. • Any conditions or requirements for the permit shall be noted on the plans or summarized concisely in the form of a formal letter or memo, which will be attached to the permit. • Please fill out your section of the tracking chart completely. Where information requested is not applicable, so note by using "N /A ". BUILDING SQUARE FOOTAGE/OCCUPANCY INFORMATION (to be filled out by Plan Checker) • SQUARE FEET OCC. LOAD SQUARE FEET OCC. LOAD SQUARE FEET OCC. LOAD SQUARE OCC. FEET LOAD SQUARE OCC. FEET LOAD TOTAL SQUARE FEET TO` • DEPARTMENTAL REVIEW "X" in box indicates which departments need to review the project. BUILDING - initial review N FIRE PLANNING PUBLIC WORKS 0 OTHER 54 BUILDING - final review PROJECT NAME , SUITE NO. SITE ADDRESS 44 LS 5 1 --110 t I c a3-a 25 14092.00 REVIEW COMPLETED PPRO 2592 R. (ROUTED) INIT: INIT: INIT. Zg 5- 5 2 - BUILDING "'ERMIT APPLICATION TRACKING CONSULTANT: Date Sent - FIRE PROTECTION: FIRE DEPT. LETTER DATED: / A}— INSPECTOR: ZONING: REFERENCE FILE NOS.: INIT:C 4 /025/92. INIT: �C,D MINIMUM SETBACKS: N- S- UTILITY PERMITS REQUIRED? (l Yes (k'No PUBLIC WORKS LETTER DATED: TYPE OF CONSTRUCTION: JA UIR Sprin lers ) Detectors Date Approved - IBAR/LAND USE CONDITIONS? ( )Yes N/ UBC EDITION (year): TOTAL OCC. LOAD n No SITE ADDRESS 0 SUITE # (0117 - f ' VAL.{ OF CONSTRUCTION - $ ` 6 5-0 ° -° , r - e, l L /•r,e4s- — r 0 r•-_.. • �► Iz RA, ESSOR ACCOUNT # R ACCOU .4 00 .05 k)- c PL (commercial) 5§ Demolition (building) ❑ Other ' PRO JE NAME/TENANT _ Lk (`> > �) k k .New TYPE OF Building L) � Addition ❑ Tenant Improvement WORK: ❑ Rack Stora e ❑ Reroof ❑ Remodel (residential DESCRIBE WORK TO BE DONE: 1 , v.,e._ V nam i re . j r{?S ( c e _ I - -. ' �� /g:0 �J2�c . - A I S n r € 1 G- -K -I-'- • gym. Imp , - r.. �. t rilti' ✓ - OW UILDING USE (office, wareh.trse, etc.) /� ) • ' g/4711__ ?/ , ; 55 (09 L --- RUC c= ADDRESS NATURE OF BUSINESS: WILL THERE BE A CHANGE IN USE? 'INo ❑ es If Yes, new building requirements may need to be m et. PI ase explain: SQUARE FOOTAGE - Building: Tenant Space: IV 4 Area of Construction: nu. Xi !! (`f7J THERE BE STORAGE OR USE OF FLAMMABLE, COMBUSTIBLE OR HAZARDOUS MATE IALS IN THE BUILDING? No ❑ Yes IF YES, PLAIN: t Or i4-E- ) L-c. IV /�T/ 4 c_ -k j tlgc iv . r � � f? � � 1 4-e d rf/l.i PROPERTY OWNER . 0.i(et) r / «A L /•r,e4s- — r 0 r•-_.. • �► Iz RA, ,U PHO a PHONE 14 'e1'1 al.- EXP. DATE ( ciq ZIP �7� g ZIP SO C ADDRESS 5' ��1� n �� /g:0 �J2�c . - A I S n r € 1 G- -K -I-'- CONTRACTOR {„� On � -_ 1 ADDRESS Q1 S WA. ST. CONTRACTOR'S LICENSE # * ARCHITECT Ls iYI d / k d rf/l.i d!/ : _ PHONE r f 3 1 -.3 Q 4 ADDRESS:2 )Z 4 rRc- 4r i f" et4t4S �G L , ciush14 C..� 0 ZIP qp , CITY OF TUKWILA Department of Community Development - Building 6300 Southcenter Boulevard, Tukwila WA 98188 (206) 431 -3670 tt'. g a - l� PLAN CHECK NUMBER BUILDING OWNER OR AUTHORIZED AGENT CONTACT PERSON I HEREBY CERTIFY THAT t. HAV EiAD AND;EXAMINED THIS A .LIGATION A l BE: TRUE: AND CORRECT AND AUTO ORIZED.TO:`APPALY FO ::THIS PERMIT. SIGNATURE PRINT NAME ADDRESS DATE APPLICATION ACCEPTED BUILDIK PERMIT APPLICATION Division DESCRIPTION `. • BUILDING PERMIT. FEE PLAN CHECK FEE <': • AMOUNT ;: RCPT # BUILDING SURCHARGE OTHER: J64-) w 4/1/ K 7):6" �� ii � fteCITY/ZIP � l 4 t : L � • ��. ( PHONE 1 ( 0 1 4 0 DATE APPLICATION SUBMITTAL In order to ensure that your application is accepted for plan review, please make sure to fill out the application completely and follow the plan submittal checklist on the reverse side of this form. Handouts are available at the Building counter which provide more detailed information on application and plan submittal requirements. Application and plans must be complete in order to be accepted for plan review. VALUATION OF CONSTRUCTION Valuation for new construction and additions are calculated by the Department of Community Development prior to application submittal. Contact the Permit Coordinator at 431 - 3670 prior to submitting application. In all cases, a valuation amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Building Division to comply with current fee schedules. 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. EXPIRATION OF PLAN REVIEW Applications for which no permit is issued within 180 days following the date of application shall expire by limitations. 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 304(d) of the Uniform Building Code (current edition). No application shall be extended more than once. If you have any questions about our process or plan submittal requirements, please contact the Department of Community Development Building Division at 431 -3670. DATE APPLICATION EXPIRES PHONE %/ Z 4' 73 0 03/16/91 COMMERCIAL NEW COMMERCIAL BUILDINGS/ADDITIONS : • • : ••••. ' . ' ' -*: • Completed bUilding permit application (one for each structure) Assessor Account Number:.;.. Y.. . Two sets (2) of the following: • :: Specifications • Structural calculations stamped by a Washington State licensed • Soils report stamped by a Washington State licensed engineer TopographiCal:suri/ey Energy calculations stamped 1)i :a Washington State engineer or architect .;,.. , • Working • .. drawings stamped by „. . architect, which include Site plan Architectural drawings Structural drawings Mechanical dmwirigs Elevations Civil drawings Landscape plan •-• ••• one p NOTE See utility permit application and checkllst for peciflc ut,ls ........ RACK ST ORAGE :.” • i•-••••:- frdihci' ................................. • . . •• • ••• ‘.. C°n1 Assessor Account Number . . s. • Two (2) of plans which include • • • rec • . .„.. Buildin 'floo : • '1;1•"her9:• . aisles and • Dimensions of all alsles • • ••• • • r floor plan .ex4a. . . • •• ..• • storage NOTE Include dimensions of racks (height, width and length) a/s/os • and exit ways.citt plan ri Structural • • CalcbtatiOnS • engineer (rack.etarage end • •••:::••••'••••••::.'":..::••:.:..::::•.:.": ..... RESIDENTIAL Completed utility permit application Six (6) sets of civil drawings NEW S1NGLE FAMILY DWELLINGS/ADDIT1ONS ii . building permit application (one for.pach:etruCtOre): ri.(e description • Assessor Account Number Two sets (2) of working drawings which include Site plan ( p/ar, show closest hydrant location Fo undation . .. .• ... . Include access to bullcilng showing • :I • •• • . • . 14. Building Building cross section • StruptUrpl framing • Completed utility permit application Six (6) sets of site plans showing utilities NOTE Building alto plan and utility utflity.perrnfrapplfcp d h si .§p submittal requirements Additional topographical anc 1 soils OforMatipn may b4requirect unique,.. SUBMITTAL CHECKLIST • proposed Tenant spriCe p lan .. :CoftSt.i..14:1?;Cld.11!4:;'.(11.:1..;Ci::::‘'!•:::!::::':•4:dW:.:::.:::.::::::.:::: d method o :• wit . ... s.''!:::::::.:: to be....t „.. :Exit :doettir egress pattern alls ::• • os SeatiOnS'.6tiiiM**1:0';)ii513,cqop pr, , : a i6i and 01119g.:, Structural : C.iiiCi;laticio6itiiiiii sf iie . 11 , ijiiiWashinbtiiii:Stat4)16066cid . :,: enoi6e0•014y 1aciulred bi!i NOTE i ii p . • a -and plai*c:.: • Landscape plan (if applicable, I e change of use Overall building plan •••••.. • Tenant location • Use of adjacent (common Wall) tenant • • de molished ....... . ... . . : ... . . . .. . .. REROOF .. • L Completed building permIt application (one for each structure) Li Assessor Account Number r - Naative describing existing roof material being removed and material being installed NOTE A off . of ce rtification letter Completed building permit application :„... rn Assessor Account Number Two (2) sets of plans which include Site Plan (showing building and location of antenna/satellite disl ..• :• Strictural:"CalCOlatiOns: ...................................................................... R ESI O ENTIAL'::REm..,,OpELS.: , •:!•: ! : ,: ,...: : : . .. :: .. • • • • ...:,..,...• , —2-..:*'"':::,,:"'::::•,:•,::•:•:::',.:•:...:,.,::.:.••::.:.:•.:..•„, .......... .1:64M .u. : .:•••• ••,...• .. . Two dr : .. S ite p : :•:.:.:.::: .::....:„....... .!.'• Foihidat.i.c1?.!0.:::: • - •••Flopi'.:Olaq . ,,:;:::: : : : ,, !.Buildie4 • Bb11etele . (a I p l a ns 1: NOTE ew.,.,:.,,, S f ...• • • 1 Ptplarti:;:::: :*-:*11 4 an d • .'. plans ...,....,,.:. . k***A**************k*********k*******k****A*********k**********4 :nTY OF TUKWILA, WA TRANSMIT 4************k*******kk****k********k**k*A.******8****A**k******k TRANSMIT Number: 92001377 Amount: 30.00 12/07/92 08:S7 Permit No: B92-0420 Type: B-DEMO DEMOLITION PEitiSi Parcel No: 004000-0426 Site Address: 4418 S 146 ST • Payment Method: CHECK Notation: JOHN LITRAS Init: SU) • ***********************************************Ak****kkk****k*k* Account Code Description Paid 000/322.100 BUILDING - RES 3040 Total (This Payment): 30.00 Total Fees: Total All Payments: Balance: 2,030.00 2,030.00 .00 GENERA 30.00 TOTAL 30.00 CHECK 30.00 CHANGE 0.00 5819A000 1012 nIr *A 1TY OF TUKWILA, WA TRANSMIT ***k*********k****ItIt****4 TRANSMIT Number: 92001372 Amount: 2,000.00 12/03/922/44/00 Permit No 092-0420 Type: B-DEMO DEMOLITION PERMIT Parcel No; 004000-0426 Site Address: 4418 S 146 ST Payment Method: CHECK Notation: LITRAS JOHN )nit: SU) h*****h*k*************A******k****A************k*k*******k*k** Account Code Description Paid 000/386.908 BUILDING BOND/DEPOSIT 2,000.00 Total (This Payment): 2,000.00 . : Total Fees: Total All Payments: Balance': 2,030.00 2,000.00 30.00 GENERA • 2000.00 TOTAL 2000.10 CHECK 2000.00 ,.. CHANGE •- • 4).00 5724A000 '16218 CITY OF TUKWILA Permit No: B92 -0420 Status:, ISSUED Applied: 11/23/1992 Issued: 12/07/1992 Address: 4418 S 146 .ST Tenant: LITRAS DIANA'L ,Type: B- DEMO... Parcel #: 004000 -0426 * * * * * ** * * * * * * * * **** * *•k* * ** * ** kkk****************• k**• k * *'k *'k ***•k *'kk** **•k * *k'kk* Permit Conditions 1:• LIMIT DEMO ACTIVITY TO WITHIN 10' OF BUILDING EXTERIOR., ' 2. No changes will be made to the scope of work unless approved by Tukwila Building Division.. ........ 3` Remove all weeds, e - s concrettar t,i;on, flat con - crete, concrete , pa t s io„s , ma s wal ls, garage oors drive- ways and stmilar4tiOCtur0 all „loose mi.sc :;flaneous material .O s rom 4,00ot ,,orr ar�ce of. ground,' proper iy cap sanitary sew, -„a %p nd , watei � f i l l l l!o otherwise' pir alll..basements,, � , cel lar•s, y �4:septi s tank. wells ands` t�ber..exaaa =wh:ehe applicable y o'Pe.rrmi�t .f ation Th ss ua.ncle,. of a permit or�' apitova`;l o 4. Val iditoy r f �,- :plans, , peci l"catl o ns } compu shall `sno bQ c o ` ° +,! t',N strued u ' be a permit for,�,�.orian approval of, any G'lolatio of any ,.of the provisions of� `t i.s code or of any 'Other 4 F;. ordi a ` of theg: l ,„_ No permit presuming tb,�g auth t yoor- , violate orcance: mt'he-� -prov i s i ons of this cod sha Nba f. vat i d. > f ,a,.,.. �. , ."''' Val 1 t y n �of fPe..r�mi t ..�:Tfi - e < ss of : t or approval' a` o pla�1 spec 1f toe ti and compu,ta ohs ha -1.1 '````' not be con sttl .�� to bye par it' n, "oI\ an of, any vio:la0,C?n� of �onyy o G t �e pric�V i a'°f ont ' ' Bu l i ig. ~Cb' e or any '6 the - • o r di ` T ra n ce ;o` t he Gri, < tl; i = ti t i " o s, \ N"n p °p 7 esuming to gtve; aut 'its, or u :gr ;cano -h s of this' code li- "' 1 x.4 i f f , f' 4'4r �a r `' 6S p 0 #,. • `k,� s h a b e' . v a l i d'n + ,�r,, ,., 4 , / r ,,� � ” {� ,v ,- _. , � z . �ti � . � iP, t•} :r�`� �'� A t '� +� d.. ,,,,,,t04,, • r • : � , l / as ' o rs, `-7 ype o nspectb . / Address: 'Lt %' /a S s / Date Called: ,... .7_2.62—* Spedal Instructions: Date Wanted: 7 3 ...5 _ a " ..... n ' P.m. Requester: Phone No.: INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 pproved per applicable codes. COMMENTS: 0 yzel PERMIT N0. / (206) 431-3670 D C9rrections required prior to approval. 0 $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, tee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. " ro ect: ype o nspecton: .... 1"vc.f. ) Address; 1 +410; S.:, itqcilt Date Called: .. Special Instructions: ' Date Wanted: ( 9 .- 1 —.?„1. am. p.m. Requester: - Phone No.: P CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 iv Approved per applicable codes. 0 Corrections required prior to approval. COMMENTS: Inspector: 2 ' INSPECTION RECORDC Retain a copy with permit I Date: a (206) 431-3670 PERMIT NO, 0 MOO REI PECTIC:1N FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Dale: • ro : 1 ype o nspect • n: Air AL ress: 1 Je , 1 y : e .: /2-2-3—, 7 . Special Instruct ons: .,.r.a,:, Date Wanted: 1? �',�, / Z am. rR Requester: Phone No.: INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION `6300 Southcenter Blvd., #100, Tukwila, WA '98188 a PERMIT 7/ (206) 431 -3670 :.❑ Approved per applicable codes. COMMENTS: ' R O' 9R1-6478 ❑ $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Corrections required prior to approval. Date: 0. o INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 0 Approved per applicable codes. COMMENTS: Y o t-ktyv< A -Se-orrt c..- -rprt4)%... T1 LL- 1 1 - Ga.Atut..9 ■.4 c CskA1-4) C4‘ A. A-1-43 "M, ArinaT" ( 1» uvre■Pco A NA" TherJ (F-r(-(-e9 Inspector: (206) 431-3670 ta. Corrections required prior to approval. Date: i o $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd. Suite 100. Call to schedule reinspection. aurkA, La Yr" ns. ' ..1 5r)1,0 -3-mai Address: 44 1 44( to 6..T I Date Called: laZL-91-- Special Instructions: Date Wanted: l q 9 rn. p.m, r ) la J-Jt Ito Reouester: . phone - 0. o INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 0 Approved per applicable codes. COMMENTS: Y o t-ktyv< A -Se-orrt c..- -rprt4)%... T1 LL- 1 1 - Ga.Atut..9 ■.4 c CskA1-4) C4‘ A. A-1-43 "M, ArinaT" ( 1» uvre■Pco A NA" TherJ (F-r(-(-e9 Inspector: (206) 431-3670 ta. Corrections required prior to approval. Date: i o $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd. Suite 100. Call to schedule reinspection. Key. Bank of Washington BANK L7A K Seat , Wa shington 98111 -0090 Mombor FDIC`' �. TtJkW J LA,:,PLJ)r `D F AR fl'i'Eh�;t.y. X ;* ... x _ .. •x2 000. 00 t0NATURE REQUIRED FOR 835,000 AND OVER PAY: :TO. THE . :ORDER OF CASHIER'S CHECK NO ECK ; 250 BILL TO LEE'S SANITAT' SERVICE, INC. P.O. BOX 66537 SEATTLE, WA. 98166 PHONE - 242.6911 / 228.4282 / 839.3637 / FAX - 242 -1452 LICENSE NO. LEESSS347CM "COMPLETE SEPTIC TANK SERVICE - SIDE SEWERS - BULLDOZING" caQ C. INVOICE 47558 DATE P.O. NO. PHONE ' ! `0 3 ” yid - : /y6 r � u)AZY MN Zer 7 5 /5 CO LTq TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MWDDM) POLICY EXPIRATION DATE (MMIDDIr0 ALL LIMITS IN THOUSANDS A A ' GENERAL }{COMMERCIAL LIABILITY GENERAL LIABILITY 01 — AP - 117299 - 7 11/20/92 11/20/93 GENERAL AGGREGATE $ 1 II 0 " ? 1 $ 1 $ 1 000 PRODUCTS•COMPIOPS AGGREGATE PERSONAL & ADVERTISING INJURY CLAIMS MADE OCCURRENCE EACH OCCURRENCE , $ 111 $ 1 $ a AUTOMOBILE — -MALL OWNER'S & CONTRACTORS PROTECTIVE FIRE DAMAGE (ANY ONE FIRE) MEDICAL EXPENSE (ANY ONE PERSON) LIABILITY ANY AUTO OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON•OWNED AUTOS GARAGE LIABILITY ' 01 —AP- 117299 -7 11/20/92 11/20 CSL $ 50O .,, INJURY (PERRY (PER PERSON) $ ate t;t h N� j r_, i+ ;•} 4.r,�?: %:;�lu ,. •� <,�. '' ; +1'' '•' ' ' ', ) aODaY t INJURY ACCIDENT% $ PROPERTY DAMAGE EX C EXCESS - LIABILITY OTHER THAN UMBRELLA FORM ; +t'�� = '. `r.FT i. EACH OCCURRENCE $ AOOREOATE $ WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY ' ii'ir Sn_E ' "::..:a;.;•,ir;::,,. _ " "_ , � • $ (EACH ACCIDENT) $ (DISEASE•POLICY LIMIT) $ (DISEASE•EACH EMPLOYEE) OTHER z if 41 PRODUCER INSURED 4 ]t .i 's}•:� { fin +, �v "�,� r• fl .:�, Sr» .�. .... r:�,r ;: �� •.t��•'.+s i., ::�rY. r U'4)t;�.( ef. .44 '3 nfy 'i i';%" ``4"i• L +Arar,y iG' ^,f . i . I < ,.. � •� +,fi,+ �,.• ; ry �r �R.; !� , i'F' + "a ..; �t >, ; 4 . e-,,, r� r c yr'. • k;� , t .t; .ru „fS�� `liil'rY'.:•:�r t;rr..-RV,r ��w '..:rl .t; f1•,t�..ix ,.�,u' � i }.t, �t.,.✓J}L.. .rv.rP�F i• (I HUMBLE & ASSOCIATES INS., INC. P.O. BOX 1150 RECE RENTON, WASH. 98055 RON'S BULLDOZING P.O. BOX 67 RAVENSDALE, WASH. 98051 DEC 0 719 OEM Q R I f 5 n "Y (QQqMPANY ' LETTER COMPANY C LETTER COMPANY LETTER COMPANY c LETTER tai i 1 A tp,T,: F � LETTER A AMERICAN STATES, INS., INC. ISSUE DATE (MMIDD/YY) e; 12 /1/92 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, I TiND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OF) CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND. CONDI- TIONS OF SUCH POLICIES. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BB CANCELLED BEFORE THE EX. PIRATION DATE THEREOF, THE 'ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI D UPON THE COMPANY, ITS AGENTS OR REP ESENTATIVES, AUTHORI7.:D R CITY OF TUKWILA 6300 SOUTHCENTER BLVD TUKWILA, WASH. 98188 ATIN: SHELLY C44L: P'•A ON 8B DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS WITH RESPECTS TO WORK PERFORMED BY THE NAMED INSURED RE: JOHN MARKUS JOB 2 4 1 - L_ONC.IZE c' RI;A6E C fig's P JecK t2.' I> ON rR•M1IL( R_.S JDEP1C. 8SMT GRPAGE } ixtek 2aO4m G (obi Sotyr TR E ET t%yd d That the P:er, Ghee, approvals are ...,c�; to errors and c, =75:.713 end approval of authorize the or c ccpy Or By Date Permit No... ` ... . -0 &O 24' :Ilion of any , nce. Pcte'pt of cstractor's. n 41r1i7 vsoro gC7/Y/rY To 14✓i7:41/4V /0 '4 Er /srirv.0 ..eviczwyq CITY OF TUKWILA APPROVED lz/012 _ BUILDING DEPT. 73 6.2.+ WATER three sw cotz, Etel/ • RECEIVED CITY OF TUKWILA • NOV 2 3 1992 . PERMIT CENTER f''m, =10tr PLDT?LN REPL_RCEIanENT ES 1 DE1(Cff LiO fl . 1 4 Trols t 1n1�#Z !4 OEJE.DESTR13YE �`� FIRS QC_TOGER ictct ColtycliZET t3Locat: f?-Es- PINE t; wflw EINe. CitE aRI4DE To El t PIKE l-I YDRA AU' yar LDAJUa i 6 GAPMI2 Rare? ONE FR_MI RsS,if e is uSMr • uurie 2. 0.}- _SOOT I 0 relPY ;, st , - ;ci iha'• the Pian c c oDrav &is are to Errors and 0mi33`_n5 and approval of not authorize the ' i . ai ion of any or c 's;: ,ce. R t (pt of c trac#or's of CITY OF TUKWILA APPROVED L 2.// .ono ,gcr/vrrY To /4//77//A/ - /0 ' ot -- xin,,vh' .es ' /LO/ y Ex7 d Elett Fog AtEg, Rg 1Vvi Loi l THE SA }Sy FIR ►�N =10 . PLDT'RS4 REPLACO/1E14T t•A b/14-1■14 Q- R-16 Uovs