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Home My WebLink AboutPermit PG07-067 - HABITAT FOR HUMANITYHABITAT FOR HUMANITY 12230 43 AV S PG07 -067 Parcel No.: 0179000270 Address: Suite No: Tenant: Name: Address: 12230 43 AV S TUKW DESCRIPTION OF WORK: PLUMBING AND GAS PIPING FOR NEW SFR Value of Plumbing /Gas Piping: Fees Collected: Plumbing Bathtub or combination bath/shower Bidet Clothes washer, domestic Dental unit, cuspidor Dishwasher, domestic, with independent drain Drinking fountain or water cooler (per head) Food -waste grinder, commercial Floor drain Shower, single head trap Lavatory Wash fountain Receptor, indirect waste Sinks Urinals Water Closet City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: / /www.ci.tukwila.wa.us HABITAT FOR HUMANITY 12230 43 AV S , TUKWILA WA Owner: Name: CITY OF TUKWILA Address: 6200 SOUTHCENTER BLVD , TUKWILA WA Contact Person: Name: KELLY MORGAN Address: 15439 53 AV S, STE B , TUKVVILA WA Contractor: Name: HABITAT FOR HUMANITY /SEA/SO KC Address: 15439 53 AV S, STE B , TUKWILA WA Contractor License No: HABITFH972LD $6,000.00 $363.50 FIXTURE TYPE AND OUANTITY * *continued on next page ** PLUMBING /GAS PIPING PERMIT Permit Number: Issue Date: Permit Expires On: Phone: Phone: 206 292 -5240 X 107 Phone: 206 292 -5240 Expiration Date: 05/04/2008 Steven M Mullet, Mayor Steve Lancaster, Director PG07 -067 07/13/2007 01/09/2008 Uniform Plumbing Code Edition: 2003 International Fuel Gas Code Edition: 2003 Plumbing (cont.) 1 Building sewer and each trailer park sewer 1 0 Rain water system - per drain (inside bldg) 0 1 Water heater and/or vent 1 0 Industrial waste treatment interceptor, including 1 its trap and vent, except for kitchen type 0 grease interceptors 0 1 Repair or alteration of water piping and/or water 0 treatment equipment 0 1 Repair or alteration of drainage or vent piping 0 2 Medical gas piping system serving (1 -5) 0 inlets /outlets for a specific gas 0 0 Medical gas piping (6 +) inlets /outlets 0 1 Gas Piping 0 Gas piping outlets (0 -5) 3 2 Gas piping outlets (6 +) 0 doc: UPC-10 /06 PG07 -067 Printed: 07 -13 -2007 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: / /www. ci. tukwila. wa. us Permit Center Authorized Signature: .e.l e.l_t 6L/• Date: 07/t3/0 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 constructs- ape ce of wo . uthorized to sign and obtain this plumbing /gas piping permit. / Signa e: i G�r'es" Date'./UG7 /3 /> 7 Print Name: r/ A • Permit Number: PG07 - 067 Issue Date: 07/13/2007 Permit Expires On: 01/09/2008 Steven M Mullet, Mayor Steve Lancaster, Director 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: UPC -10/06 PG07 -067 Printed: 07 -13 -2007 Parcel No.: 0179000270 Address: Suite No: Tenant: doc: Cond -10/06 12230 43 AV S TUKW HABITAT FOR HUMANITY 1: ** *PLUMBING AND GAS PIPING * ** City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 - 431 -3665 Web site: http://www.cidtdcwila.wa.us PERMIT CONDITIONS * *continued on next page ** Permit Number: Status: Applied Date: Issue Date: PG07 -067 ISSUED 03/19/2007 07/13/2007 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas Code. 6: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection. 7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall be insulated to minimum R-3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be protected by steel nail plates not less than 18 guage. 9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No plumbing piping shall be directly embedded in concrete or masonry. 10: All pipes penetrating floor /ceiling assemblies and fire- resistance rated walls or partitions shall be protected in accordance with the requirements of the building code. 11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin layers to twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, cinderfill, frozen earth, or construction debris. 12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the jurisdiction. PG07 -067 Printed: 07 -13 -2007 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and 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 construction or the performance of work. doc: Cond -10/06 PG07 -067 Date: t/G ordinances governing or local laws regulating Printed: 07 -13 -2007 Tenant Name: Community Development Department Public Works Deparmmer' Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us 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 ** Site Address: x' 2 3 0 �(r 3 Ave S Property Owners Name: +In b t fcc 4- far 4u ►man t Mailing Address: 154? )9 4/e 5u t i Lam_ Name: 1(A H O rq q h c / Day Telephone: 2O( — 2_92 52.40 b y f- 101 Mailing Address: 1 5 43 Q tat �t ale, `� cCU , g J- m�G.vU t t /et a i /// tray State Zip E -Mail Address: IA mnrQCa n r' sicai -'{e — b r 4t 4- . Ore) Fax Number: 2D (o Company Name: Hu F r HA rYl Ctvl t — G +Re / ✓1 C, Co . Mailing Address: 154 3l 5, r t At?if ��c t � �2 /Tu k to < A J LA 9 I c S , $ City Contact Person: LN Mora , / 1 r)e5 rndr o�r�t�3 S e4 * — bt -tu� or E -Mail Address: bh t �n 4. gym. .Fo (r, — ha A .a.-4 . oy of Contractor Registration Number: 1.4 toa, ITFH 9 1 2,LtJ Company Name: klo ,l - � e / W a J O t-D P,r Mailing Address: Rl 1 151- '' // AL12. u�t t t 1 . - to n `� Contact Person: jr r1 CEO t op e_ E -Mail Address: j l(O f pe, ( &v tk , r O ni Company Name: Mailing Address: Contact Person: E -Mail Address: See Q: AppliationsWonns- Applications On tineO -2006 - Permit Application.doc Revised: 4.2006 be Prcnif oC 1�C1)rri King Co Assessor's Tax No.: 01 q 0(72.9 (-) Suite Number: Floor: New Tenant: .... Yes ..No Ffcck le, l Vo v1 63 CO city State Zip Tukk)t 01103a9d-tal°5 )C Day Telephone:lj ?O l� [f7?, -- - 7 t, f(,3 Fax Number: t O(o - aqa 5Q41 Expiration Date: &afte wA q toy Day Telephone: (206) car { q — 5Z $/; Fax Number. ( c, (0) 4-L( — J7 Z9 State Zip [ GlERG -. Aa M h Fx City Day Telephone: Fax Number: State Zip Page 1 of 6 Valuation of Project (contractor's bid : $ q0) 000 Scope of Work (please provide detailed information): Q:\ Applications\Pomu- Applications On Lined -2006 - Permit Appliation.doc Revised: 4 -2006 bh Exist' iilding Valuation: $ 1 CIO C.) eXt Ct V a. t - 4 tol,t.i v1Q c4 Z SA c { 4 - Ico? Will there be new rack storage? ❑ ..Yes d eNo (If yes, a separate permit and plan submittal will be required) r ovide, Alt Suildini yeas In quire Footage Belo Attacked Carport' ',..Detached arport Covered Dec 1 ' 2 " ° Floor ': 3"` Floor - Floors�,x asemen J ncavered Deck 685 0304 &a .Q L PLANNING DIVISION: G Single - family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) g 5 *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: 1 Compact: t Handicap: Will there be a change in use? ❑ ....Yes 14 .No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ .- Sprinklers ❑ ..Automatic Fire Alarm 14.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. SEPTIC SYSTEM: El On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. Page 2 of 6 Water District Tukwila ❑ ... Water District # 125 ...Water Availability Provided Sewer District ...Tukwila 0 ...Sewer Use Certificate Submitted with Application (mark boxes which apply): 0 ...Civil Plans (Maximum Paper Size — 22" x 34 ") 0 ...Technical Information Report (Storm Drainage) 0 ...Bond ❑ .. Insurance ❑ .. Easement(s) Proposed Activities (mark boxes that apply): 0 ...Right -of -way Use - Nonprofit for less than 72 hours Right -of -way Use - No Disturbance 1341...Construction/Excavation/Fill - Right -of -way Non Right -of -way Total Cut 4 cubic yards ...Total Fill r) cubic yards D... Va1Vue ❑... Sewer Availability Provided ...Sanitary Side Sewer 0 ...Cap or Remove Utilities 0 ...Frontage Improvements 0 ...Traffic Control ...Backflow Prevention - Fire Protection " Irrigation " Domestic Water X .-Permanent Water Meter Size... !✓ )L-t '3'1"1 C� ... Temporary Water Meter Size • J ❑...Water Only Meter Size iR..Sewer Main Extension Public 0 ...Water Main Extension Public Q: ApplicationaWotns-Applieatione On LineV -2006 - Pemtit Application.doc Revised: 4 -2006 bh Abandon Septic Tank 0 .. Curb Cut .. Pavement Cut 0.. Looped Fin Line . Highline Scope of Work (please provide detailed i;mation): Call before you Dig: 1- 800 -424 -5555 Please refer to Public. Works Bulletin #1 for fees and :estimate sheet: 0 .. Renton 0...Seattle .. • Approved Septic Plans Provided ❑ .. Geotechnical Report 0 .. Maintenance Agreement(s) .. • Right -of -way Use - Profit for less than 72 hours .. • Right -of -way Use — Potential Disturbance .. • Work in Flood Zone .. ▪ Storm Drainage 0 ...Renton .. Grease Interceptor ❑ .. Channelization .. • Trench Excavation .. • Utility Undergrounding .. .Deduct Water Meter Size Private X Private E ?5}i 0 0 ...Traffic Impact Analysis 0... Hold Harmless — (SAO) ❑...Hold Harmless — (ROW) '1 FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) tj ...Water ...Sewage Treatment Monthly Service Billing to: i 1 - th - x 12.' 52.40 6O� Name: - NCtIOt �Cc'�" �� t�V� �•ht� - S� = -�� 4 160 � � Co � Day Telephone: '�' Mailing Address: 15 ?tq 5afti Psija.. c.11 t$ Ted i i C1 ) (.t)R Q R % 1 City State Zip Water Meter Refund/Billing: Name: < J iniVe as A too V-& Mailing Address: Day Telephone: City State tip Page 3 of 6 Un it TYPe= -=-Qtr: 1 Qty - Kili -0 , s Qty .. 4Boiler-M9APressarr Furnace<100K BTU Air Handling Unit >10,000 CFM Fire Damper 9 ( Yr 0-3 HP /100,000 B TU I Fumace>100K BTU Evaporator Cooler 0 Diffuser 0 3 -15 HP/500,000 BTU Floor Furnace Ventilation Fan Connected to Single Duct 4 Thermostat t 15 -30 HP /1,000,000 BTU Suspended/Wall/Floor Mounted Heater Ventilation System �( Wood/Gas Stove 0 30 -50 HP /1,750,000 BTU Appliance Vent Hood and Duct f Water Heater 1 50+ HP/1,750,000 BTU Repair or Addition to Heat/Refrig/Cooling System ,23i j'� Incinerator - Domestic 0 Emergency Generator Air Handling Unit <10,000 CFM Incinerator – Comm/Ind Other Mechanical Equipment / y`' MECHANICAL CONTRACTOR INPt1.MATION Company Name: k4- - ' i - :ALk o in ‘t-k- - se0.' ‘e,, So ; Y- t,.._.o Mailing Address: (54?� Gj 3rd , 5 t �a k4- 6 Tu kW ( {4 WA q f State Zip Contact Person: y j i-h h PS City Day Telephone: (2O(,) .(Z,7 — 70? E -Mail Address: bin C S t w H (e. – ' Q I^ Fax Number: (21)1.62,M, Si. - I Contractor Registration Number. (-iM l3 Cfl ff t7 2!� �} Expiration Date: Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): ( ( 1 c' Ina. U 'Di -c et" d ,7 C cWY1 I Pl(ie-(li U)k VU1t Use: Residential: New ....4 Replacement .... 0 Commercial: New ....0 Replacement .... 0 Fuel Type: Electric 0 Gas ...$ Other: Indicate type of mechanical work being installed and the quantity below: Q:Upplicstions\Fomu- Applications On Line\3 -2006 - Permit Appliation.doc Revised: 4-2006 bh Page 4 of 6 FI*tint Tyype:. cA Fixture Type :' . ICI `Fixture Type: 'Qty , FixtttreType Bathtub or combination bath/shower Drinking fountain or water cooler (per head) Wash fountain ,5 y� Gas piping outlets Bidet Food -waste grinder, commercial , r Receptor, indirect waste Clothes washer, domestic t Floor drain /) Sinks Dental unit, cuspidor 5 Shower, single head trap Urinals Dishwasher, domestic, with independent drain - j Lavatory 2 Water Closet Building sewer or trailer park sewer Rain water system — per drain (inside building) 4 Water heater and/or vent l Industrial waste pretreatment interceptor, including its trap and vent, except for kitchcn type grease interceptors 0 Repair or alteration of water piping and/or water treating equipment Repair or alteration of drainage or vent piping Medical gas piping system serving one to five inlets/outlets for specific gas Additional medical gas inlets/outlets — six or more V,PLUMPLIN IFINtr i'ta , 1 J1 L VLt I PLUMBING AND ____ PIPING CON'tsakCTOR INFORMATION _ _tMATION Company Name: Mailing Address: Contractor Registration Number: Q:1ApplicationsWenns- Applications On Line\3-2006 - Permit Appliation.doe Revised: 4 -2006 bh city Contact Person: Day Telephone: E-Mail Address: Fax Number: Expiration Date: Valuation of Project (contractor's bid price): S Scope of Work (please provide detailed information): 1 v1 C (o o r h ?t k Lout k1 o /1 cto n!(k n G C(Ct 5 L)ator ‘A oak ) gas 4c1e) cga5 ck r Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: State Zip Page S of 6 Print Name: Mailing Address: ,6 0 I Date Application Accepted: VI ; lk - 77/ 7 4V2_6• Ay Q7 (55/t01101- Q: 1ApplieationsWonns- Applications On Line13 -2006 - Permit Application :doe Revised: 4-2006 bh It emits ;in tnis a Value of Construction — In all cases, a vailliP6f construction amount should be entered by the appit'cant. 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. Building and Mechanical Permit 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). Plumbing Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing 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. BUILDIN 1 ` OR AUTHO • ✓ I AGENT: Signa zae,A■2 . / //t/.si�� / Date: 5f/'J/O Day Telephone: 2,0)6 2 -9 Z 5"2—¢D eier//5 City State Zip Date Application Expires: Staff Initials: I Page6of6 Parcel No.: 0179000270 Permit Number: PG07 -067 Address: 12230 43 AV S TUKW Status: APPROVED Suite No: Applied Date: 03/19/2007 Applicant: HABITAT FOR HUMANITY Issue Date: Receipt No.: R07 -01386 Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: / /www.ci.tukwila.wa.us Initials: LAW Payment Date: 07/13/2007 12:20 PM User ID: 1632 Balance: $0.00 Payee: HABITAT FOR HUMANITY OF SEA/SKC RECEIPT TRANSACTION LIST: Type Method Description Amount Payment Check 1120 299.50 ACCOUNT ITEM LIST: Description GAS - RES PLAN CHECK - RES PLUMBING - RES Account Code Current Pmts 000/322.100 000/345.830 000/322.100 Payment Amount: $299.50 88.00 2.50 209.00 Total: $299.50 0296 07/13 9710 TOTAL 2199.63 doc: Receiot -06 Printed: 07 -13 -2007 Doc: RECSETS -06 RECEIPT NO: R07 -00391 Initials: JEM User ID: 1165 Payee: HABITAT FOR HUMANITY SET TRANSACTIONS: Set Member Amount City bf Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: http: //www.cLtukwila.wa.us D07 -090 1,438.67 M07 -051 34.31 PG07 -067 64.00 TOTAL: 1,536.98 SET RECEIPT Payment Date: 03/19/2007 Total Payment: 1,536.98 SET ID: 5000000708 SET NAME: HABITAT FOR HUMANITY TRANSACTION LIST: Type Method Description Amount Payment Check 23571 1,536.98 TOTAL: 1,536.98 ACCOUNT ITEM LIST: Description PLAN CHECK - RES PW BASE APPLICATION FEE PW PLAN REVIEW Account Code Current Pmts 000/345.830 1,056.98 000/322.100 250.00 000/345.830 230.00 TOTAL: 1,536.98 Pro e t i,76// a i Type of nspection: T � �7 - ar 4 Address: /22;e) 4 /V Date Called: Special Instructions: Date Wance d: �.2 /2 ' � 4 - 7 p.m. Requester: INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 proved per applicable codes. COMMENTS: 634-s — n//0 1 ezilv ,/ -/r• PAo7eG 7 Corrections required prior to approval. Da j J REINSPECTION FEE v QUIRED. P or to inspection, fee must be at 6300 Southcenter Blvd., Suite 100. Call the schedule re' spection. Receipt No.: 'Date: Projec : l7 ' 4 2 -7/ L :- / //rl m /nip / - ' Type Inspe tion: / e>i /7 - 1;1.d Address: /2230 ' wS Date Called: Special Instructions: Date Wanted: Requester: Phone No: 2D a /O ? INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 PERMIT NO. (206)431 -3670 COMMENTS: /d /,f4 - d g /7 70t/L°V Da y Approved per applicable codes. Corrections required prior to approval. .00 REINSPECTION FEE RE(iJ11RED. Per to inspection. fee must be aid at 6300 Southcenter Blvd., Suite 100. Call the schedule reinspection. (Receipt No.: 'Date: Projpg: , Type of 1)spection: Address: / 2 2 3 4. '4 __ 7 4 ; / Date Called: Special Instructions: Ci\ Date Wanted: '7 6 Requester: Phone No: 2e, - 4(_.5 - -q.3 ci INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 P60 7 6 6 7 EZ Approved per applicable codes. ID Corrections required prior to approval. , COMMENTS: ) • r (Date: .00 REINSPECTION FE REQUIR . Prior to inspection. fee must be aid at 6300 Southcenter lvd.. Sui 100. Call the schedule reinspection. I R ceipt No.: 'Date: PERMIT COORD COPY'w taw PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG07 -067 DATE: 03 -19 -07 PROJECT NAME: HABITAT FOR HUMANITY SITE ADDRESS: 12230 43 AV S X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEPARTMENTS: /3W(/ 60- 01 Build Division Public Works tom. DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Comments: Fire Prevention Structural Incomplete ❑ Et Planning Division ❑ Permit Coordinator n DUE DATE: 03-20-07 Not Applicable ❑ Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS RO TING: Please Route Structural Review Required REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: No further Review Required DATE: C DUE DATE: 04-1 7 -07 Approved n Approved with Conditions LJ Not Approved (attach comments) n Notation: REVIEWER'S INITIALS: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents/routing slip.doc 2 -28 -02 DATE: License Information License HABITFH972LD Licensee Name HABITAT FOR HUMANITY /SEA/SO KC Licensee Type CONSTRUCTION CONTRACTOR UBI 601059723 Ind. Ins. Account Id 82709900 Business Type CORPORATION Address 1 15439 53RD AVE SO SUITE B Address 2 City TUKWILA County KING State WA Zip 98188 Phone 2062925240 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 6/4/2003 Expiration Date 4/5/2008 Suspend Date PRESIDENT Separation Date 03/09/2006 Parent Company Previous License SEATTHF055MJ Next License Associated License Business Owner Information Name Role Effective Date Expiration Date HADALLER, DONNA TREASURER 06 /04/2003 GALLEGOS, DIANE VICE PRESIDENT 06 /04/2003 CROSON, KATHLEEN VICE PRESIDENT 03/09/2006 GAYLORD, TOM VICE PRESIDENT 03/09/2006 EPP, BRYON M VICE PRESIDENT 03/09/2006 HINES, BENTON VICE PRESIDENT 10/30/2006 LARSON, ALLEN VICE PRESIDENT 10/30/2006 WILSON, ALICE VICE PRESIDENT 03/09/2006 10/30/2006 HOWLAND, TIMOTHY PRESIDENT 06/04/2003 03/09/2006 Look Up a Contractor, Electric »n or Plumber License Detail Page 1 of 2 U✓ 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. httns:// fortress .wa.eov /lni/hhin /nrinter.asnx ?Licen HABTTFH972LD 06/29/2007