HomeMy WebLinkAboutPermit PG09-091 - BOSLEY & SMITH RESIDENCEBOSLEY & SMITH RESIDENCE
14727 56 AV S
PGO9-09 1
Parcel No.: 1157200178
Address:
Suite No:
14727 56 AV S TUKW
Tenant:
Name: BOSLEY & SMITH RESIDENCE
Address: 14727 56 AV S , TUKWILA WA
Owner:
Name: BOSLEY MIKE S +SMITH MARK R
Address: 14727 56TH AVE S , TUKWILA WA
Contractor:
Name: CUSTOM RENOVATIONS NW LLC
Address: 4653 S 150 ST , TUKWTLA WA
Contractor License No: CUSTORN912JG
Value of Plumbing /Gas Piping:
Fees Collected:
$4,750.00
$180.00
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
doc: UPC -7/07
City tf 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
PLUMBING /GAS PIPING PERMIT
Contact Person:
Name: DAN O'CONNOR, CUSTOM RENOVATIONS NW
Address: 4653 S 150 ST , TUKW LA WA
DESCRIPTION OF WORK:
ADD A 3/4 BATH. VENTS WILL TIE IN WITH POWDER BATH ON THE MAIN FLOOR. WASTE
WATER WILL TIE IN WITH SEWER STUB IN BASEMENT. STACKABLE WASHER/DRYER AND A
SMALL KITCHEN ALSO TO BE ADDED.
FIXTURE TYPE AND OUANTITY
* *continued on next page **
a
Permit Number:
Issue Date:
Permit Expires On:
Phone:
Phone: 206 832 -5616
Phone: 206 - 832 -5616
Expiration Date: 04/07/2011
Uniform Plumbing Code Edition:
International Fuel Gas Code Edition:
PG09 -091
09/16/2009
03/15/2010
2006
2006
Plumbing (cont.)
0 Building sewer and each trailer park sewer 0
0 Rain water system - per drain (inside bldg) 0
1 Water heater and /or vent 0
0 Industrial waste treatment interceptor, including
1 its trap and vent, except for kitchen type
0 grease interceptors 0
0 Repair or alteration of water piping and/or water
0 treatment equipment 0
1 Repair or alteration of drainage or vent piping 0
0 Medical gas piping system serving (1 -5)
0 inlets /outlets for a specific gas 0
0 Medical gas piping (6 +) inlets /outlets 0
2 Gas Piping
0 Gas piping outlets (0 -5) 0
0 Gas piping outlets (6 +) 0
PG09 -091 Printed: 09 -16 -2009
Permit Center Authorized Signature:
Print Name:
doc: UPC -7/07
City ofTukwila
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
\ 1 Cool/12,c
Permit Number: PG09 -091
Issue Date: 09/16/2009
Permit Expires On: 03/15/2010
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 - ance of work. I am authorized to sign and obtain this plumbing /gas piping permit. G 6 7,0�
Signature: Date: -! / 6 / / -
Date: q � t tD - O'y
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.
PG09 -091 Printed: 09 -16 -2009
Parcel No.: 1157200178
Address: 14727 56 AV S TUKW
Suite No:
Tenant:
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.ci.tukwila.wa.us
BOSLEY & SMITH RESIDENCE
PERMIT CONDITIONS
Permit Number:
Status:
Applied Date:
Issue Date:
PG09 -091
ISSUED
08/04/2009
09/16/2009
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.
doc: Cond -10/06
* *continued on next page **
PG09 -091 Printed: 09 -16 -2009
S I
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: /O h 't
C9
i
CI CC ' hirk
doc: Cond -10!06 PG09 -091
Date:
ordinances governing
or local laws regulating
Printed: 09 -16 -2009
CITY OF TUKWILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.cltukwila.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 LOCATION
/ 54 AVE S
Site Address:
Tenant Name: ,. �±
Property Owners Name: ,✓MICE ,6056 6.1 /)74K S
Mailing Address: e Lt 12 1 c b 4 L, Oct. 5
CONTACT PERS
Company Name:
Contact Person:
'who do we contact when
Mailing Address: L A L. - 5 1 Sol k &)
Wt. \ t v1'rtz, y r
{ � ,�
E -Mail Address: CAA Yl re v7(i tac. 4 ; c 5 �' r ,
Contractor Registration Number: (...tA. �j ( ` i r in
?& r t # King Co Assessor's Tax No.: itc1- ,O - ° L
ti572 11
%/
City
Name: Vel y t,,\ J o 4� i1i�t' �C- t+S-� iw� lltevoo 440 Its . Day Telephone:
Mailing Address: is 5 3 61 5
City
E -Mail Address: 6.(A.`) - +D w0v.;. %4 t' - Fax Number:
Suite Number: Floor:
New Tenant: ❑ Yes ❑..No
. S ate
1._e 432- 5z,1 �
et g
State
Zip
GENERAL CO T RACTOR INFC
(Cont"ractor Information for Mechanical (pg 4
City State
Zip
Day Telephone: 2'4 � 2_ - & EA ( a
Fax Number:
Expiration Date:
`-� --7 Z ��
ARCHITECT OF RECORD -
11 plans must be wet stamped by Arch
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax.Number:
State
Zip
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
H:\ApplicationsWorms- Applications On Line\2009 Applications \1 -2009 - Permit Application.doc
Revised: 1 -2009
bh
State
Zip
Page 1 of 6
9r y v •
O.17_ 031
I
Valuation of Project (contractor's bid price): $ —5 I 1 oO ` 2 Existing Building Valuation: $
Scope of Work (please provide detailed information): 1 CA( 1) cctr' rtt4f' •C\') '( „pp+r�4-
k i tVPV, 11- fa by, 1 ti LA vtr�a i� � tutit
(ecl a ■•11 mod.
%*), LO1 4.. ►l k
1.-Ai\& mai ,11 (.,v0■4 fn, 4
titi .�,li4n �.. ►� vat • T 1 1
Will there be new rack storage? ❑ Yes
No If yes, a separate permit and plan submittal will be required.
•
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 of 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:
Will there be a change in use? ❑ Yes
H: 1ApplicationslForn s -Appl ications On Line12004 Applications\ 1 -2009 - Permit Appl ication.doc
Revised: I -2009
bh
Compact:
Handicap:
❑ No If `yes ", explain:
FIRE PROTECTION /HAZARDOUS MATERIALS: pp ``
❑ Sprinklers ❑ Automatic Fire Alarm ❑ None P Other (specify) /I � l,�f,ti ' ,
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 including quantities and Material Sae Data 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.
Page 2 of 6
4
I;zisttng.
7 k x
J -� - - ; d
.n, , Y
Interior�itemodr I�
,' Addition i' ;+
''f �'ti ^Np}t'3
. 4. E xts hn � g yr i
': tz ture
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r. - v. 'vtL �ti s' ti ak
qve eii 'Deck
nS§.9 ret, Pke
9r y v •
O.17_ 031
I
Valuation of Project (contractor's bid price): $ —5 I 1 oO ` 2 Existing Building Valuation: $
Scope of Work (please provide detailed information): 1 CA( 1) cctr' rtt4f' •C\') '( „pp+r�4-
k i tVPV, 11- fa by, 1 ti LA vtr�a i� � tutit
(ecl a ■•11 mod.
%*), LO1 4.. ►l k
1.-Ai\& mai ,11 (.,v0■4 fn, 4
titi .�,li4n �.. ►� vat • T 1 1
Will there be new rack storage? ❑ Yes
No If yes, a separate permit and plan submittal will be required.
•
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 of 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:
Will there be a change in use? ❑ Yes
H: 1ApplicationslForn s -Appl ications On Line12004 Applications\ 1 -2009 - Permit Appl ication.doc
Revised: I -2009
bh
Compact:
Handicap:
❑ No If `yes ", explain:
FIRE PROTECTION /HAZARDOUS MATERIALS: pp ``
❑ Sprinklers ❑ Automatic Fire Alarm ❑ None P Other (specify) /I � l,�f,ti ' ,
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 including quantities and Material Sae Data 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.
Page 2 of 6
4
V
UBLIC WORKS PERMIT INFORMATION = 206 =433= 0179
Scope of Work (please provide detailed information): -
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ ...Tukwila 0... Water District #125
❑ ...Water Availability Provided
Sewer District
❑ ...Tukwila
❑ ...Sewer Use Certificate
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 cubic yards
❑ ...Total Fill cubic yards
❑ ...Sanitary Side Sewer
❑ ...Cap or Remove Utilities
❑ ...Frontage Improvements
❑ ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
Call before you Dig: 1 800 - 424 - 5555
❑ .. Abandon Septic Tank
❑ .. Curb Cut
❑ .. Pavement Cut
❑ .. Looped Fire Line
H:\Applications\Forms- Applications On Line\2009 Applications \1-2009 - Permit Application.doc
Revised: 1 -2009
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❑ .. Highline
❑...Valley View ❑ .. Renton
❑ ... Sewer Availability Provided
❑ .. Geotechnical Report
❑ .. Maintenance Agreement(s)
❑ .. Work in Flood Zone
❑ .. Storm Drainage
❑ .. Renton
❑ .. Seattle
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.
❑ .. Right -of -way Use - Profit for less than 72 hours
❑ .. Right -of -way Use — Potential Disturbance
❑ ...Permanent Water Meter Size... WO #
❑ ...Temporary Water Meter Size .. f 9 WO #
❑...Water Only Meter Size WO # ❑...Deduct Water Meter Size
❑ ...Sewer Main Extension Public ❑ Private ❑
❑ ...Water Main Extension Public ❑ Private ❑
❑ ... Traffic Impact Analysis
❑ ... Hold Harmless — (SAO)
❑ ... Hold Harmless — (ROW)
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ ...Water ❑ ...Sewer ❑ ...Sewage Treatment
Monthly Service Billing to:
Name: - - _ - Day Telephone:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
City
State Zip
Day Telephone:
City
State Zip
Page 3 of 6
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
Emergency
Generator
50+ HP/1,750,000 BTU
Repair or Addition to
Heat/Refrig/Cooling
System
Incinerator - Domestic
Other Mechanical
Equipment
Air Handling Unit
<10,000 CFM
Incinerator — Comm/Ind
Company Name:
Mailing Address:
MECHANICAL PERMIT:INF0'RMATIN}.= 206 4
MECHANICAL CONTRACTOR INFORMATION
b5 3 5 iS0.1-(% a kedi P�
State zip
`
Contact Person: DO hr C t t A h v+ C { Day Telephone: t 6 - 5 (�
E -Mail Address: Gl.7 OM revt3votl ow) IP'vJ (i ;vun,1 ; cow, Fax Number:
Contractor Registration Number: OA \% ' r 11 GI 1 Z. ` ( Expiration Date: `1 [7 2_.07 I
Valuation of Mechanical work (contractor's bid price): $ \ Z. DD . 1:r0
Scope of Work (please provide detailed information): . f t
d 11P4,1 d WL T 1.11 ied Y�t�w+ •
r1 ltl^c'►, bat vi) M 41.�ip
�hu.Pbv � 4-to- 14 l , +1 ��..� 4 le 6.t
Use: Residential: New .... ❑ Replacement .... ❑
Commercial: New .... ❑ Replacement .... ❑
Fuel Type: Electric ❑ Gas.... El Other:
Indicate type of mechanical work being installed and the quantity below:
H:1Applications\Forn s- Applications On Line\2009 Applications11 -2009 - Permit Application doe
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City
•
Page 4 of 6
ti
Fixture; Type:
'Qty
Fixture Type;
Qty
Fixture Type :: ',: -
Qty
Fixture Type ::
QtY
Bathtub or combination
bath/shower
Bidet
Clothes washer, domestic
'
Dental unit, cuspidor
Dishwasher, domestic,
with independent drain
1
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
Building sewer and each
trailer park sewer
Rain water system — per
drain (inside building)
Water heater and/or vent
Industrial waste treatment
interceptor, including trap
and vent, except for kitchen
type grease interceptors
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Repair or alteration of
water piping and/or water
treatment equipment
Repair or alteration of
drainage or vent piping
Medical gas piping
system serving 1 -5
inlets/outlets for a
specific gas
Each additional medical
gas inlets /outlets greater
than 5
Backflow protective
device other than
atmospheric -type vacuum
breakers 2 inch (51 mm)
diameter or smaller
Backflow protective device
other than atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Each lawn sprinkler
system on any one meter
including backflow
protection devices
Atmospheric -type vacuum
breakers not included in
lawn sprinkler backflow
protections (1 -5)
Atmospheric -type
vacuum breakers not
included in lawn
sprinkler backflow
protections over 5
Gas piping outlets
PLUMBING AND. GAS. PIPING PERMIT:INFORMATIO
PLUMBING AND, GAS PIPING CONTRACTOR INFORMATION
Company Name: LLt: •
Mailing Address: U b `) 3 5 i
Contact Person:
E -Mail Address: f_v a't 01" yPwo.se, 4 t)- S h 1 114 i"Al a IC W1
Contractor Registration Number: (1.1'• 'ti r r 0 1 1 7 a V
Valuation of Project (contractor's bid price): $ i 7 5 '0 0 0
Scope of Work (please provide detailed information): ti 6t (
ttq �C
` 1 Q, 1. pUwetfv tar,kV,
ti A grh l:i k'e
Building Use (per Int'l Building Code):
Occupancy (per Int'l Building Code):
Utility Purveyor: Water:
Indicate type of plumbing fixtures and /or gas piping outlets being installed and the quantity below:
H:Wpplications\Forms- Applications On- Line\2009 Applications \1-2009 Permit Application.doc
Revised: 1 -2009
bh
icd
City
Day Telephone: 1.t t ._ 1 7- > € i 6
Fax Number:
Expiration Date:
LAI
t k - � 7 -- - 2 c
- 14/%4 1 £totr - Via. --)ie
6 . },, k. } It
State Zip
t....711) 4;1
►- :�.�-�� ,.
Sewer:
Page 5 of 6
Date Application Accepted:
V O" 1
V I
oI
Date Application Expires: Q4 Jto
Staff Initials: ,
I
S p` 1 '6111 tall a idiits>in t % pl catch'
ti; kAioWitrl
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 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 OWNNR OR AU HORIZED AGENT:
Signature: / `� ...-- ----°'
Print Name: Da titit. I r.:a Y
Mailing Address: `'k -7 `, is0-1,1 `J
H: Applications\Fonns- Applications On Line12009 Applieationn\l -2009- Pennil Application.doc
Revised: 1-2009
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Day Telephone:
.4tttt►.. let
City
Date: I I — I
- Lob - y2. -
State
Page 6 of 6
RECEIPT NO: R09 -01220
Initials: JEM
User ID: 1165
Payee: MIKE S BOSELY
SET TRANSACTIONS:
Set Member Amount
D09 -154
EL09 -0470
M09 -097
PG09 -091
TOTAL:
•
City of Tukwila.
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -431 -3670
Fax: 20 6- 431 -3665
Web site: http: /hvww. ci. tukwila.wa. us
1,977.90
96.60
196.29
180.00
1,977.90
SET RECEIPT
Payment Date: 08/04/2009
Total Payment: 2,450.79
SET ID: S000001279 SET NAME: Tmp set/Initialized Activities
TRANSACTION LIST:
Type Method Description Amount
Payment Check 2580 2,450.79
TOTAL: 2,450.79
ACCOUNT ITEM LIST:
Description
BUILDING - RES
ELECTRICAL PERMIT - RES
MECHANICAL - RES
PLAN CHECK - RES
PLUMBING - RES
STATE BUILDING SURCHARGE
Account Code Current Pmts
000/322.100
000.322.101.00.0
000.322.102.00.0
000/345.830
000.322.103.00.0
640.237.114
TOTAL:
1,196.00
96.60
157.03
852.66
144.00
4.50
2,450.79
PAYMENT
RECEIVED
Prgyect: t,��{./ /�
Q Sf2� 2tsM� th Red
Type of Inspectio : nr
r; A G■.¢ , L
` 1
v
Address: '7�
Date Called:
Special Instructions:
3 n 15 ` O
O !
Y L1r U n o s Up
Date Wanted:
12 -24 - i�
p.m.
Requester:
Phone No: ,�/
2o r G Sao /4
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
P1- ter
PERMIT NO.
J
(206)431 -36
Approved per applicable codes. ❑ Corrections required prior to approval.
COMMENTS:
Inspector:
cp1/44-UkL-L
Date:
I 2. ,��`,�
EJ $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
r
Pr ect:
B ku
iTk
Type f Inspection:
� - I p l v.w1 h
Address:
Z ^ S `
S-
Date Called:
Special Instructions:
Date Wanted: 6.rfi'
1 r 1 Pq 105 P.m.
Requester:
Phone No:
206,- 133Z-61b
INSPECTION NO.
- INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
PERMIT NO.
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3.70
CO ENTS:
Receipt No.:
Date:
Lb /ai Ids
i
ri $60. ' i REINSPECTION FE REQUIRED. Pr or to inspection, fee must be
pai. /t 6300 Southcenter Bl Suite 100: Call to schedule reinspection.
Date:
Approved per applicable codes. Corrections required prior to approval.
Pro ct: �'.,{ J Z
L sle1 et s (`'+ eS .
Type of Inspection:
,- � ,jit. I.va/'�
Address:
14T2. S / `P'1�
( " - s
Date Called:
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Special Instructions:
03(00.55
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el
-(
Date Wanted: ! /, . , m
7_ 2i1 p. ay p.m.
Requester:
Phone
-32
-
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 -36 70
Approved per applicable codes. ❑ Corrections required prior to approval.
COMMENTS:
, / ,L A ?f
Inspedtor:
Date: ‹.--•
- L
0 $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
e. - nix argagtainE 3iis k.ta.' :a.
Bond
Bond
Company
Name
Bond
Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
2
Great
American
Ins. Co.
2875299
04/01/2009
Until
Cancelled
$12,000.00
04/30/2009
1
Great
American
Surety
Company
2493699
04/01/2009
04/01/2009
$12,000.00
04/07/2009
Insurance
Company
Name
Policy Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Amount
Received
Date
1
BANKERS
INS CO
46044000156800004
/01/200904/01/2010
$1,000,000.0004
/07/2009
Name
Role
Effective Date Expiration Date
O'Conner, Daniel Patrick
PARTNER /MEMBER
04/07/2009
Untitled Page
General /Specialty Contractor
A business registered as a construction contractor with LItI 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.
Business and Licensing Information
Name
Phone
Address
Suite /Apt.
City
State
Zip
County
Business Type
Parent
Company
Custom Renovations NW
LLC
2068325616
4653 S 150th St
TUKWILA
WA
98188
KING
Limited Liability Company
UBI No.
Status
License No.
License Type
Effective Date
Expiration
Date
Suspend Date
Specialty 1
Specialty 2
602911670
ACTIVE
CUSTORN912JG
CONSTRUCTION
CONTRACTOR
4/7/2009
4/7/2011
GENERAL
UNUSED
Business Owner Information
Bond Information
Insurance Information
•
0
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https: // fortress .wa.gov /lni/bbip /Detail.aspx
09/16/2009