HomeMy WebLinkAboutPermit M05-139 - BAY VALVE SERVICEBAY VALVE SERVICE, INC.
4385 S 133 ST
M05-139
Parcel No.: 2613200133
Address: 4385 S 133 ST TUKW
Suite No:
City G. Tukwila
Tenant:
Name: BAY VALVE SERVICE
Address: 4385 S 133 ST, TUKWILA WA
Owner:
Name: COLEMAN DAN & SALLY SUE
Address: 3327 EVERGREEN PT RD, MEDINA WA
Contact Person:
Name: STEVE TEETER
Address: 4385 S 133 ST, TUKWILA WA
Contractor:
Name: C 0 SIMONS CONSTRUCTION
Address: 2470 EVERGREEN POINT RD, MEDINA WA
Contractor License No: COSIMC *161KH
DESCRIPTION OF WORK:
INSTALL SEAL -WELD 12" BOILER STACK
Value of Mechanical: $1,000.00
Type of Fire Protection:
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: ci.tukwila.wa.us
Furnace: <100K BTU 0
>100K BTU 0
Floor. Furnace 0
Suspended /Wall /Floor Mounted Heater 0
Appliance Vent 0
Repair or Addition to Heat/Refrig /Cooling System.... 0
Air Handling Unit <10,000 CFM 0
>10,000 CFM 0
Evaporator Cooler 0
Ventilation Fan connected to single duct 0
Ventilation System 0
Hood and Duct 0
Incinerator: Domestic 0
Commercial /Industrial 0
doc: IMC- Permit
MECHANICAL PERMIT
EQUIPMENT TYPE AND QUANTITY
Fees Collected: $170.40
International Mechanical Code Edition: 2003
* *continued on next page **
M05 -139
Permit Number:
Issue Date:
Permit Expires On:
Phone:
Phone: 206 782 -7800
Phone:
Expiration Date:05 /02/2007
Steven M. Mullet, Mayor
Steve Lancaster, Director
M05 -139
09/28/2005
03/27/2006
Boiler Compressor:
0 -3 HP /100,000 BTU 0
3 -15 HP /500,000 BTU 0
15 -30 HP /1,000,000 BTU.. 0
30 -50 HP /1,750,000 BTU.. 0
50+ HP /1,750,000 BTU 0
Fire Damper 0
Diffuser 0
Thermostat 0
Wood /Gas Stove 0
Water Heater 0
Emergency Generator 0
Other Mechanical Equipment 1
Printed: 09 -28 -2005'
• It
Permit Center Authorized Signature:
Print Name: ST a VE 7 ; <
doc: IMC- Permit
City 6� Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206- 431 -3670
Fax: 206 - 431 -3665
Web site: ci.tukwila.wa.us
VlKA
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M05 -139
Steven M. Mullet, Mayor
Steve Lancaster, Director
Permit Number: M05 -139
Issue Date: 09/28/2005
Permit Expires On: 03/27/2006
Date: O
I hereby certify that I have read and min 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 constru n or the perf9rmance of work. I am authorized to sign and obtain this mechanical permit.
Signature: � .-� -L -. Date: 7 . -
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.
Printed: 09 -28 -2005
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 - 3670
PERMIT CONDITIONS
Parcel No.: 2613200133 Permit Number: M05 -139 1
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Address: 4385 S 133 ST TUKW Status: ISSUED "• 2
Suite No: Applied Date: 09/22/2005 v
Tenant: BAY VALVE SERVICE Issue Date: 09/28/2005 U O
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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.
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5: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, 01—
any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits w cwi'
presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila i"' ,
shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the v_ O
Building Official from requiring the correction of errors in the construction documents and other data. ui u y
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•
* *continued on next page ** z
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.
doc: Conditions
M05 -139 Printed: 09 -28 -2005
Print Name:
doc: Conditions
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
I hereby certify that I have read these conditions and will comply with them as outlined. All provisions
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 provision of any
regulating construction or the performance of work.
Signature: /. —.ta Date:
r& E. TyrEZ
M05 -139
of law and ordinances
other work or local laws
Printed: 09 -28 -2005
1
SITE LOCATION
Site Address:
Tenant Name: BP J �t-�� �U ► �--e i t� C
Property Owners Name: ��- E C3L C)
Mailing Address: 4t-c2-0 t'r-C
Name: 6 Tr u e 7 rE2
Mailing Address: 4.385 S ° . i,'v' 3 ri
E -Mail Address:
GENERAL CONTRACTOR INFORMATION - (Mechanical Contractor . information on back page
Company Name:
Mailing Address:
1 - )_' �ih- �•�r�-
CITY OF TUKWILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
43`65 5o. 133 r� o
ST -r , v ,c L U C L�
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 **
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4 r1
Contact Person: 0 r k I
F- rGi -FN pr. 12-
t -6N5
City
Day Telephone: 2-0 /3t,
Fax Number: - (4A b q3 7 `6
Expiration Date: 051(72-i C
* *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
E -Mail Address: ��// ff ,,,,
Contractor Registration Number: X 4 M (.,'4 iJ
, ;ARCHITECT OF: RECORD All plans must be wet stamped by. Architect of Record
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
ENGINEER .OF RECORD � All plans must be'wet stamped :by Engineer of Record
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
q:ltpennits phuticc chanktestpermit application (7.2004)
Revised: 6-605
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Page I
Building Permit No
Mechanical Permit
Public Works Permit No
Project No
(For ofce. only)
King Co Assessor's Tax No.: 2 (2 (3 2 O(c, .33
Suite Number: Floor:
New Tenant: [ .... Yes ❑ ..No
320
City
Stae
Zip
Day Telephone: 2 cc> - 7% z- 7 b C ��
State Zip
Fax Number: 2" (o — 782 'R 6
City
i'.4 E-0-t WA u-A , 93 ° 3
lrR
City
Day Telephone:
Fax Number:
State Zip
State
Zip
City
Day Telephone:
Fax Number:
State Zip
2t) 7 723aO
4..1,411. L., 04,
...
Valuation of Project (contractor's bid price): $ Existing Building Valuation: $
Scope of Work (please provide detailed information):
Will there be new rack storage? ❑ ..Yes ❑ .. 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: Compact: Handicap:
Will there be a change in use? ❑ ....Yes ❑ ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑.. Sprinklers ❑..Automatic Fire Alarm ❑..None ❑ . Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ ..Yes ❑ ..No
If "yes", attach list of materials and storage locations on a separate 8 -1 /2 x 11 paper indicating quantities and Material Safety Data Sheets.
q: \\permits plus\icc changes \permit application (7.2004)
Revised' 64.05
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Page 2
Existing
Interior
Remodel
Addition to
Existing
Structure
New
Type of
Construction .
per IBC
Type of
Occupancy per
IBC
I" Floor
2' Floor
3r Floor
Floors thru
Basement
Accessory Structure *
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
Valuation of Project (contractor's bid price): $ Existing Building Valuation: $
Scope of Work (please provide detailed information):
Will there be new rack storage? ❑ ..Yes ❑ .. 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: Compact: Handicap:
Will there be a change in use? ❑ ....Yes ❑ ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑.. Sprinklers ❑..Automatic Fire Alarm ❑..None ❑ . Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ ..Yes ❑ ..No
If "yes", attach list of materials and storage locations on a separate 8 -1 /2 x 11 paper indicating quantities and Material Safety Data Sheets.
q: \\permits plus\icc changes \permit application (7.2004)
Revised' 64.05
bh
Page 2
, PUBLIC WORKS PERMIT INFO..
Scope of Work (please provide detailed information):
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ ...Tukwila ❑... Water District #125
❑...Water Availability Provided
Sewer District
❑...Tukwila ❑ ... ValVue ❑ .. Renton ❑ ...Seattle
❑ ...Sewer Use Certificate 0... 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)
❑ ...Bond ❑ .. Insurance ❑ .. Easement(s)
Proposed Activities (mark boxes that apply):
❑ ...Right -of -way Use - Nonprofit for less than 72 hours
❑ ...Right -of -way Use - No Disturbance
❑ ...Construction/Excavation/Fill - Right -of -way
Non Right -of -way
❑...Total Cut
❑ ...Total Fill
cubic yards
cubic yards
❑...Sanitary Side Sewer
❑ ...Cap or Remove Utilities
❑ ...Frontage Improvements
❑ ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑ ...Permanent Water Meter Size...
❑ ...Temporary Water Meter Size ..
❑ ...Water Only Meter Size
❑ ...Sewer Main Extension Public _
❑ ...Water Main Extension Public _
q: \\petmits phu \ice changes\permit application (7.2004)
Revised: 641 -03
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„
„
Call before you Dig: 1- 800 - 424 -5555
❑ .. Abandon Septic Tank
❑ .. Curb Cut
❑ .. Pavement Cut
❑ .. Looped Fire Line
„
WO#
WO#
WON
Private
Private
TION- 206- 433 -0179
❑ .. Highline
❑ .. Geotechnical Report ❑...Traffic Impact Analysis
❑ .. Maintenance Agreement(s) ❑...Hold Harmless
❑ .. Right -of -way Use - Profit for less than 72 hours
❑ .. Right -of -way Use — Potential Disturbance
❑ .. Work in Flood Zone
❑ .. Storm Drainage
FINANCE INFORMATION
Fire Line Size at Property Line
❑ ...Water ❑ ...Sewer ❑ ...Sewage Treatment
Monthly Service Billing to:
Name:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
Number of Public Fire Hydrant(s)
Day Telephone:
City
State
Zip
Day Telephone:
City
State
Zip
Page 3
❑ ...Renton
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
❑...Deduct Water Meter Size "
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Compressor:
Qty
Furnace <100K BTU
Air Handling Unit >10,000
CFM
Fire Damper
0 -3 HP /100,000 BTU
Furnace >100K BTU
Evaporator Cooler
Diffuser
3 -15 HP /500,000 BTU
Floor Furnace
Ventilation Fan Connected
to Single Duct
Thermostat
15 -30 HP /1,000,000 BTU
Suspended /Wall /Floor
Mounted Heater
Ventilation System
Wood /Gas Stove
30 -50 HP /1,750,000 BTU
Appliance Vent
Hood and Duct
Water Heater
50+ HP/I,750,000 BTU
Repair or Addition to
Heat/Refrig/Cooling
System
Incinerator - Domestic
Emergency
Generator
C) �l Le--t C 1Mi1
Air Handling Unit
<10,000 CFM
Incinerator – Comm/Ind
Other Mechanical
Equipment
( t b � z-r J
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
Contractor Registration Number:
* *An original or notarized copy of current Washington State Contractor
Valuation of Project (contractor's bid price): $ I f
Scope of Work (please provide detailed information): 1 jTPr -C-
t c1=.
Indicate type of mechanical work being installed and the quantity below:
MECHANICAL PERMIT INFORMATION - 206- 431 -3670
IdJ
&Pk/
City State
Contact Person: Day Telephone:
E -Mail Address: Fax Number: cr 7`l
Zip
Expiration Date:
License must be presented at the time of permit issuance **
i 2 IS
Use: Residential: New .... ❑ Replacement ❑
Commercial: New ....0 Replacement ❑
Fuel Type: Electric ❑ Gas ....(N Other:
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.
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 OWN $,�UTHORI AG T:
Signature
Print Name:
Mailing Address:
Date Application Accepted:
q: \\permits plusticc changes■permit application (7.2004)
Revised 6.1.05
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4,3 °m, 5 o. f 3 i-C
Date Application Expires:
Page 4
Date: 9'27(
Day Telephone: P-' 782 ss, O
City State Zip
Staff Initials:
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 2613200133
Address: 4385 S 133 ST TUKW
Suite No:
Applicant: BAY VALVE SERVICE
RECEIPT
Receipt No.: R05 -01441 Payment Amount: 142.32
Initials: 3EM Payment Date: 09/28/2005 09:24 AM
User ID: 1165 Balance: $0.00
Payee: BAY VALVE SERVICE, INC.
TRANSACTION LIST:
Type Method Description Amount
doc: Receipt
Payment Check 66989 142.32
ACCOUNT ITEM LIST:
Description
MECHANICAL - NONRES
Account Code Current Pmts
000/322.100 142.32
Permit Number: M05 -139
Status: APPROVED
Applied Date: 09/22/2005
Issue Date:
Total: 142.32
7647 09/29 9710 TOTAL 142.53
Printed: 09 -28 -2005
Parcel No.:
Address:
Suite No:
Applicant:
Receipt No.:
Initials:
User ID:
Payee:
SEBCO
R05 -01400
)EM
1165
TRANSACTION LIST:
Type Method
Payment Check
ACCOUNT ITEM LIST:
Descr
doc: Receipt
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
2613200133
4385 5 133 ST TUKW
BAY VALVE SERVICE, INC
: PLAN CHECK - NONRES
Description
66947
Account Code
000/345.830
RECEIPT
Permit Number:
Status:
Applied Date:
Issue Date:
Payment Amount:
Payment Date:
Balance:
Amount
28.08
Current Pmts
28.08
Total: 28.08
M05 -139
PENDING
09/22/2005
28.08
7462 09/22 9716 TOTAL 28.08
09/22/2005 09:38 AM
$142.32
Printed: 09 -22 -2005
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Type of Inspec iocn::,
Ad��ess: �Q
,
Date Called:
�
ll
5 ecinstruc s
Spec
Date Wanted:
Requester:
Phone No:
l
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INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
;- Agi ;°•
(206 31 -3670
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
Tri
r oA fr,„ y 4„,"
h ate 2-14 .lI
In c;��i o J D ��.1 . .�
)14/ f' Gl
Inspector:
Date: //
El $58. i01EINSPECTION FCE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
Receipt No::
'Date:
. .w iisNeti 44144$ . 1413
PP bje // c tt: ■ U �-+
Type o S
A iss 5— Sc 13?
Date Called: q(11(05"
Specs I Instructions:
Date Wanted: j
Requester:
7
PhVI
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
oS
PE',, T N
206)431 -3670
Approved per applicable codes. 0 Corrections required prior to approval.
/
COMMENTS:
ri $5 .00 REINSPECTI FEE RE . IRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
(Receipt No.:
`Date:
{
project: r ,
77P1-4' WCA( o cift,-,2
Type ofAispection:
Kfi
Address:
Ll3ifbg S. /3 c7
Date Called:
Special Instructions:
i
Date Wanted:
2-9--06
Requester: 9 /
4...), ((
Phone No:
• • •.' . . •
INSPECTION RECORD •
Retain a copy with permit
INSPEC1TON NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Approved per applicable codes.
(206)431-3670
Corrections required prior to approval.
COM ENTS:
T2--)
74-ir- > K A4.01 J
$58.00 R INSPECTION FE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
'Receipt No.:
'Date:
•
07 -03 -2006
STEVE TEETER
4385 S 133 ST
TUKWILA WA 98168
RE: Permit No. M05 -139
4385 S'133 ST TUKW
Dear Permit Holder:
In reviewing our current records the above noted permit has not received a final inspection by the City of Tukwila Building Division.
Per the International Building Code and/or the International Mechanical Code, every permit issued by the Building Division under the
provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not
commenced within 180 days from the date of such permit, or if the building or work authorized by such permit is suspended or
abandoned at any time after the work is commenced for a period of 180 days.
Based on the above, you are hereby advised to:
Call the City of Tukwila Inspection Request Line at 206 - 431 -2451 to schedule for the next or final inspection.
This inspection is intended to determine if substantial work has been accomplished since issuance of the permit or last inspection; or if
the project should be considered abandoned.
If such determination is made, the Building Code does allow the Building Official to approve one or more extensions of time for
additional periods not exceeding 90 days each. Extension requests must be in writing and provide satisfactory reasons why
circumstances beyond the applicants control have prevented action from being taken.
In the event you do not call for the above inspection and receive an extension prior to 08/27/2006, your permit will become null and
void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
xc:
nife M rshall,
ermit ician
Permit File No. M05 -139
Cily of Tukwila
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 -431 -3670 • Fax: 206.431.3665
02 -08 -2006
STEVE TEETER
4385 S 133 ST
TUKWILA WA 98168
RE: Permit No. M05 -139
4385 S 133 ST TUKW
Dear Permit Holder:
City of Tukwila
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
In reviewing our current records the above noted permit has not received a final inspection by the City of Tukwila Building Division.
Per the International Building Code and/or the International Mechanical Code, every permit issued by the Building Division under the
provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not
commenced within 180 days from the date of such permit, or if the building or work authorized by such permit is suspended or
abandoned at any time'after the work is commenced for a period of 180 days:
Based on the above, you' are hereby advised to:
Call the City of Tukwila Inspection Request Line at 206 -431 -2451 to schedule for the next or final inspection.
This inspection is intended to determine if substantial work has been accomplished since issuance of the permit or last inspection; or if
the project should be considered abandoned.
If such determination is made, the Building Code does allow the Building Official to approve a one or more extension of time for,
additiona perios not exceeding 90 days each. Extension requests must be in writing and provide satisfactory reasons why
circumstances beyond the applicants control have prevented action from being taken.
In the event you do not call for the above inspection and receive an extension prior to 03/29/2006, your permit will become null and
void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
•
if LMarshall,
Permit Technician
A cift4A,t,Q
xc: Permit File No. M05 -139
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: M05 -139 DATE: 09 -22 -05
PROJECT NAME: BAY VALVE SERVICE, INC.
SITE ADDRESS: 4385 S 133 ST
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS:
Buildi'ng Division id
Public Works
Complete
Comments:
Documenlshouting slip.doc
2.28 -02
�irfPre n io @
Structural
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Incomplete
TUES /THURS ROUT NG:
Please Route Structural Review Required
REVIEWER'S INITIALS:
APPROVALS OR CORRECTIONS:
Approved n Approved with Conditions
Notation:
REVIEWER'S INITIALS:
C
n Permit Coordinator n
DATE:
DATE:
Planning Division
DUE DATE: 09-27-05
Not Applicable
Permit Center Use Only
INCOMPLETE LETTER MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
LETTER OF COMPLETENESS MAILED:
No further Review Required
Not Approved (attach comments)
n
DUE DATE: 10-25-05
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
License Information
License
COSIMC* 161 KH
Licensee Name
C 0 SIMONS CONSTRUCTION
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
600529884
Ind. Ins. Account Id
#8
Business Type
INDIVIDUAL
Address 1
2470 EVERGREEN POINT RD
Address 2
City
MEDINA
County
KING
State
WA
Zip
980391530
Phone
2062261998
Status
ACTIVE
Specialty I
GENERAL
Specialty 2
UNUSED
Effective Date
5/8/1984
Expiration Date
5/2/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated License
Business Owner Information
Name
Role
Effective Date
Expiration Date
SIMONS, CRAIG OWEN
OWNER
01/01/1980
Bond
Amount
Bond Information
Bond
Bond Company
Name
Bond
Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
#8
CONTRACTORS
BONDING &
INS CO
SF5041
05/01/2004
Until
Cancelled
$12,000.00
04/20/2004
DEVELOPERS
Look Up a Contractor, Electrici 1 or Plumber License Detail Page 1 of 3
Washington State Department of Labor and Industries
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 liability insurance.
https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= COSIMC 161KH 09/28/2005
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