HomeMy WebLinkAboutPermit 6242 - Garden Properties - Single Family Residence DemolitionThis 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.
6242
Garden Properties
1281642 nd Avenue South
RECORDS DIGITAL D- ) EXEMPTION LOG
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
Page # tode Exemption = 8rlef Explanatory DeSclriptiop �t�tutel ule
The Privacy Act of 1974 evinces Congress'
intent that social security numbers are a private
concern. As such, individuals' social security
Personal Information —
numbers are redacted to protect those
Social Security Numbers
individuals' privacy pursuant to 5 U.S.C. sec.
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
552(a), and are also exempt from disclosure
552(a); RCW
552(a); RCW
under section 42.56.070(1) of the Washington
42.56.070(1)
42.56.070(1)
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 numbers, electronic check numbers, credit
Personal Information —
expiration dates, or bank or other financial
RCW
15
DR2
Financial Information —
account numbers, which are exempt from
42.56.230(5)
RCW 42.56.230(4 5)
disclosure pursuant to RCW 42.56.230(5),
except when disclosure is expressly required by
or governed by other law.
garden properties 6242
PROPERTY OWNER Garden Properties
PHONE 242 -8228
ADDRESS
4310 South 131st Place, Seattle, WA
ZIP
98168
CONTRACTOR
Washington Wrecking Co.
PHONE
772 -6556
ADDRESS
13001 Empire Way South, Seattle, WA
ZIP
98178
WA. ST. CONTRACTOR'S LICENSE #
WASHIWR135J2
EXP. DATE
4 -09 -91
ARCHITECT
PHONE
ADDRESS
ZIP
USE .4,
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of lay
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 pf I am authorized to sign for and obtain this building permit.
1 / / ! `
SIGNATURE:i -% ,' f' �: j / - .' : ir (. '
DATE: V , �( f i C.
//
COMPANY: (,' > i ► V( t ►1 i (
('ODI
c•crr�1F'�
inrJc'r
FLOOR,
Z
SQUARE
FEET
OCC.
LOAD
SQUARE
FEET
OCC.
LOAD
SQUARE
FEET
OCC.
LOAD
SQUARE
FEET
OCC.
LOAD
SQUARE
FEET
OCC.
LOAD
TOTAL
SQUARE FEET
TOTAL
OCC, LOAD
TOTAL
1
TYPE OF CONST.: UBC 1AD1T1ON (year) 1988
SETBACKS: N - S - E- W-
FIRE PROTECTION:
❑Sprinklers ❑ Detectors ®N/A
UTILITY PERMITS
_
(through
REQUIRED? ❑Yes Q No Public Worksl
ZONING:
BAR /LAND USE CONDITIONS? ❑ Yes C) No
CONDITIONS (other than those noted on or attached to permit/plans)
/
APPROVED FOR BUILDING
ISSUANCE BY:
JFAMIPP41-. `, ;1 J OFFICIAL
DATE: I
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of lay
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 pf I am authorized to sign for and obtain this building permit.
1 / / ! `
SIGNATURE:i -% ,' f' �: j / - .' : ir (. '
DATE: V , �( f i C.
//
COMPANY: (,' > i ► V( t ►1 i (
/�' / i
r f/ /
PRINT NA: c I`; c'')1 t :�r')C 7 ("' I . - . , )C',1 - '1
CITY OF TUKWILA
Dept. of Community Development - Building Division
6300 Southcenter Boulevard, Tukwila WA 98188
(206) 431 -3670
BUILDING
PERMIT NO. (pc LI a
DATE ISSUED:
ASSESSOR ACCOUNT # 734060- 0720 -0
TYPE OF ❑ New Building Addition Tenant Improvement (commercial) U Demolition (building) Li Grading/Fill
WORK: ❑ Rack Storage ❑ Reroof ❑ Remodel (residential) O Other:
DESCRIBE WORK TO BE DONE:
PROJECT NAME/TENANT Garden Properties
This permit shall become null and void if the work is not commenced withi 80 days from the to o
issuance, or if the work is suspended or abandoned for a period of 180 days from the last ins action.
CERTIFICATE OF DATE ISSUED:
OCCUPANCY NO.
q air) a0
BUILDILG PERMIT
LOCATION)
Demolition,of single - family residence.
'���: CONSPICUOUS WITH 'CARD AND PLANS
(POST WITH INSPECTION CARD AND PLANS
IN A
BUILDING PERMIT FEE ;:'
PLAN CHECK FEE : ;` <"
BUILDING 'SURCHARGE : .
OTHER ; :!':
TOTAL
30:00
1684
9 14 -90
PLAN CHECK NO.:
90 -386
- ERMIT NO.
•
CONTACTED
3t�
ai�1�!
..
-4_0, /
ATE READY
DATE NOTIFIED
Gi ^a
I 0
BY:
init.
,..,,p
• ERMIT EXPIRES
2nd NOTIFICATION
BY:
init.
• UNT OWING
to
RD NOTIFICATION
BY:
init.
BUILDINCCOPERMIT
APPLICATION TRACKING
PR E T NAME C ard2n Pr owe r fii25
SUITE NO.
SITE ADDRESS )%/( - u l/
PLAN CHECK
NUMBER
(10- D(n
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)
TOTAL
DEPARTMENTAL REVIEW
"X" In box Indicates which departments need to review the project.
0 FIRE
0 OTHER
ig BUILDING -
initial review
O PLANNING
3
WORKS
BUILDING -
final review
REVIEW COMPLETED
¶1 1 1 o _ _(ROUTED)
INIT:
INIT:
INIT:
INIT:
INIT: 6 ,
ZONING:
ate
REFERENCE FILE NOS.:
MINIMUM SETBACKS: N- S-
UTILITY !UMED?
LETTER DATED:
TYPE OF CONSTRUCTION
FIRE PROTECTION: [ J Sprinklers _I Ibetectors [/A
FIRE DEPT. LETTER DATED: INSPECTOR:
ISARILAND USE CONDITIONS? [ JYes NNo
Yes f A'No
W
/2>1 TW c 1 f0. \ — C ° L , 7
UBC EDITION (year):
CITY OF TUKWILA
Department of Community Development -
6300 Southcenter Boulevard, Tukwila WA
(206) 431 -3670
PLAN CHECK � � —5S
,
NUMBER O
APPI ICA ZION Illllti 1 HL
FILL ED OUT COT1IPI E TE L Y
ARCHITECT
ADDRESS
CONTACT PERSON
BUILDINJ PERMIT
APPLICATION
Building Division
98188
DESCRIPTION
BUILDING: PERMIT FEE
PLAN CHECK` FEE
BUILDING SURCHARGE'
OTHER:
TOTAL -
DATE
SITE ADDRESS
SUITE #
VALUE OF CONSTRUCTION - $
PROJECT NAME/TENANT
G (kV) Pro Pe{ (
TYPE OF U New Building (_J Addition
WORK: 0 Rack Storage 0 Reroof
ASSESSOR ACCOUNT #
`7 3 ya Cpl --r"1 . Z20 --C`
Li Tenant Improvement (commercial) (Jtemolition (building)
0 Remodel (residential) O Other:
DESCRIBE WORK TO BE DONE:
BUILDING USE (office, warehouse, etc.)
NATURE OF BUSINESS:
WILL THERE BE A CHANGE IN USE? U No U Yes IF YES, EXPLAIN:
SQUARE FOOTAGE - Building:
Tenant Space: Area of Construction:
WILL THERE BE SJORAGE OR USE OF FLAMMABLE, COMBUSTIBLE OR HAZARDOUS MATERIALS IN THE
BUILDING? No 0 Yes IF YES, EXPLAIN:
PHONE 2y Z-- ZZ�
PROPERTY OWNER GcLed evl P n ' < ,f-- 4- I �S ( be , ; ,
AD DRESS r . i 5 �' p �ecalic� ZiP� �I Cn
CONTRACTOR )311 t )`.-) TO)) WECC_K. ■ JO G e<7 PHONE .1 i 2 ( ic
ADDRESS I CO % I ��' v P 1 IL. U) F) y �e c 1 - " - H e u) 0 ZIP 9D 1 P
WA. ST. CONTRACTOR'S LICENSE # w 14S R t. W C . ( y2 EXP. DATE q l c lc? (
PHONE
ZIP
BUILDING OWNER
OR
AUTHORIZED
AGENT
DATE (7
PHONE :
CITY /ZIP �., , 7y 7
PHONE -7 7 - (r)
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
• „ norm miry. n--s - ----A .'-' , - ")s ^a +ton P!"hmi tel. 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 ACCEPTED
) GI a
DATE APPLICATION EXPIRES
0710WY0
COMMERCIAL
NEW COi1NERCIAL BUILDINGS %ADDITIONS
C Completed building permit application (ens for each structure
•
Assessor Account Number
sets (2) of the following
Sped lioations
S uctural calculation pd •b
s stamped a Washington State iloen
engineer •
Soils report stamped by *Washington State:licensed engines
Topographical survey
Energy caiculatlons stamped by a Washingtcn`State licen
engineer or architect
Legal description
W odsinp drawings, stamped by a Washi Shte licensed
ardtitect; which include,
;• SIN plan
• Archilactural drawings
Structural drawings:.,
Mechanical drawings : ::
Elevations
Civic drawings
andegape. pi�i:::
CompisMd utility permit application (one for entire
Six (6) sets of dwl drawings
NOTE Inc dhtonakns of tacks (height, Nddtfr artd lerpMrA ail
and surd Nave ors pia i
Struoturssl calculations stamped by a Washington State liven •
engineer (rads . !.and over),
RESIDENTIAL
NEW SINGLEfAIIUILY DWELLMIQB/ADDI
Completed building permit application (one for each stucture
Legal description
E Assessor Account Number
wo •sets (2) of w orking draw ings, which incl
Slid plan
• Foundation pie*
Floor. Plan
■ Roof
Building elevations (all views
Building oro :t- section
Structural framing plans
Washington State Energy Code data
n Completed utility permit application
Six (6) sets of site plans showing utilities:'
NOTE Building site plan and utility site On may, be f�ornblrrtrd Sea
uOPlgr
pant* application and checklist, for apec1Na submittal rtiqu+ antefts
Addilon■l lepopraphkal and soils infotma may be ragtrirrd If unique
:of condWOns.
Csitnp leted.bullcing permitappuati on (one for each structur
Assessor Account' Number
Narrative describing existing ;roof, material •being removed and
materfat being installed
NOTE A certification letter is required prior to fi nal Inspection and s
ell al Ore permit :.
material.bei
SISBMITTAL CHECKLIST
Cityf Tukwila
6200 Southcenter Boulevard
Tukwila Washington 98188
(206) 433-1800
Gary L. VanDusen, Mayor
TO: Kim Hart, Finance
FROM: Shellie Bates, Permit Center
DATE: October 26, 1990
SUBJECT: Refund
Please refund $6,000.00 to Washington Wrecking. The original
transaction took place on September 14, 1990 on Receipt #I685.
The project has been completed as of October 24, 1990 and can
now be released.
riistnateI WAse t ' u'inetmeWSn+i.Mkwais eanu...m.r«..aNum
CITY OF TUKWILA
Building ,runartment
6300'So nter Boulevard
Tukwila,
(206) 431 -3670
Type of Inspection i 11(?.`
Site Address - . ► 1--j0 P\\) --cP\\)
Requestor 10Q_ f\ \ P Y SCE. n
Special Instructions
Inspection Results /Comments:
INSPECTION RECORD
PERMIT # Ltr t-tc
Date 10 a (4-6.10
Inspector l 5 v L)2 -- "..
Date /6/2(
J
Date Wanted jc7— Li -6 10 a.m. p.n
Project C.-1U b.Dr F'ft .P►�tie�
Phone #
WASHINGTOL WRECKING Co
General Contractors
(206) 772.6837
STATE LIC. # WASHIWC135J2
Phil Frazer
Tukwila Public Works
Re: Septic System
I talked to Larry Kirshnet at the King County Environmental Health Division
about the procedures involved in abandoning a septic system. He told me
that there is no permit required for this procedure. I was also told how
that the abandonment procedure should be performed. King County asks that
we first have the tank(s) pumped, then provide an opening for the fill mater-
ial, then fill the tank with the fill material of our choice. At this time
the tank may be abandoned in place.
I called again today to request a letter to this effect and he was not in.
So I talked to a man named Sid, (I didn't catch his last name), and he told
me the same procedure. I asked if he would send a letter to this effect
to either me or you. He told me that he would not send us a letter but,
he would talk to you over the phone or you could look it up under //3 of
their regulations. I'm
So this is where I am.
me a call.
Thank you. c,
0 9 c°+
Joseph C. Anderson
Owner
P4 Z96
JCA /JGA
13001 EMPIRE WAY S.
not sure what regulations he was talking about.
If there is anything more
I can do
SEAT
RECEIVED
SEP 2 5 199
ILA
PUBLIC WORKS
please give
, y
e.2 5?
X0
15 0‘ '6, Li
• 6 - A
A 98
1Y�
JAMES I. ANGLE, President
C.H. WALMER, Secretary
W.C.L. WIESE, Commissioner
.Telephone: 242.9547 •
a ter 2 i1r id flo 12
P.O. Box 68147, Riverton Hls, Br:'
SEATTLE, WASHINGTON 98168
September 2 , 1990'
FRANKLIN PEARSON
Superintendent
ANN WILSON"
Office Manager
in Coui1
Office: 2849 South 150th
RECEIVED
SEP 25 1990
TUKWILA
PUBLIC WORKS
TO "WHOM IT MAY CONCERN:'
Washington Wrecking has :•paid his bills for the .fo1lowin - g .
addresses: 1.2 12, . 1► 816, 13014: 42nd. Av South I "hey have:
. :regLtested by letter that these :. meters btu. removed:'
September 25, 1990
RE: Properties at 12802, 12812•and 12816 42nd Ave.
To Whom it May Concern:
This is to verify that the above listed . properties .
are outside of the Val Vue Sewer District boundaries
and we have no sewers serving these properties.
Steven D. Fletcher
Side Sewer Inspector
RECEIVED
SEP 2 5 1990
1 UKWfLA
PUBLIC WORKS
P, O. BOX 68063
SEATTLE, WA 99168:
J48,(6 MILITARY ROAD SOUTH
BETTY LUNZ
MICHAEL J. WEST
DAVID L. RUITER.,
COMMISSIONERS
T.J.'.MATELICH
MANAGER
206/242.3236
MEMORANDUM
TO: DUANE GRIFFIN, BUILDING
44e
FROM: PHIL FRASER, PUBLIC WORKS
DATE: 9/20/90
SUBJECT: 3 DEMOLITION PERMITS: PUBLIC WORKS REVIEW AND
REQUEST FOR ADDED INFORMATION FROM APPLICANT:
A. 12812 42ND AVE. S - PL.CK.N0.90 -385
B. 13014 42ND AVE. S - PL.CK.N0.98 -384
C. 12816 42ND AVE. S - PL.CK.N0.98 -386
PER MY DISCUSSION WITH KELLY, RECEPTIONIST FOR WASHINGTON
WRECKING COMPANY ON 9/20/90 8:30 AM, I LEFT MESSAGE FOR
"LITTLE JOE" IN CHARGE OF THIS PROJECT AS FOLLOWS:
IN ORDER FOR PUBLIC WORKS TO COMPLETE PLAN REVIEW FOR
THESE THREE DEMOLITIONS, THE FOLLOWING IS REQUIRED:
A. APPROVAL LETTER FROM VAL VUE SEWER DISTRICT FOR THE
CAPPING OFF OF SIDE SEWER.
B. APPROVAL LETTER FROM WATER DISTRICT #125 FOR
CAPPING /REMOVAL OF WATER METER AND SERVICE.
C. IDENTIFICATION ON PLANS HOW CAP /ABANDONS
(1) WATER METER /SERVICE
(2) IDENTIFY EXISTENCE OF SIDE DRAINS FROM STRUCTURE
AND, IF EXIST, HOW TO BE CAPPED OFF.
IF STRUCTURES TO BE MOVED ON CITY ROADS TO ANOTHER SITE, A
OVERSIZED LOAD PERMIT SHALL BE APPLIED FOR AND INCLUDE THE
FOLLOWING DOCUMENTATION:
A. UTILITY PERMIT APPLICATION FORM FILLED OUT:
B. 5,000 BOND
C. 1,000,000 BODILY INJURY /PROPERTY DAMAGE
D. TUKWILA BUSINES LICENSE
E. ROUTING MAP
PUBLIC WORKS WILL REVIEW ABOVE FOR APPROVAL ONCE
KELLY SAID SHE WOULD GET BACK TO LITTLE JOE WITH
I REQUESTED HE CALL ME AT 433 - 0179 IF HE HAD ANY
AND WHEN HE HAS REQUESTED INFORMATION. IN MEAN
ARE RETURNED TO BUILDING DEPT WITH THIS MEMO.
RECEIVED.
INFORMATION
QUESTIONS.
TIME, FILES
i (\ckrSo n
WASH I IOCI "1 k)3(ZC- I
` J
1 3001 May
os Se +-1-Ie_ Wit? 49F 1J
Ti z %
Demo�%- oc t400Sc.5
c -F 128 1281 , i 3C�1
"X"
REQUIRED INSPECTIONS
PHONE
DATE
APPROVED
INSPECT.
INITIALS
DATE(S)
CORRECTION NOTICE ISSUED
1 Footings
431 -3670
2 Foundation
431 -3670
3 Slab and/or Slab Insulation
431 -3670
4 Shear Wall Nailing
431 -3670
5 Roof Sheathing Nailing
431 -3670
6 Masonry Chimney
431 -3670
7 Framing
431 -3670
8 Insulation
431 -3670
9 Suspended Ceiling
431 -3670
10 Wall Board Fastening
431 -3670
12
13
14 FIRE FINAL Insp:
575 -4407
15 PLANNING FINAL
431 -3670
16 PUBLIC WORKS FINAL
431 -3670
X
17 BUILDING FINAL
431 -3670
(INSPECTOR COMMENT SECTION ON REVERSE)
CITY OF TUKWILA
Department of Community Development - Building Division
6200 Southcenter Boulevard, Tukwila WA 98188
(206) 431 -3670
SITE ADDRESS:
12816 42 Av S
BUILDING PERMIT
INSPECTION RECORD
(Post with Building Permit In conspicuous place)
SUITE NO.:
BUILDING
PERMIT NO.
DATE ISSUED:
PROJECT:
Garden Properties
CALL FOR INSPECTIONS AT LEAST 24 HOURS IN ADVANCE
aLl
-at9-qb
INSPECTION PROCEDURES AND REQUIREMENTS
All approved plans and permits shall be maintained available on the site in the same location.
1. FOOTING - When survey stakes and forms are set and rebar is tied in place.
2. FOUNDATION - When forms and rebar are in place.
3. SLAB - If structural slab or if underslab insulation is required.
4. SHEARWALL NAILING - Prior to cover.
5. ROOF SHEATHING NAILING - Prior to cover.
6. MASONRY CHIMNEY - Approximately midpoint.
7. FRAMING - After rough -in inspections such as mechanical, plumbing, gas piping, electrical and fire stopping is in place.
8. INSULATION - After framing approval, but before installation of wallboard. Baffles must be installed to keep attic
ventilation points clear.
9. SUSPENDED CEILING - Fasten diffusers, lights and seismic bracing.
10. WALL BOARD FASTENING - Prior to taping (see UBC Chap. 47 and Table 47G).
11.
12.
13.
14. FINAL FIRE INSPECTION - Contact Fire Department for their requirements.
15. FINAL PLANNING INSPECTION - Contact Planning Department for their requirements.
16. FINAL PUBLIC WORKS INSPECTION - Contact Public Works Department for their requirements.
17. FINAL BUILDING INSPECTION - When all work, corrections, reports and other inspections are complete.
OTHER AGENCIES:
Plumbing (including gas piping) — King County Health Department — 296 -4732
Electrical — Washington State Department of Labor and Industries — 277 -7272
A preconstruction meeting with the Building Inspector may be scheduled prior to starting the job by
contacting the Department of Community Development, Building Division at 431 -3670. Although not
required, a meeting of this type can often eliminate problems, delays and misunderstandings as the
project progresses.
05117/90
3ashier's Check
131/sld
REMITIE
iithreorderaf ** *CITY OF TUKWILA * **
A Ii! WRECKING
, per tym
arm 00 eau"
WES71'ONrs
BANK
6000 DOLsoo CTS
:
West One Hank. Renton Renton, Washington 98057
SEPTEMBER ;14
Authorized Signature
CITY OF TUKWILA
CUSTOMER IA)GE TRANSMITTAL
DATE: � ( ��
EMPLOYEE'S NAME: f3 Oz4?b
CUSTOMER: W N`i"Z1,a kUf w r�K1 o(
CHARGES:
DESCRIPTION ACCOUNT NUMBER AMOUNT
000 lib .q aiS s ►000 - oo
TOTAL s to , 0 c
** *6000.00 * **
N2
n
.ODE 3UB•CODE
tl3URED
M ;O tI1. CERTIFICATE OF INSURANCE
A X
B
h
BEESCN COMPANY
Pest Office Box 84187
Seattle, Washington 98124
WASHINGTON WREC',I< I NG COMPANY
13001 EMPIRE WAY SOUTH
SEATTLE, WASHINGTON 98178
TYPE. OF It13URANCE
GENERAL LIABILITY
COMI,IFRCIAL LiENERAL L•ABiLITV
CLAIMS MAO'S X ;).^.CUR
OWNER'S A CON/, AC •ROT.
WASH STOP GAP
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AJTOs
X SOHEDULE'U AUTOS
[XERES LIABILITY
OTHER
0 rNEA 1 HAN UMBRELLA FARM
WORKER'S COMPENSATION
AND
EMPLOYER° LIABILITY
CITY OF TUKW I LA
6300 SOUTH CENTER BOULEVARD
TUKW I LA, WA 98 188
ACORD 25.6 (3,68)
SEP- -: •4—'90 FRI 13:5 It' : BEESON CO
Phone: (206) 467 5858
POLICY NUMBER
BFBI 89 1125
SOX 89 5026
COMPANY
LCTTeo A
COMPANY Int
LETTER
COMPANY ` .
LETTER
COMfrANY D
LETTER
COMPANY
LETTER E
TEL H0:206 =lb'' I t; .)
....- .«+... - .a *. r ..... .... ._.+N... r . 1
:.
THIS CERTIFICATE IS ISSUED A:i A MATTEFI OP IWi-e.)1 %.■;:,; •C t,NE. Cil`;PE.F
NO RIGHTS UPON me CERTIFICATE HOLc l:Fi TIII$' OF..h "! "i'', VAf1 ::5 NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFI•OAULC' BY ;'++E POLICIES e•rt OW
COMPANIES AFFORDING COVEFIAGe
C JA REINSURANCE Of LC$4t,)N, LTD. '° P•S►,;
(Prinlary General Liability Only)
SPHERE DRAKE PLC -- PSU
(Excess General Liability Only)
F I N A N C I A L I NDEMII I _I r' COMPANY C/C;
COVERAGES
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEK ISSUED 10THrr L•JEUI'i:O f, ;' ACf �' !' F': F' T' f ;!t:i. t Pr P.:1):;
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER 0(')OlJME',T Y /,'!N ?L.:,r' :. :' I vi 1 ■CH TH:1
GERTIF(CATE MAY C l$$UED OR MAY PERTAIN, THE INSURANCE AFFIif1DED BY THE POLIOIES DESCRIED HEf:F:F. IS 5L 3JEO7 ",:1 A..I.'1't +l•. TERM.
EXCLUSIONS AND C :OtJDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED SI' PAID CLARA.
POLICY EFFECTIVE POLICY t'PINA1IO11
DATE (AUdrD,:'IYY) DATE (MMrlililYY)
C HIRED AUTOS 06123908 03/23/90 03/23/91
NON.awrie) AUTO'
GARAGE' LIABILITY
03/23/90 03/23/91 3 1,000.
03/23/90 03/23/91 perm - NAL 5 AUvESITt ::'rt': ,..t.:r• .4 1,600,
E�:= • : :.1RRCr;c`!i s ? $ i IL 1 (.
PInr') ?.t.1AijE' ore ''n'
ME¢n;aL EF :EiISE I Ally one t:►+,n•i
gn•;ri! r
LIAui I , ,
THE ATTACHED ENDORSEMENT, FORM C 201011B5,
APPLIES TO THE POLICIES LISTED HEREON FOR s
THE ITEM DESCR I BED BELOW FOR THE. BENEFIT s
Of THE CERTIFICATE MOLDER.
A111HORIZE4I I f,11NYE
04/0 IOW Or
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i ''EJCRIPTION OF OPtNATIONSll6 r A1' InN5 1VENIClE9'RtsTRICTIONSIBWECIAL ITCMd
DEM3LITION OF GARDEN PROPERTIES BUILDINGS, TUKW I LA, WA. �. .
CERTIFICATE HOLDER _ � - CANCELLATION
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•• SHOULD ANY OF :NE L:•U;■ES Dr. C,.1'v■I:L.E'G 135'rC'If: , !H
EXPIRATION DATE THt.HFOP, THE IS6iri'IG COVF'AN1' YIN.:. :f":L "FAY'_SR 10
• MAIL 0 DAYS ly VITEN NC.TICC TO THE Ci;117I: CATC :•IC110', NAMED lr:: I HI:
i; LEFT, stir FAIL TO .1AI1. S11CH 1 �tH' IMPC:i:'
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POLICY, NUMfl R.
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS (FORM 6)
Tins endorsement modifies insurance provides} udder the ioifowing
COMMERCIAL GENERAL LIABILITY COVEI?ACiE PART
SCHEDULE
Name of Person or Organization:
Of no entry i ppe3C$ above; i 'tOr!llc'tt ion required to i;i :riir.iI tL fli Il "� '1 f t be ' 1 w I ' trt "t.
t 't is �t:. :;s: tt.. t '�� .� : 11'. C!t:; 1 �.,t :ra•; :;
as opals abl,:'+. to this endorsert ent ;)
WHO IS AN IN :',BRED (Section II ) is amended to :rtf :It '4S iirt insured the u''F,;ii c.t.1r,r, }
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but only with re )ieCt to liability aris!ng out c11 , your woi k' for t .; i b r 1 0!
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