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Home My WebLink AboutPermit D06-258 - Extendicare - Demolition, Partition and LightingEXTENDICARE 16040 CHRISTENSEN RD STE 205 D06 -258 City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 2523049039 Address: 16040 CHRISTENSEN RD TUKW Suite No: Tenant: Name: EXTENDICARE Address: 16040 CHRISTENSEN RD, STE 205, TUKWILA WA Owner: Name: MCELROY GEORGE & ASSOC INC Address: 3131 S VAUGHN WAY STE 301, AURORA CO Contact Person: Name: VICKI SOMPPI Address: 22002 64 AV W, STE 2C, MOUNTLAKE TERRACE WA Contractor: Name: CHINN CONSTRUCTION LLC Address' P.O. BOX 2137, REDMOND, WA Contractor License No: CHINNCL000DS Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N doc: Devperm DEVELOPMENT PERMIT Water Main Extension: N Private: Public: Water Meter: N " Continued Next Page ** Permit Number: D06 -258 Issue Date: 07/18/2006 Permit Expires On: 01/14/2007 Phone: Phone: 425 670 -6706 Phone: 425 898 -1688 Expiration Date:03 /05/2008 DESCRIPTION OF WORK: DEMOLITION, NEW PARTITION IN BREAK AREA, AND CHANGE EXISTING LIGHT LOCATION PER PLAN. Value of Construction: $15,000.00 Fees Collected: $518.28 Type of Fire Protection: SPRINKLER/AFA Uniform Building Code Edition: Type of Construction: VB Occupancy per UBC: 0008 Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: N Hauling: N Start Time: End Time: Land Altering: N Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: N Moving Oversize Load: N Start Time: End Time: Sanitary Side Sewer: N Sewer Main Extension: N Private: Public: Storm Drainage: N Street Use: N Profit: N Non - Profit: N D06 -258 Printed: 07 -18 -2006 doc: Devperm City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Permit Center Authorized Signature: M .l I hereby certify that I have read and an Date: Il *l ri Iao is permit and know the same to be true and correct. All provisions of law and ordinances governing this work will b -'. mph 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 t,-rformance of work. I am authorized to sign and obtain this development per rpit. Signature: I`- Date: .7 (e3/6(0 Print Print Name: Fad_ "., ti'e--S 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. DO6 -258 Printed: 07 -18 -2006 Cr'Y r'r TuY \ .,.. A DEP . ('? CC:,::. , , .. i Y CC ' C :N`_ NT 6300 G.;UTKCLN T ER CLVD. TUKWILA, WA 96188 1: ***BUILDING DEPARTMENT CONDITIONS "' PERMIT CONDITIONS PERMIT CENTER Parcel No.: 2523049039 Permit Number: D06 -258 Address' 16040 CHRISTENSEN RD TUKW Status: ISSUED Suite No: Applied Date: 06/30/2006 Tenant: EXTENDICARE Issue Date: 07/18/2006 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center (206/431- 3670). 4: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 5: New suspended ceiling grid and light fixture installations shall meet the non - building structures seismic design requirements of ASCE 7. 6: Partition walls that are tied to the ceiling and all partitions greater than 6 feet in height shall be laterally braced to the building structure. 7: All construction shall be done in conformance with the approved plans and the requirements of the International Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code. 8: Ventilation is required for all new rooms and spaces of new or existing buildings and shall be in conformance with the International Building Code and the Washington State Ventilation and Indoor Air Quality Code. 9: All electrical work shall be inspected and approved under a separate permit issued by the Washington State Department of Labor and Industries (206/248- 6630). 10: VALIDITY OF PERMIT: The issuance or granting of a permit 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 ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. 11: ***FIRE DEPARTMENT CONDITIONS*** 12: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the following concerns: 13: "'MEANS OF EGRESS*** - IFC Chapter 10 14: No point in a building may exceed the maximum exit access travel distance listed in Chapter 10, section 1015, Table 1015.1 of the International Fire Code and International Building Code. 15: Egress doors shall be readily openable from the egress side without the use of a key or special knowledge or effort. (IFC 1008.1.8.3 subsection 2.2) doc: Conditions D06 -258 Printed: 07 -18 -2006 CITY OF TUKWIIA DEPT. OF C0'.,:•,LINITY DEVELOPMZNT 6300 SCUTFICC.NTEll TUKW ILA, WA 17: ***SPRINKLER SYSTEMS*** - IFC Chapter 9 - NFPA 13 and 25 PERMIT CENTER 16: Dead bolts are not allowed on auxiliary exit doors unless the dead bolt is automatically retracted when the door handle is engaged from inside the tenant space. (IFC Chapter 10) 18: Maintain sprinkler coverage per N.F.P.A. 13. Addition /relocation of walls, closets or partitions may require relocating and /or adding sprinkler heads. (IFC 901.4) 19: All new sprinkler systems and all modifications to existing sprinkler systems shall have fire department review and approval of drawings prior to installation or modification. New sprinkler systems and all modifications to sprinkler systems involving more than 50 heads shall have the written approval of the W.S.R.B., Factory Mutual, Industrial Risk Insurers Kemper or any other representative designated and /or recognized by the City of Tukwila, prior to submittal to the Tukwila Fire Prevention Bureau No sprinkler work shall commence without approved drawings. (City Ordinance #2050) 20: All sprinkler system plans, calculations and the contractors Materials and Test Certificates submitted to the Tukwila Fire Prevention Bureau must be stamped with the appropriate level of competency seal. (WAC 212 -80) 21: When walls and ceilings are required to be of fire resistive or noncombustible construction, interior finish materials shall meet the requirements of International Building Code 803. 22: Accumulation of combustible waste material is prohibited during the demolition phase of this project. Remove and properly dispose of all waste material prior to the close of the working day and as often throughout the day as needed. 23: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of such condition or violation. 24: These plans were reviewed by Inspector 510. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575 -4407. doc: Conditions **continued on next page" 006 -258 Printed: 07 -18 -2006 CITY OF Tl!KVTt A DEPT. CF CC:.::.1U; ;NY 02:L1 ; IT 6300 1 TUKWILA WA 98188 D. I hereby certify that I have read these conditions and will comply with them 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 regulating construction or the performance of work. Signature: ^�R?�� Date: -- / `C Print Name: doc: Conditions PERMIT CENTER as outlined. All provisions of law and ordinances cancel the provision of any other work or local laws D08 -258 Printed: 07-18-2006 Company Name: Mailing Address: Contact Person: Contact Person: E -Mail Address: tpennin, ple \icc clangetpetmit application (7 -2004) CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 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 ** I SITE LOCATION King Co Assessor's Tax No.: 25 236'' -q 3c1 2523 - t re Site Address: 1GC'/Q C hv 5teinZel -t D.Tott,i � 7-0, &S Floor: i r i )� W uite Number: Tenant Name: EX4CC%\a'lCC re . New Tenant; O.... Yes ❑ ..No Property Owners Name: ` Mailing Address: 4()()() C I lhs—kerise 1 S4lari 4*) CONTACT PERSON Name: V Da Y Telephone: i P '4 1p7t5 5 - -fin 7f X:, , : 1I 2 Mailing Address: 22 37 C, vvk ' A,p tA1psf 4. 2c; Mnuntlato nfen2 fat w A 6 11504R 504R ti�� 5 @,Cn City E - Mail Address: Vic lZ lnvv o,t1Ap.c h • c„ . ' . Fax Number: t{? 5 - 774 -t Z1 q Zip GENERAL CONTRACTOR INFORMATION'- (Mechanical Contractor information on back page) Contact Person: E -Mail Address: Contractor Registration Number: Expiration Date: * *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance ** ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record Company Name: CO nYt¢. I I Ues Mailing Address: ZZWZ Me( A. A1ae r } tz. E - Mail Address: Ole h ry Q en N tne 11 c 1 S \{ l. CA Yl G1ropp ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Record Company Name: Mailing Address: Page I Sera }i1 City o use on Pc(49 -24 Building Permit No. Mechanical Permit No.-. Public Works Permit No. Project No. lal is% State Z City" State Zip Day Telephone: Fax Number: s_* City J' State Zip Day Telephone: uZ 5 - t 7C) -6 706, Fax Number: N25- 77y- sq I City State Zip Day Telephone: Fax Number: IJILDING PERMIT INFO ION - 206 -431 3670 Valuation of Project (contractor's bid price): $ i S 00 0 LA • • aS.a n •• m • • i/, Scope of Work (please provide detailed information): (Wt , t s13e. 2xis1;Yj V Inrahovn per O V\ - Will there be new rack storage? ❑ .. Yes ❑ .. No If "yes ", see Handout No. for requirements. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single - family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ ....Yes No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 3 744prinklers ,..Automatic Fire Alarm ❑..None ❑ . Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes ..No If "yes", attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Materia Sa fly Data Sheets. `permits pbtsVa rh application (7-2004) Page 2 'x'10 Existing Building Valuation: $ Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC In Floor NA NA- 5R 2n' Floor 3' Floor Floors thru Basement - Accessory Structure* Attached Garage Detached Garage. Attached Carport Detached Carport CoveredDeck Uncovered Deck, IJILDING PERMIT INFO ION - 206 -431 3670 Valuation of Project (contractor's bid price): $ i S 00 0 LA • • aS.a n •• m • • i/, Scope of Work (please provide detailed information): (Wt , t s13e. 2xis1;Yj V Inrahovn per O V\ - Will there be new rack storage? ❑ .. Yes ❑ .. No If "yes ", see Handout No. for requirements. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single - family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ ....Yes No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 3 744prinklers ,..Automatic Fire Alarm ❑..None ❑ . Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes ..No If "yes", attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Materia Sa fly Data Sheets. `permits pbtsVa rh application (7-2004) Page 2 'x'10 Existing Building Valuation: $ l PUBLIC WORKS PERMITINFOIATION 206433 -0179 Scope of Work (please provide detailed information): Water Distric ...Tukwila ❑...Water District #125 ❑ ...Water Availability Provided ew r ist is ...Tukwila 0... ValVue ❑..Renton ❑...Seattle ❑ ...Sewer Use Certificate 0... Sewer Availability Provided ❑ .. Approved Septic Plans Provided ❑...Septic System - For onsite septic system, provide 2 copies of • current septic design approval by King County Health Department &bmitted with Application (mark boxes which apply): LJ ...Civil Plans (Maximum Paper Size -22 "x34 ") ❑...Technical Information Report (Storm Drainage) ❑...Bond ❑ .. Insurance ❑ .. Easement(s) ❑ .. Maintenance Agreement(s) ❑...Hold Harmless Proposed Activities (mark boxes that apply): ❑ ...Right-of-way Use - Nonprofit for Tess 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 Please refer to Public Works Bulletin #1 for fees and estimate sheet. ❑ . ❑ . ❑ • ❑ . ❑ ...Backflow Prevention - Fire Protection " Irrigation Domestic Water ❑...Permanent Water Meter Size... ❑ ...Temporary Water Meter Size .. ❑ ...Water Only Meter Size ❑...Sewer Main Extension Public o ...Water Main Extension Public *mitt plulicc cMnga■vma application (7-2004) Call before you Dig: 1- 800 - 424 -5555 . Abandon Septic Tank . Curb Cut . Pavement Cut . Looped Fire Line WO# WO# WOO( Private Private Page 3 ❑ .. Highline ❑ .. Geotechnical Report ❑ .. Right-of-way Use - Profit for Tess than 72 hours ❑ .. Right-of-way Use — Potential Disturbance ❑ .. Work in Flood Zone ❑ .. Stone Drainage ❑ ...Renton ❑ .. Grease Interceptor ❑ .. Channelization ❑ .. Trench Excavation ❑ .. Utility Undergrounding ❑...Deduct Water Meter Size ❑...Trafc Impact Analysis FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) ❑...Water ❑...Sewer ❑...Sewage Treatment lvlonthly Service Billinp to: Name: Day Telephone: Mailing Address: City State Zip Water Meter Refund/Billing: Name: Day Telephone: Mailing Address: City State Zip 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 Funtace>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/I,750,000 BTU Appliance Vent Hood and Duct Water Heater 50+ HP /1,750,000 BTU Repair or Addition to Heat/Refrig/Cooling System Incinerator - Domestic Emergency Generator Air Handling Unit <10,000 CFM Incinerator — Comm/Ind Other Mechanical Equipment MECHANICAL: PERMIT INFORMATION - 206 -431 =3670 MECHANICAL CONTRACTOR INFORMATION Company Name: Mailing Address: cm Contact Person: Day Telephone: E -Mail Address: Fax Number: Contractor Registration Number: Expiration Date: * *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance** Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): Use: Residential: New .... ❑ Replacement ❑ Commercial: New .... ❑ Replacement ❑ Fuel Type: Electric ❑ Gas —.0 Other: Indicate type of mechanical work being installed and the quantity below: PERMIT APPLIrrATIONNOTES — Applicable to all permits in`titis application Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may 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 107.4 of the Uniform Building Code (current edition). No,application shall be extended more than once. [ 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 OWNE 0 AUTHORIZED AGENT: Signature: I, , [ Print Name: \ i c(�� bt L tIM , �`(2 • Day Telephone: 5 6070 'it 7061 Mailing Address: Z2R- (..Y Tt I Date Application Accepted: 64 \perms ph*tiee channe\pen^b appl'r+lioe (74004) Date Application Expires: 24 tap Page 4 State Zip Date: 3d o?-496 r2�Z11- Te rd L.O,4 `T vLf City State L Staff Initials: Project: Addres : 0 fii Date Called: Special Instruction,: a ✓ i 1-405 00 ' r -0 Date Wanted: / j �.:l�l - /� iiiiima _✓. I_.141 INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 O Approved per applicable codes. COMMENTS: Corrections required prior to approval. $58.00 REINSPECT! FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. (Receipt No.: Date: Project: IPA/ 0 A r X PA/0 re Type of Inspection: // /J Sins pFmifGV ce -v Address: /0440 C'f/r.s,huscv Date Called: cl 2r1 Special Instructions: - -' -� Date Wanted: a.m. Requester: Phone No: .26C V23 -66 91, 7 Approved per applicable codes. Receipt No.: INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Date: Do4 -aye PER (206)431 -36 Corrections required prior to approval. COMMENTS: 58.00 REINSPECTIO FEE REQUIR '. Prior to Inspection, fee must be paid at 6300 Southce ter Blvd., 5 e 100. Call to sechedule reinspection. Project: Type of Ins se i.n: Address: / / �r "y�r� f- ' `�� s �Datee C Iced: Spedal" instructions: " tlate W m Requester: i Phone No: INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 PER r, 7r. (206)431-3670 pproved per applicable codes. Corrections required prior to approval. COMMENTS: $58.00 REINSPECTION /E REQUIRED. Prior to inspection, fee must be paid at 6300 Southcent r Blvd., Suite 100. Call to sechedule reinspection. (Receipt No.: 'Date: COMMENTS: Type of Inspection: 5,4i fel a Canon, Af 7,77.17.4 Address: /6o yo Chr :sla- s l e i Suite #: ar Zr, Contact Person: SA,vus _ 2 •-t. a iK Special Instructions: /C// a / re, its ti- ten- O. Monitor: Pre -Fire: 5 rr n' ! » ren 2 /..e Occupancy Type: / 2 , . f l ..- Project: Exferi c) 'cote- Type of Inspection: 5,4i fel a Canon, Af 7,77.17.4 Address: /6o yo Chr :sla- s l e i Suite #: ar Zr, Contact Person: SA,vus _ 2 •-t. a iK Special Instructions: Hood & Duct: Phone No.: Z5 - zcz— 70i/ Needs Shift Inspection: Sprinklers: Y Fire Alarm: `. A Hood & Duct: M Monitor: Pre -Fire: Permits: Occupancy Type: INSPECTION NUMBER Word /Inspection Record Form.Doc INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA FIRE DEPARTMENT i pproved per applicable codes. 12/2/05 04 7St OC..c. /yy PERMIT NUMBERS Wa. 98188 206- 575 -4407 n Corrections required prior to approval. Inspector: SG✓ Date: sem Hrs.: r $80.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be pa • at 444 Andover Park East. Call to schedule reinspection. Receipt No.: Date: T.F.D. Form F.P. 85 Project: � F - -ej4r/'jrore. j Type of Inspection: � V r1- Rnu Address: Suite #: /t9 ye, C 11/ 7 &e Contact Person: Special Instructions: 2 O Phone No.: Needs Shift Inspection: *5 Sprinklers: i Fire Alarm: /1/04 e- Hood & Duct: p Monitor: Pre -Fire: 7 Permits: pf,,,, Occupancy Type: ( 2 444 Andover Park East. Tukwila, Wa. 98188 206 - 575 -4407 ns INSPECTION NUMBER V Approved per applicable codes. COMMENTS: ector: 1 ra $80.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be .t 444 Andover Park East. Call to schedule reinspection. Receipt No.: I Date: Word /Inspection Record Form.Doc INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA FIRE DEPARTMENT Date: 9//706 O - �,s"e o — 5 -1''ly PERMIT NUMBERS 12/2/05 T.F.D. Form F.P. 85 1 - 1 Corrections required prior to approval. ACCOUNT ITEM LIST: Description Current Pmts City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 2523049039 Permit Number: D06 -258 Address: 16040 CHRISTENSEN RD TUNNY Status: APPROVED Suite No: Applied Date: 06/30/2006 Applicant: EXTENDICARE Issue Date: Receipt No.: R06 -01060 Payment Amount: 315.88 Initials: JEM Payment Date: 07/18/2006 08:35 AM User ID: 1165 Balance: $0.O0 Payee: CHINN CONSTRUCTION, LLC TRANSACTION LIST: Type Method Description Amount Payment Check 111010 315.88 BUILDING - NONRES STATE BUILDING SURCHARGE RECEIPT Account Code 000/322.100 311.38 000/386.904 4.50 Total: 315.88 7477 07113 9716 TOTAL 315.88 doc: Receipt Printed: 07 -18 -2006 City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 2523049039 Permit Number: D06 -258 Address: 16040 CHRISTENSEN RD TUKW Status: PENDING Suite No: Applied Date: 06/30/2006 Applicant: EXTENDICARE Issue Date: Receipt No.: R06 -00963 Payment Amount: 202.40 Initials: JEM Payment Date: 06/30/2006 01:14 PM User ID: 1165 Balance: $315.88 Payee: CONNELL DESIGN GROUP TRANSACTION LIST: Type Method Description Amount RECEIPT Payment Check 14059 202.40 ACCOUNT ITEM LIST: Description Current Pmts PLAN CHECK - NONRES Account Code 000/345.830 202.40 Total: 202.40 6964 06/30 9716 TOTAL 202.40 doc: Receipt Printed: 06-30-2006 ACTIVITY NUMBER: D06 -258 DATE: 06 -30 -06 PROJECT NAME: EXTENDICARE SITE ADDRESS: 16040 CHRISTENSEN RD, STE 205 X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEP t ��5 do6 Bui dil ng Division Publi Works IVA. '1 -5 �D DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete d Incomplete ❑ Comments: TUES/THURS ROUT NG: Please Route Structural Review Required Review Required REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Approved ❑ Notation: REVIEWER'S INITIALS: Documents/routing slip.doc 2-28-02 ,PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP 5to Am. -of Fire Prevention RU Planning Division Structural ❑ Permit Coordinator ❑ DUE DATE: 07-06-06 Not Applicable ❑ Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: No further Review Required DATE: DUE DATE: 08-03-06 Approved with Conditions Not Approved (attach comments) ❑ DATE: n Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: License Information License CHINNCL000DS Licensee Name CHINN CONSTRUCTION LLC Licensee Type CONSTRUCTION CONTRACTOR UBI 602019515 Ind. Ins. Account Id PARTNER/MEMBER Business Type LIMITED LIABILITY COMPANY Address 1 P O BOX 2137 Address 2 City REDMOND County KING State WA Zip 980732693 Phone 4258981688 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/10/2000 Expiration Date 3/5/2008 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information Name Role Effective Date Expiration Date WAKAYAMA, GLORIA AGENT 01/01/1980 CHINN, KEVIN W PARTNER/MEMBER 01/01/1980 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 '\ * 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. Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date Until https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= CHINNCL000DS 07/18/2006 x x x