HomeMy WebLinkAboutPermit M02-077 - SIMPLY THAISIMPLY THAI
1001 ANDOVER PARK
EAST
EXPIRED
4 -8 -03
M02 -077
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Parcel No.:
Address:
Suite No:
Tenant:
Name:
Address:
Owner:
Name:
Address:
Contact Person:
Name:
City of'1'ukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
2623049019
1001 ANDOVER PK E TUKW
SIMPLY THAI
1001 ANDOVER PK E, TUKWILA, WA
M -3 PROPERTIES LLC
6625 S 190 ST, B -105, KENT WA
DON ANGELINE
Address: 14528 128 ST, PUYALLUP, WA
Contractor:
Name: NORTHWEST STAINLESS
Address: 14528 128TH ST E, PUYALLUP WA
Contractor License No: NORTHS*016B1
DESCRIPTION OF WORK:
INSTALLATION OF CLASS ONE HOOD
Permit Center Authorized Signature:
MECHANICAL PERMIT
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P'M
Permit Number:
Issue Date:
Permit Expires On:
Phone:
Phone: 253 - 606 -0525
Phone:
Expiration Date: 02/11/2004
Value of Construction: $2,000.00 Fees Collected:
Type of Fire Protection: Uniform Mechnical Code Edition:
Date:
MO2 -077
04/24/2002
10/21/2002
$65.06
1997
1997
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and
ordinances governing this work will be complied with, whether specified herein or not.
The granting of 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 of work. I am authorized to sign and obtain this mechanical permit.
Signature:
Print Name: 1c < . k10.0
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.
doc: Mech
Date: e). -.
MO2 -077 Printed: 04 -24 -2002
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City of 1 1k1 a
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 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 provision of any other work or local laws
regulating construction or the performance of work.
Signat_- _--- E � -t� :G.- Date: /ay /
Print Name: G C 4 Mc,o /LL—
doc: Conditions
MO2 -077 Printed: 04 -24 -2002
doc: Conditions
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 2623049019
Address: 1001 ANDOVER PK E TUKW
Suite No:
Tenant: SIMPLY THAI
PERMIT CONDITIONS
1: ** *BUILDING DEPARTMENT * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: Plumbing permits shall be obtained through the Seattle -King County Department of Public Health. Plumbing will be inspected by
that agency, including all gas
piping (296- 4722).
4: Electrical permits shall be obtained through the Washington State Division of Labor and Industries and all electrical work will be
inspected by that agency
(206- 835 - 1111).
5: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any construction. These
documents are to be
maintained and available until final inspection approval is granted.
6: Readily accessible access to roof mounted equipment is required.
7: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997 Edition) as
amended, Uniform Mechanical Code
(1997 Edition), and Washington State Energy Code (1997 Edition).
8: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations shall not be construed to be a
permit for, or an approval
of, any violation of any of the provisions of the building code or of any other ordinance of the jurisdiction. No permit presuming to
give authority to violate
or cancel the provisions of this code shall be valid.
9: Manufacturers installation instructions required on site for the building inspectors review.
10: ** *FIRE DEPARTMENT CONDITIONS * **
11: The attached set of plans have been reviewed by The Fire Prevention Bureau and are acceptable with the following concerns:
12: Commercial -type food heat - processing equipment from which grease -laden vapors emanate in normal cooking application shall be
protected by an approved automatic
extinguishing system. The extinguisher system shall be interconnected to the fuel and current supply so that the fuel or current is
automatically shut off to
all equipment under the hood, when the system is actuated. (UFC 1006)
13: All new fire alarm systems or modifications to existing systems shall have the written approval of the Tukwila Fire Prevention
Bureau. No work shall commence
until a fire department permit has been obtained. (City Ordinance #1900) (UFC 1001.3)
14: Local U.L. central station supervision is required. (City Ordinance #1900)
15: A wet chemical portable fire extinguisher having a minimum rating of 2A:1 B:C:K shall be installed within 30 feet of commercial
food heat - processing equipment,
as measured along an obstructed path of travel. (UFC 1006.2.7).
16: Contact the Tukwila Fire Prevention Bureau to witness all required inspections and tests. (UFC 10.503) (City Ordinance #1900 and
#1901)
17: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of such
condition or violation.
18: These plans were reviewed by Inspector 511. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575-
4407.
MO2 -077
Permit Number: MO2 -077
Status: ISSUED
Applied Date: 04/09/2002
Issue Date: 04/24/2002
Printed: 04 -24 -2002
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11/1/99
niech permitdoc
Mechanical Permit Application
Date application accepted:
CITY OF T' 'KWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Project Number.
Permit Number: - f
R Si /NI USE ONIY
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
MECHANICAL; PERMIT.: REVIEW ANDAPP REQUESTED .(1 OUT! BYAPPLICANT)�.
Description of work to be done (please be specific):
Current copy of Washington State Department of Labor and Industries Valid Contractor's License. If not available at the time of
application, a copy of this license will be required before the permit is issued OR submit Form H-4, "Affidavit in Lieu of Contractor
Registration ".
Building Owner /Authorized Agent: If the applicant is other than the owner, registered architect/engineer, or contractor licensed by the
State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and obtain the
permit will be required as part of this submittal.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
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 114.4 of the Uniform Mechanical Code (current edition). No application shall be
extended more than once.
4-9 -o)--
Date application expires:
/0 —q -OZ,
Application taken by: (initials)
�r�
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.Submittal Requirements
Floor plan and system layout
Roofplan required to identify individual equipment and the location of each installation (Uniform
Weclianidal 'Cede :.404 (e))
Details and elevations (for roof mounted equipment) and proposed screening
Heat Loss Calculations or Washington State Energy Code Form #H -7
H.V.A.C. over 2,000 CFM (approximately 5 ton and larger) must be provided with smoke detection shut-
off and will be routed to the Fire Prevention division for additional comments (Uniform Mechanical
Code 1009).
Specifications must be provided to show that replacement equipment complies with the efficiency ratings
and other applicable requirements of the Washington State Nonresidential Energy Code.
Structural engineer's analysis is required for new and the replacement of existing roof equipment
weighing 400 pounds and greater (Uniform Building Code 1632.1). Structural documentation shall be
stamped by a Washington State licensed Structural Engineer.
Mechanical Permits
COMMERCIAL: Two complete sets of drawings and attachments required with application submittal
NOTE: Water heaters and vents are included in the Uniform Mechanical Code — please include any water
heaters or vents being installed or replaced.
RESIDENTIAL: Two complete sets of attachments required with application submittal
Submittal Requirements
New Single Family Residence
Heat loss calculations or Form H -6.
Equipment specifications.
11/2/99
miscpm►.doc
Change -out or replacement of existing mechanical equipment
I Narrative of work to be done, including modification to duct work.
Installation of Gas FireElace
Narrative with specification of equipment and chimney type.
If using existing chimney, provide a letter by a certified chimney sweep stating that the chimney is in safe
condition.
NOTE: Water heaters and vents are included in the Uniform Mechanical Code — please include any water
heaters or vents being installed or replaced.
ACCOUNT ITEM LIST:
doc: Receipt
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
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RECEIPT
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Parcel No.: 2623049019 Permit Number: MO2 -077 V
Address: 1001 ANDOVER PK E TUKW Status: PENDING N O
Suite No: Applied Date: 04/09/2002 W =
Applicant: SIMPLY THAI Issue Date: —i
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Receipt No.: R020000544 Payment Amount: 65.06 g Q
Initials: KAS Payment Date: 04/24/2002 03:14 PM CO d
User ID: 1684 Balance: $0.00 W
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Payee: SIMPLY THAI W W;
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TRANSACTION LIST: O N `
01—:
Type Method Description W W .
Amount
U. [I"'
Payment Check 22751 65.06 0
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Current Pmts
MECHANICAL - NONRES
PLAN CHECK - NONRES
Description Account Code
000/322.100 52.05
000/345.830 13.01
Total: 65.06
TOTAL
Printed: 04 -24 -2002
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Special Instru tions:
Date Called:
Requester:
Phone No:
•
INSPECT
ITY. OF TUKWILA BUILDING DIVISION
300Southcenter Blvd:, #100, Tukwila, WA 98188
Approved per applicable codes.
INSPECTION RECORD
Retain a copy with permit
(206)431 -3670
COMMENTS:
Ii L2- --- '"
Corrections required prior to approval.
$47.00 REINSPECTION SEE REQUIRED. Prior to inspection, fee must be
' paid att300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
f RecelptNo.: :
IDate:
Project ', :; .:. .. +
111 1144V
Type of Inspection:
10101 Mme, 1-}09t) - rEs r
Address: •
1 C0 ( - Th E
Date Called:
I O — 2 M Z—
Special,lnstructions: ::
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Date Wanted: y � y
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Phone No: n
Approved
INSPECTION RECORD � OZ_D.7.7
Retain a copy with permit
:INSPECTION NO. PERMIT NO.
OF TUKWILA BUILDING DIVISION
6300. Southcenter Blvd :, #100, Tukwila, WA 98188
Receipt No . .:
per applicable codes.
COMMENTS:
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(206)431 -3670
Corrections required prior to approval.
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 1;300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Date:
Sp - cia Instructs • ns:
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd;, #100, Tukwila, WA 98188
Approved per applicable codes.torrections required prior to approval.
COMMENTS:
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Inspector:
IDate: Je' H27
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at b300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
1 ReceiptNo.:
'Date:
•
COMMENTS:
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Type of Ins a ection:
Address:
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Date called:
Special instructions:
Date wanted:, f
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Phone:
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INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
El Approved per applicable codes.
Inspecto
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
(206)431 -3670
Corrections required prior to approval.
A/4" Date: 9-5107
$47.00 REINSPECTIIISN FEE REQUIRED. Prior to inspection, fee must be paid
46300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No:
Date:
:etir k::MjVP.44tr! ;`i;' .1 "AL:4•7 -'• �i.n. ,�r ;y..y "%41: " yr,:4 k Mn.‘ t4( ua't he;^v,; {:a.ei.;,�:... • .. 77r
City of Tukwila
Fire Department
TUKWILA FIRE DEPARTMENT
FINAL APPROVAL FORM
Project Name /1"1 12 `/ 6 � d
/ou / ,40 64W- /
Address _ Suite #
FINA.LAPP.FRM
Retain current inspection schedule
Needs shift inspection
Approved without correction notice
Approved with correction notice issued
Sprinklers:
Fire Alarm:
Hood & Duct:
Halon:
Monitor:
Pre -Fire:
Permits:
Authorized Signature
I
Feo /
T.F.D. Form F.P. 85
s4s
John W. Rants, Mayor
Thomas P. Keefe, Fire Chief
Permit No. / 4/C)-()) 7
/ 0 -- 1- U .y
Date
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575.4404 • Fax (206) 575 44139
Project: S, r '174 A-t
Archt.:
Engr.:
Date:
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N SYSTEM
BALANCE
NEBB
TEST REPORT
NEUDORFER ENGINEERS, INC.
Consulting Engineers
1170 Republican St.
Seattle, Washington 98109
(206) 621 -1810
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PAGE OF
MOTOR DATA
Make /Frame
hA (t 'I j / `, ;-
H.P. /RPM
3/(7 / + / ...,'
Volts /Phase /Hertz
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F.L. Amps /S.F.
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Make Sheave
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Sheave Diam. /Bore
Sheaved Distance
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Rotation
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Belt Tension /Alignment
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Overloads/Amps
No. Filters /size
TEST DATA
DESIGN
ACTUAL
Discharge S.P.
DESIGN
ACTUAL
Total CFM
Suction S.P.
"'
'—
Reheat Coil AS.P.
Total E.S.P.
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Outside Air CFM
Out. Air Damp. Position
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Exhaust Air CFM
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Motor to Retract
Motor to Extend
UNIT DATA
Make
/if A
Model No.
Serial Number
Arr. /Class
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Discharge
SI-/
Make Sheave
C c 4. ? U
Sheave Diam. /Bore
MO //• G ''
No. Belts /size 1/44
fa &
No. Filters /size
TEST DATA
DESIGN
ACTUAL
Total CFM
3q00
3
Total S.P.
Total E.S.P.
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Fan RPM
--
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Motor Volts T- T3T1 -
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Outside Air CFM
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Return Air CFM
Exhaust Air CFM
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LOCATION
REMARKS:
f EST DATE
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READINGS BY
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VELOCITY
SUBTOTALS
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- (206) 621 -1810 (206) 343 -9820 (fax)
PROJECT ✓ / I Y /R
LOCATION /ZONE
DUCT
SIZE (0 �J SQ FT /, 3 5
SYSTEM /UNIT
ACTUAL AIR TEMP
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DUCT S.P.
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REQUIRED
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ACTUAL
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Rotation
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Belt Tension /Alignment
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Overloads /Amps
TEST DATA
DESIGN
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ACTUAL
Discharge S.P.
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3` b t '/..5
Suction S.P.
Reheat CoilAS.P.
tal E.S.P.
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Filters AS.P.
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Rotor Amps T 1 T2 T3
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)utside Air CFM
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Out. Air Damp. Position
teturn Air CFM
.-'
Ret. Air Damp. Position
:xhaust Air CFM
g
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Motor to Retract
Motor to Extend
lEMARKS:
EST DATE
READINGS BY
SYSTEM /UNIT
61
'ROJECT �1M P AL / art
_OCATION
NATIONAL ENVIRONMENTAL BALANCING BUREAU
PAGE OF
UNIT DATA
\lake
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Model No.
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Jo. Belts /size
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TEST DATA
DESIGN
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'ptai CFM
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teturn Air CFM
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:xhaust Air CFM
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lEMARKS:
EST DATE
READINGS BY
SYSTEM /UNIT
61
'ROJECT �1M P AL / art
_OCATION
NATIONAL ENVIRONMENTAL BALANCING BUREAU
PAGE OF
POSITION
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1
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March 11, 2003
Don Angeline
14528 128th Street
Puyallup, WA 98374
RE: Permit Application No. MO2 -077
1001 Andover Park East
Dear Permit Holder:
City of Tukwila
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 Uniform Building Code and /or Uniform Mechanical Code, every permit issued by the
Building Official 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 Permit Center at (206) 431 -3670 to arrange 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 -time
extension up to 180 days. 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 or request and receive an extension prior to April 6, 2003,
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,
Stefanie Spencer
Permit Technician
Xc: Permit File No. MO2 -077
Bob Benedicto, Building Official
Steven M. Mullet, Mayor
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206- 431 -3670 • Fax: 206 - 431 -3665
September 9, 2002
Mr. Don Angeline
14528 128 St
Puyallup, WA 98374
Dear Permit Holder:
City of Tukwila
RE: Permit Application No. MO2 -077
Location: Simply Thai
1001 Andover Pk E
Xc: Permit File No.MO2 -077
Bob Benedicto, Building Official
Thank you for your cooperation in this matter.
Sincerely,
KC(i Gig iliU C � ; 0.J
Kathryn A. Stetson
Permit Technician
In reviewing our current records the above noted permit has not received a final inspection by the City of
Tukwila Building Division. Per the Uniform Building Code and /or Uniform Mechanical Code, every permit
issued by the Building Official 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.
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
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•Call the City Of Tukwila Permit Center at (206) 431 -3670 to arrange for the next U
scheduled inspection u_
This inspection is intended to determine if substantial work has been accomplished since issuance of the iii N
permit or last inspection; or if the project should be considered abandoned. U
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The Building Code does allow the Building Official to approve a one -time extension up to 180 days. Z
Extension requests must be in writing and provide satisfactory reasons why circumstances beyond the
applicant's control have prevented action from being taken.
In the event you do not call for the above inspection or request and receive an extension prior to October
21, 2002, your permit will become null and void and any further work on the project will require a new permit
and associated fees.
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206- 431 -3670 • Fax: 206- 431 -3665
4
Revision I Date
No. I Received
Staff
1 Initials
i Date ;
Issued !
Staff
Initials
/ I 9- 72aZ
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4-04-
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Summary of Revision:
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•
Revision
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Date
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Summary of Revision:
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Revision
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Received By:
PROJECT NAME: �Jilc� / J.0
Site Address: /oo/ fl�E-
Revision
No.
Summary of Revision:
Date
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REVISION LOG
Staff
Initials
P ERM I . J O :._ /� "��' 7 7
Original Issue Date: 5
Received By:
Date
Issued
ip)e print)
(please print)
(please print)
(please print)
please print
Staff
Initials
Documents/routing stlp.doc
2.28 -02
APPROVALS O CORRECTIONS:
Incomplete
REVIEWER'S INITIALS:
PERMIT COORD COPY
PERMIT COORD
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: MO2 -077
PROJECT NAME: SIMPLY THAI
SITE ADDRESS: 1001 ANDOVER PARK EAST
_ Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # X Revision # 1 After Permit Is Issued
DATE: 09 -13 -02
DEPARTMENTS:
' I Fire Prevention ❑ Planning Division
Public Works ❑ Structural ❑ Permit Coordinator
DUE DATE: 09-17-02
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete d
Comments:
Not Applicable ❑
Permit Center Use. Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS ROUTING:
Please Route ES Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
DUE DATE: 10-15 -02
Approved Approved with Conditions ❑ Not Approved (attach comments) ❑
Notation:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
ACTIVITY NUMBER: MO2 -077
PROJECT NAME: Simply Thai
SITE ADDRESS: 1001 Andover Pk E
X Original Plan Submittal
Response to Correction Letter # Revision #
DATE: 04 -09 -02
Response to Incomplete Letter #
After Permit Is Issued
DEPARTMENTS:
i -nom
AUG D i I
Public Works ❑
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete Incomplete n
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED:
Departments determined incomplete:
LETTER OF COMPLETENESS MAILED:
Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS ROUTING:
Please Route [ Structural Review Required
REVIEWER'S INITIALS:
APPROVALS OR CORRECTIONS:
Approved ❑
Notation:
REVIEWER'S INITIALS:
Documents/routing sllp.doc
2.28 -02
ERMIT COORD COO "
PLAN REVIEW /ROUTING SLIP
Approved with Conditions
Fire l ention
4 4iss
Structural ❑
7,
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑
Staff Initials:
PERMIT COORD COPY
Planning Division
Permit Coordinator
DUE DATE: 04-11-02
Not Applicable ❑
❑ No further Review Required
DATE:
DUE DATE: 05 -09 -02
Not Approved (attach comments) ❑
DATE:
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Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted
through the mail, fax, etc.
Date: 6/ / 3/O 2. Plan Check/Permit Number: 0 2— Q 7 7
0 Response to Incomplete Letter #
0 Response to Correction Letter #
0 Revision # after Permit is Issued
Project Name:
Project Address:
Contact Person: 22, Phone Number:- 66' cti' 2 j
Summary of Revision:
9
CA-effeeee.
City of Tukwila
Department of Community Development - Permit Center
6300 Southcenter Blvd, Suite 100
Tukwila, WA 98188
(206)431 -3670
/00/
•
RECEIVED
CITY OF TUKWItA
•
L s I J 2002
PERMIT CENTER
Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by:
(Z Entered in Sierra on 9
08/30/00
REGISTERED AS PROVIDED BY LAW AS
CONST CONT GENERAL
REGIST..# EXP. DATE
CC01;, NORTHS *016B1 02/11/2004
EFFECTIVE 'DATE , .:' 01/21/1999
NORTHWEST STAINLESS ;., \ -. ;
14528 128TH ST, , E >: :. ,`..'K ' 7..,..� � ,..
PUYALLUP WA `j98374
Signature
' Issued by DEPARTMENT OF LABOR AND INDUSTRIES
clrvRO F B TUK ° WIL4
APR " 9 2002
DERMIT CENTER
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