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HomeMy WebLinkAboutPermit PG08-122 - PEDERSON CLASSIC HOMES - LOT 2PEDERSON CLASSIC HOMES LOT 2 14111 57 AV S PGO8-122 Parcel No.: 3365900346 Address: Suite No: Cit,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.ci.tukwila.wa.us 14111 57 AV S TUKW PLUMBING /GAS PIPING PERMIT Permit Number: Issue Date: Permit Expires On: PG08 -122 06/23/2008 12/20/2008 Tenant: Name: PEDERSON CLASSIC HOMES, LOT 2 Address: , TUKVVILA WA Owner: Name: DUNAWAY JAMES & MARY Address: 14117 57TH AVE S , TUKW LA WA Contact Person: Name: TED PEDERSON Address: 27148 12 AV S , DES MOINES WA Contractor: Name: MARATHON PLUMBING Address: 20901 SE 7 , REDMOND WA Contractor License No: MARATP* 101 OM Phone: Phone: 206 947 -0638 Phone: 425 - 392 -4766 Expiration Date: 09/12/2009 DESCRIPTION OF WORK: PLUMBING AND GAS PIPING FOR 2813 SF SFR Value of Plumbing /Gas Piping: Fees Collected: $8,000.00 $422.00 Uniform Plumbing Code Edition: 2006 International Fuel Gas Code Edition: 2006 FIXTURE TYPE AND OUANTITY Plumbing Bathtub or combination bath/shower 2 Bidet 0 Clothes washer, domestic 1 Dental unit, cuspidor 0 Dishwasher, domestic, with independent drain 1 Drinking fountain or water cooler (per head) 0 Food -waste grinder, commercial 0 Floor drain 0 Shower, single head trap 0 Lavatory 0 Wash fountain Receptor, indirect waste 0 Sinks 6 Urinals 0 Water Closet 3 0 Plumbing (cont.) Building sewer and each trailer park sewer 0 Rain water system - per drain (inside bldg) 0 Water heater and/or vent 1 Industrial waste treatment interceptor, including its trap and vent, except for kitchen type grease interceptors 0 Repair or alteration of water piping and/or water treatment equipment 0 Repair or alteration of drainage or vent piping 0 Medical gas piping system serving (1 -5) inlets /outlets for a specific gas 0 Medical gas piping (6 +) inlets /outlets 0 Gas Piping Gas piping outlets (0 -5) 4 Gas piping outlets (6 +) 0 * *continued on next page ** doc: UPC -10/06 PG08 -122 Printed: 06-23 -2008 City 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 Number: PG08 -122 Issue Date: 06/23/2008 Permit Expires On: 12/20/2008 Permit Center Authorized Signature: Date: cut qA I hereby certify that I have read and aned this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied h, whether specified herein or not. The granting of this p construction or the Signature: Print Name: it does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating work. I am authorized to sign and obtain this plumbing /gas piping permit. Date(/p" e (/ 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 PG08 -122 Printed: 06 -23 -2008 • • 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 CONDITIONS Parcel No.: 3365900346 Address: Suite No: Tenant: 14111 57 AV S TUKW PEDERSON CLASSIC HOMES, LOT 2 Permit Number: Status: Applied Date: Issue Date: PG08 -122 ISSUED 04/18/2008 06/23/2008 1: ** *PLUMBING AND GAS PIPING * ** 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. 5: 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. * *continued on next page ** doc: Cond -10/06 PG08 -122 Printed: 06-23 -2008 • 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. Signature: Print Name: z,_------- im,.5 ad Date: fr-.23 -(>d- ordinances governing or local laws regulating doc: Cond -10/06 PG08 -122 Printed: 06 -23 -2008 CITY OF TUKWIL Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Building Mechanic l.Permit•No. Playing /Gas Belt N offs c nl3') 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** King Co Assessor's Tax No.: 3-3 6,- <9 rr Site Address: jJ ECs-% 114 Suite Number: L,t,' ' Floor: a Tenant Name: f l6Ve t* ^01(irl��j Property Owners Name: - A. e S 6 U f N.1/4.,0 A Mailing Address: 1 (--111, 1 6 1` -.6 Aye.- 'So New Tenant: ( .... Yes D ..No Name: ‘--1-"FG-t) Mailing Address: 10-1,S4 i 2- 5 0 City 4 State Zip E -Mail Address: Company Name: Mailing Address: Day Telephone: Cc, '(1 441 — & (a' 3 C).‹ s Ac 9. ig City State Zip Fax Number: 2. o L - (1 z.`? ° 2 % Contact Person: s C-2:0 E -Mail Address: Contractor Registration Number: Pe De.-, Qc (-t q -i 3 p 4k Company Name: Mailing Address: Contact Person: E -Mail Address: City State Zip Day Telephone: 24., k r Z L(7 06-4( Fax Number: Expiration Date: 3 - V - 0 ci Company Name: Mailing Address: Contact Person: E -Mail Address: City Day Telephone: Fax Number: State Zip Q:\Applications\Forms- Applications On Line\3 -2006 - Permit Application.doc Reviled: 9 -2006 bh City Day Telephone: Fax Number: State Zip Page 1 of 6 L V 1LL11 • V -I 1:41%1Y11 1v1' — GU() -431-30 /U Valuation of Project (contractor's bid price): $ [ (f • Cr , Existing building Valuation: $ Scope of Work (please provide detailed information): w p A' , s� i ffw 6) K Will there be new rack storage? ❑.... Yes .. No Provide All Building,.. If yes, a separate permit and . submittal will be required. Foot xis in riu: 5 Li autcy per. BC PLANNING DIVISIO : Single family building f' atprint (area of the foundation of all structures, plus any decks over 18 inches and overhan _` reater than 18 inches) *For an Accessory d ling, provide the following: Lot Area (si ` ): Floor area of principal dwelling: Floor area of acc ssory dwelling: *Provide a cumentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Park' g Stalls Provided: Standard: 7i Compact: Handicap: Will there be a change in use? ❑ Yes ®. No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm .1a. None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No 1f `yes', attach list of materials and storage locations on a separate 8 -1 /2 "x 11" paper including quantities and Material Safe ata Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. Of..4% �cenNem Focma- Applications On Line0 -2006 - Permit Applicstion.doe Revised: 9 -2006 bh Page 2 of 6 PLUMBING AND GAS :PIPIN ERMIT INFORMATION — 2 PLUMBING AND GAS PIPING CONT CTOR INFORMATION � Company Name: Met %f L t 1k) Lv..> 1 c Mailing Address: Z.& 0 C � � 7 ST S ./IN-Vi t ■ %.c L. City Contact Person: gt \1 E -Mail Address: Contractor Registration Number: I. isc.Pi ,T At4 i 0 i 0 W' Expiration Date: - 3erte- A- iC-e7cf State Zip Day Tele h LZ ?&3 p one: 5 - y Fax Number: Valuation of Plumbing work (contractor's bid price): $ 000. Valuation of Gas Piping work (contractor's bid price): $ t c4 e.) . Scope of Work (please provide detailed information): Pitt PO1 (7i9 f1112 144.1 c--26(1- Building Use (per Int'l Building Code): Occupancy (per Int'l Building Code): Utility Purveyor: Water: Sewer: Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: :.: ix i:0 Ty* :Qty , FtxtUre Tmype..: QtY Ftx(ttre Type i9t' SF !.,.. , Y.P., Bathtub or combination bath/shower Drinking fountain or water cooler (per head) Wash fountain Gas piping outlets Bidet Food -waste grinder, commercial Receptor, indirect waste Clothes washer, domestic ( Floor drain Sinks (oP Dental unit, cuspidor Shower, single head trap Urinals Dishwasher, domestic, with independent drain 1 Lavatory coli. Water Closet Building sewer or trailer park sewer Rain water system — per drain (inside building) Water heater and /or vent 1 Additional medical gas inlets /outlets — six or more Industrial waste pretreatment interceptor, including its trap and vent, except for kitchen type grease interceptors 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 Q:\Applicationslporms- Applications On Line' -2006 - Permit Application.doc Revised: 9 -2006 bh Page 5 of 6 PERMIT APPL;ICATIQ,N ;NO Applicable; to al permits; in this is itign 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. 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 1 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 OWNER A H ! 3 '; D AGENT: Signature: Print Name: Mailing Address: ad Date: q—/ / l r Day Telephone: 'Zot, v Y--2 Q - City State Zip Date Application Accepted: ` t 1 141 n Date Application Expires: ( j 12,12 Staff Initials: % Q:\Application\Forns- Application On Line'3.2006 - Permit Application.doc Revised: 9 -2006 bh Page 6 of 6 1 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 SET RECEIPT RECEIPT NO: R08 -02219 Initials: JEM User ID: 1165 Payee: PEDERSON'S CLASSIC HOME, INC. Payment Date: 06/23/2008 Total Payment: 11,104.05 SET ID: 0623 SET NAME: PEDERSON CLASSIC HOMES SET TRANSACTIONS: Set Member Amount D08 -196 10,405.42 EL08 -426 140.00 M08 -109 218.63 P298 122 340.00 TOTAL: 11,104.05 TRANSACTION LIST: Type Method Description Amount Payment Check 5058 ACCOUNT ITEM LIST: Description TOTAL: 11,104.05 11,104.05 Account Code Current Pmts BUILDING - RES CASCADE WATER ALLIANCE ELECTRICAL PERMIT - RES GAS - RES MECHANICAL - RES PLAN CHECK - RES PLAN CHECK - WATER METER PLUMBING - RES PW LAND ALT PERMIT FEE PW PERMIT /INSPECTION FEE PW PLAN REVIEW STATE BUILDING SURCHARGE TRAFFIC MITIGATION FEES 000/322.100 401/386.550 000.322.101.00.0 000.322.103.00.0 000.322.102.00.0 000/345.830 000/345.830 000.322.103.00.0 000/342.400 000/342.400 000/345.830 000/386.904 104.367.120 2,681.20 5,674.00 140.00 92.00 180.90 37.73 10.00 248.00 23.50 100.00 25.00 4.50 1,297.22 3968 06/23 9710 TOTAL 11104.05 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 WATER CONNECTION WATER INSPECTION FEE WATER INSTALLATION (DEP) WATER TURN -ON FEE 401/379.002 60.00 401/342.400 15.00 401/386.520 490.00 401/343.405 25.00 TOTAL: 11,104.05 r� .. ov•ecnr AO • City of Tukwila • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206131 -3665 Web site: http: //wwwci.tukwila.wa.us SET RECEIPT RECEIPT NO: R08 -01229 Initials: JEM Payment Date: 04/18/2008 User ID: 1165 Payee: PEDERSON'S CLASSIC HOME, INC. Total Payment: 2,157.28 SET ID: S000001002 SET NAME: Tmp set /Initialized Activities SET TRANSACTIONS: Set Member Amount D08 -196 2,067.78 M08 -109 7.50 ��PG08^T22' 82.00 tY6 aW TOTAL: 2,157.28 TRANSACTION LIST: Type Method Description Amount Payment Check 5005 2,157.28 TOTAL: 2,157.28 ACCOUNT ITEM LIST: Description Account Code Current Pmts PLAN CHECK - RES PW BASE APPLICATION FEE PW PLAN REVIEW 000/345.830 1,832.28 000/322.100 250.00 000/345.830 75.00 TOTAL: 2,157.28 1324 04/18 9711 TOTAL 2157.28 Don: REC;SETS -OR INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Pro Q6o 0 I CiAZI Type ospection: ,— DIVA ( v Address: Igi)I 7Aa(e) Date Called: Special Instructions: Date Wanted: Id- a3--o9 a.m. �. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. Z COMMENTS: ,h`1: 1 f►��+ ,A�� -�,� F�ti 1 / NOVA f.00 REINSPECTION F REQUIRE ' . Prior to inspection, fee must be . aid at 6300 Southcenter :lvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: 3 INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 INSPECTION RECORD Retain a copy with permit Proje�c�t�j. �y 7"e"l /r -/5Qy✓ (,/AS.. /e Type of Inspection: 1 �it 4 / -- l' -016 Address: /h/ //) 5--7 4d- Si) Date Called: Special Instructions: Date Wanted: _3_ /a -41-5 p Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. 7 COMMENTS: 0 64/41-c-. Q IW£9s: / `''E G/ -,P /ov &I ✓i4s_, .'r r��(i.e- ,-� Ai Pg .j, cti or: Date:, iu .00 REINSPECTION FE REQUIRED. Prior to inspection, fee must be aid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: INSPECTION RECORD Retain a copy with permit r3Ges - /LZ CITY OF TUKWILA BUILDING DIVISION \js('L 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 INSPECTION NO. PERMIT NO. Projec j ,0//oVs64J Type of Inspection: / " 4 /- ‘. 1f Address: 7 '- % / / / .-.$ / , Ny u. 3 Date Called: Special Instructions: Date Wanted: m. Requester: Phone No: ❑ Approved per applicable codes. ® Corrections required prior to approval. 7 COMMENTS: (.J 6,s r)/Artie % f}m/ i1/ cdIT Ph/ $ b A I or Date: 0.00 REINSPECTION PREIJ. Priorto inspection, fee must be aid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: -� .ILJauoaaa INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION ,.:f' 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -36'0 \t-ip ce {.l ( S, W Q.1/C7 k _I / ■.l ? MWPr Type of , ` Addresss: Date Called: Specil Instructions: Date9'Wanted: Requester: Phone No: — C/ Li7-a &3A' INN4 Approved per applicable codes. Corrections required prior to approval. // COM ENTS: �.t Inspect • r: 1 .w1 Dam 3 , vy� 0.00 REINSPECTION FEE RBUIRED. Pr or to inspection, fee must be id at 6300 Southcenter Blvd., uite 100. all to schedule reinspection. Receipt No.: 'Date: INSPECTION RECORD Retain a copy with permit e6oe-tzz4- INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 2-- 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Project: ,p Type oglnectioy�i Addres - /W// 5 7 4vS Date Called: l Special Instructions: Date Wanted: ---/ 67-42E a!m. Requester: Phone No: NApproved per applicable codes. fl Corrections required prior to approval. COMMENTS: 0645 /P,, >2a - „l or: Aool Dat! /t 0.00 REINSPECTIONIFEE R QUIRED. Prior to inspection, fee must be id at 6300 Southcent r Blvd'., Suite 100. Call to schedule reinspection. Receipt No.: Date: 02 -02 -2009 City of f 7aa Jim Haggerton, Mayor TED PEDERSON 27148 12 AV S DES MOINES WA 98198 Department of Community Development Jack Pace, Director RE: Permit No. PG08 -122 14111 57 AV S 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 Uniform Plumbing Code and/or International Fuel Gas 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 Plumbing and/or Gas Code does allow the Building Official to approve one extension of time for an additional period not exceeding 180 days. Extension requests must be in wrttink 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 03/22/2009 , 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, TtQQ Bill Rambo Permit Technician xc: Permit File No. PG08 -122 � PERMIT COORD COPY • PLAN REVIEW/ROUTING SLIP ACTIVITY NUMBER: PG08 -122 DATE: 04 -18 -08 PROJECT NAME: PEDERSON CLASSIC HOMES, LOT 2 SITE ADDRESS: 14111 57 AV S X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: Bu I ng Division n Public Works N / 47V Fire Prevention Structural Planning Division nPermit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Comments: Incomplete n DUE DATE: 04 -22 -08 Not Applicable n 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 dStructural Review Required n No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved n Approved with Conditions Notation: REVIEWER'S INITIALS: DUE DATE: 05-20-08 Not Approved (attach comments) DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents/routing slip.doc 2 -28 -02 Look Up a Contractor, Elect ian or Plumber License Detail Washington State Department of Labor and Industries GenerallSpecialty 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. License Information License MARATP* 101 OM Licensee Name MARATHON PLUMBING Licensee Type CONSTRUCTION CONTRACTOR UBI 601131166 Ind. Ins. Account Id Business Type INDIVIDUAL Address 1 20901 SE 7TH Address 2 City REDMOND County KING State WA Zip 98053 Phone 4253924766 Status ACTIVE Specialty 1 PLUMBING Specialty 2 UNUSED Effective Date 9/14/1990 Expiration Date 9/12/2009 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information Name Role Effective Date Expiration Date GREEN, WILLIAM D OWNER 01/01/1980 • Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date #4 AMERICAN STATES INS CO EX805125 08/21/2001 Until Cancelled $6,000.00 09/12/2001 AMERICAN Page 1 of 3 https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= MARATP* 101 OM 06/23/2008