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HomeMy WebLinkAboutPermit D10-091 - ZIAD RESIDENCE - DECK COVERZIAD DECK COVER 15221 65 AV S EXPIRED 10 -27 -10 D10 -091 Citylkf Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite # 100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us Parcel No.: 3597000342 Address: 15221 65 AV S TUKW Suite No: DEVELOPMENT PERMIT Permit Number: D10-091 Issue Date: 04/20/2010 Permit Expires On: 10 /17 /2010 Tenant: Name: ZIAD DECK COVER Address: 15221 65 AV S , TUKVVILA WA Owner: Name: ZIAD MOHAMMED Address: 8524 17TH AVE NW , SEATTLE WA 98117 Phone: Contact Person: Name: CARL PAGH Address: 6416 22 AV NW , SEATTLE WA 98107 Phone: 206 898 -2558 Contractor: Name: RIDGELINE DEVELOPMENT INC Address: 6418 22 AV NW , SEATTLE WA 98107 Phone: 206 - 898 -2558 Contractor License No: RIDGEDI933CN Expiration Date: 03/12/2011 DESCRIPTION OF WORK: CONSTRUCT OVERHANGING ROOF ABOVE EXISTING DECK. ROOF TO MATCH CLOSELY TO EXISTING OVERHANG IN STYLE, MATERIALS, AND STRUCTURE. Value of Construction: $3,200.00 Fees Collected: $439.63 Type of Fire Protection: SMOKE DETECTORS International Building Code Edition: 2006 Type of Construction: VB Occupancy per IBC: 0022 * *continued on next page ** doc: IBC -10/06 D10 -091 Printed: 04 -20 -2010 City olI'ukwila Department of Community Development 6300 Southcenter Boulevard, Suite # 100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us Permit Number: D10-091 Issue Date: 04/20/2010 Permit Expires On: 10/17/2010 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: Hauling: N Start Time: End Time: Land Altering: Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: Moving Oversize Load: Start Time: End Time: Sanitary Side Sewer: Sewer Main Extension: Private: Public: Storm Drainage: Street Use: Profit: N Non - Profit: N Water Main Extension: Private: Public: Water Meter: N Permit Center Authorized Signature: Date: /3C)-0-- k 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 construction or the ormance of work. I am authorized to sign and obtain this development permit. / Signature: Date: 6 /// U Print Name: 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: IBC -10/06 D10 -091 Printed: 04 -20 -2010 • 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 Parcel No.: 3597000342 Address: 15221 65 AV S TUKW Suite No: Tenant: ZIAD DECK COVER PERMIT CONDITIONS Permit Number: D10 -091 Status: ISSUED Applied Date: 04/05/2010 Issue Date: 04/20/2010 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 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 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. 4: 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. 5: All wood to remain in placed concrete shall be treated wood. 6: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 7: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building Department (206- 431 - 3670). 8: 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. * *continued on next page ** doc: Cond -10/06 D10 -091 Printed: 04 -20 -2010 • • 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 ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local laws regulating construction or the performance of work. Signature: Print Name: eetJi- P4 j/C- Date: doc: Cond -10/06 D10 -091 Printed: 04 -20 -2010 • CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http: ictt w.ci. tukwilu. wu. us 11 Budding *Permit No. Mechanical Permit No • :Plumbng/Gas Permit No ,Public `Works -Permit No. :Project .No. (FFor office:use only) 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 5 9 ADO D 3 2-/..2_40 / � Site Address: /S2 2' / 6 ts� ,.ve • rJ n - Suite Number: Floor: Tenant Name: h New Tenant: ❑ Yes ❑ ..No Property Owners Name: AID D A�m�'11 'eo /. d. Mailing Address: /.5-- / & J� 7/4 GLVe • s City State Zip CONTACT PERSON - who do we' contact when your pei-mitris ;ready-to,be issued ?4 Name: Mailing Address: C // �`[� - o - /!4t • Jew e 4t/.4 9 ,g/0 City State Zip E -Mail Address: (744" / e G�`�li /fiehniJ • CO /7-1 Fax Number O6' �� � gZ? ea.r- / / Day Telephone: ale54, o%o P2 SST .GENNRAL CONTRACTOR INFORMA,Ti -O,. ., (Contractor Information for Mechanical (pg i) for Elum6ing and Gas Piping_(pg 9))? e eve1,90/ne - Ac. as r%w • ie 6ciffe J,4 9 "" Company Name: le/1 / J Mailing Address: `a "/ /� City State / Zip Contact Person: (a%. !/ / Lf Day Telephone: ,2‘)/P g%)- aS,» E -Mail Address: '6!/`' 0 /Viz h h e /24). CO Q Fax Number: 2O (p g9-7 a Contractor Registration Number: Expiration Date: ARCHITECT OF RECORD Alhplansmusttbe.wet stamped, by Arch of Record Company Name: Mailing Address: City Contact Person: Day Telephone: E -Mail Address: Fax Number: State Zip ENGINEER OF RECORD — All; plans must be wet stampedby Engineer of 'Record Company Name: Mailing Address: City Contact Person: Day Telephone: E -Mail Address: Fax Number: H: \Applications\Forms- Applications On Line\2009 Applications \1 -2009 - Permit Application.doc Revised: 1 -2009 bh State Zip Page 1 of 6 • BUILDING PERMIT INFORMATION— 206 - 431 - 3670: Valuation of Project (contractor's bid price): $ 3;- 6 0 . d d Existing Building Valuation: $ Scope of Work (please provide detailed information): (;54 r 7 L - Mot d- ,fO t kIS77 %,4ov t' •�X.t S41�sq ��P�G%G . � t �D r1�a� dos- � `f dVell Aadaol ? 1 5 e 5/r , Will there be new rack storage? ❑ Yes IS.. No If yes, a separate permit and plan submittal will be required. Provide All BuildingAreasin '.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 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: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION /HAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm ❑ None Other (specify) CJAN- Dtn 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 Sa ety 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. H:\Applications\Ponns- Applications On Line\2009 Applications \I -2009 - Permit Application.doc Revised: 1 -2009 bh Page 2 of 6 _• . _ • '•Existing • . ....... _, • ' '; `,Interior Remodels, Addition to R . i ;.. Existing . .. ) +. Structure, • • New . • ' Type of Construction per IBC of Type of Occupancy per IBC 1st Floor ••• . _ • ' / Q g d 2"d Floor— 3rd Floor —69-- Floors thru / D er D O _/ ,_ Basement •.., `•`! /aZ 0 Acceisory Struettire *:•. __6—_ Attached Garage Detached Garage Attached Carport Detached Carport , • •''.' —�' Covered Deck . /5-.1 Uncovered Deck / ' 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: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION /HAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm ❑ None Other (specify) CJAN- Dtn 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 Sa ety 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. H:\Applications\Ponns- Applications On Line\2009 Applications \I -2009 - Permit Application.doc Revised: 1 -2009 bh Page 2 of 6 PERMIT APPLICATION NOTES, -- Applicable::toryal w peririits in this'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. 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). 1 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 OWNER OOR /UTHO ZED AGENT: Signature: //! -- - Print Name: eatAJV OPHEt " Mailing Address: , 41 ( 22.'D dive N w Date: 3-3-io Day Telephone: "zo 6 -'f22 - fit 66 SFAtTt,.E. City W ginoq- State Zip Date Application Accepted: �� `� � V 6" Date Application Expires: �( OG 16 Staff Initials: I H:\ApplicationsWorms- Applications On Line\2009 Applications \1-2009 - Permit Application.doc Revised: 1 -2009 bh Page 6 of 6 • 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 Parcel No.: 3597000342 Address: 15221 65 AV S TUKW Suite No: Applicant: ZIAD DECK COVER RECEIPT Permit Number: D10 -091 Status: APPROVED Applied Date: 04/05/2010 Issue Date: Receipt No.: R10 -00668 Initials: User ID: Payee: WER 1655 Payment Amount: $332.90 Payment Date: 04/20/2010 11:15 AM Balance: $0.00 RIDGELINE DEVELOPMENT TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA - Authorization No. 111456 ACCOUNT ITEM LIST: Description 332.90 Account Code Current Pmts BUILDING - RES STATE BUILDING SURCHARGE 000.322.100 328.40 640.237.114 4.50 Total: $332.90 PAYMENT RECEIVED doc: Receiot -06 Printed: 04 -20 -2010 • 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 Parcel No.: 3597000342 Address: 15221 65 AV S TUKW Suite No: Applicant: ZIAD RESIDENCE RECEIPT Permit Number: D10 -091 Status: PENDING Applied Date: 04/05/2010 Issue Date: Receipt No.: R10 -00573 Payment Amount: $106.73 Initials: JEM Payment Date: 04/05/2010 12:59 PM User ID: 1165 Balance: $332.90 Payee: RIDGELINE DEVELOPMENT TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA - Authorization No. 125921 ACCOUNT ITEM LIST: Description 106.73 Account Code Current Pmts PLAN CHECK - RES 000.345.830 106.73 Total: $106.73 ENT ECEIVE doc: Receipt -06 Printed: 04 -05 -2010 INSPECTION RECORD Retain a copy with permit INSPECTIO NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION Iz 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Project: z__, k-D be Govc r Type of Inspection: a A t , Address: 15-2-2A GAS Aui, -1 Date Called: mO `G P tAA %(.L vCi �? Special Instructions: / Date Wanted: a,m c 4,3d -(a p.m. Requester: Phone ACV r (00 ( — Siri Approved per applicable codes. Ei Corrections required prior to approval. COMMENTS: tJ Jt- /Lodi Ske d`' ! p )/ V�-- i • ,z4K Inspector: Date: J -!J El $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: FILE COPY Permit No. Plan review approval is subect to errors and omissions. /Approval of construction documents does not authorize the violation of any adopted code or ordnance. Receipt ni approved Field Co conditions is admO 9ed' By Date: y City Of 1Ukwila BUILDING DIVISION •14 REVISIONS No changes shall be made to the scope of work without prior approval of Tukwila Building Division. NOTE: Revisions will require a new Wan submittal and may inciude additional plan roving• T 5 — REVIEWED FOR CODE COMP ANCE - APPR®VED AI'lZ i 2 2010 5 U�1� City of Tukwil _ BUILDI Rim TUKWLA APR 0 5 Zulu PERMIT CENTER SITE PLAN) : SUI.>t; I" = 20' PA?-cEL- NumSER : LE4AL Oems+t110M 1. IN TE PA) so,AN 10 Lor 18 5 YT TLE t o - 0 "PF°PoSE 2 C o'J f D D E C-1S AOOo t o N' SOUTH ELEv ATtoN ip I ilmrm i jj 1Ib I II 5O vTH FVvA?1oro P,R.oPo5E1) ROQ ADDITION J 111 11 11 11 11I Ill(ll wEST E1- Evit-1 o"- M Ex\51\).-)(7 111 EA sT Ft_ fuRno REVIEWED FOR - CODE COMPLIANCE APPROVED APR i 2 2010 City Tukwila Ci of T ' BUILDING Dlhleinw.I RECEIVED CITY OF TUKWILA APR 0 5 2010 PERMIT CENTER tW_0" •tsnu(, Foot ovEK E 1-tp bEC.K Lid _c,, SCALE REVIEWED FOR CODE COMPLIANCE APPRRVED APR i 2 2010 City of Tukwila BUILDINS III fl Iflnl RECEIVED CITY OF TUKWILA APR 0 5 2010 PERMIT CENTER pg Po5E D R 00 mate vvE\ -EnsTtN(' Eck 1 ■ CALKET 1R-od F t Tte,r) 1 Flo' -0" Pict 61-1N (, Roo - Estsilikt6 DEck 5 cALf_ /y° = t REVIEWED FOR CODE COMPLIANCE APPRflVED APR i 2 2010 City of Tukwila BUILDING nniminni crTmeT‘tinERmLA APR 0 5 2010 PERMIT CENTER MITCHELL ENGINEERING INC. rR Ain FILE COPY Sc.& - IA)* le--; 12gVIA bV A 1r Aof i 2 7 7821 - 168th Ave. N.E. Redmond, WA 98052 (425) 747 -1500 - © ✓ 4 >'/'7,9 / �- acre 4 To Ars 2 r3 , / ?J ' �� () 2S 4/al/E. (1= /� -` �4 077i- = 356,4 9 36, F - pia -s2 / = 4,51),/2 e.t 75,E /-/g --= 5z/4 72 j /1 /4 l2 I /6 k ,7 GV° LL4 777s ; , //J chhcg 4,45 Li. 35 71/0,,5 34,714P frse#7 415 2 / = 4/4)92 3.75,4 -/S-= 471x,/ 5 4,es –0- 30, l 3 74 IL zo - _ 40 • Add k"›4/ / 4,�.w REVIEWED FOR CODE COMPLIANCE APPROVED APR 12 2010 City of Tukwila BUILDING DIVISION PREPARED BY /1/4'/'' DATE 3 22 /o PROJECT SUBJECT CRYEO�TUI MLA APR 0 5 2010 PERMIT CENTER 131 0 -0°t1 /ZektZ /ili ✓J044°4-fr. SHEET NO __ OF 4 ,4 6i.4 Lr /20vF Srall6 k6 JOB NO. 4:40 � E,4/517,I41 .0,4TE i At) 24'24'174.12'icle Aar/AL g74/57-71:j 7 10 _ /VALE ' C2� ��.t/ Corm To C4.I024_11 4t co Cot. %?77Ahgclor F44, -/ /, 1 1 � eDA ✓ i h9 T 0j, /..g1 L441 652 MITCHELL ENGINEERING INC. ✓ Mew ,Q' Jtg 1 40,12 ki,7/ ,.1 DF 7821 - 168th Ave. N.E. Redmond, WA 98052 (425) 747-1500 ,mil 2.4,4v T � s� 1641 Fax- kA& Z-14:210 A-77,:J Al I PREPARED BY � PROJECT !�" �G %ti° 144, DATE SHEET NO. 4 OF 4 SUBJECT JOB NO. 0 f J "l j l s 3 CitJ/sf ' �1 Jim Haggerton, Mayor Department of Community Development CARL PAGH 641622 AV NW SEATTLE WA 98107 RE: Permit No. D10 -091 15221 65 AV S TUKW Dear Permit Holder: Jack Pace, Director In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and /or the National Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has begun for a period of 180 days. Your permit will expire on 10/27/2010. Based on the above, you are hereby advised to: 1) Call the City of Tukwila Inspection Request Line at 206 - 431 -2451 to schedule for the next or final inspection. Each inspection creates a new 180 day period. -or- 2) Submit a written request for permit extension to the Permit Center at least seven (7) days before it is due to expire. Address your extension request to the Building Official and state your reason(s) for the need to extend your permit. The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your extension request is granted, you will be notified by mail. In the event you do not call for an inspection and /or receive an extension prior to 10/27/2010, 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, ■ZdUQ ot.A1-- Bill Rambo Permit Technician File: Permit File No. D10 -091 6300 Southcenter Boulevard, Suite #100 0 Tukwila, Washington 98188 o Phone: 206 - 431 -3670 e Fax: 206 - 431 -3665 14)ERMIT COORD COSY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D10 -091 DATE: 04/05/10 PROJECT NAME: ZIAD DECK COVER SITE ADDRESS: 15221 65 AV S X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # after Permit Issued DEPART ENTS: Ilding Ivl C n E Public Works Ak V/4 M-4-( O re Prevention Structural 1/4V, 4)J4- 4 -6'( D Planning Division LiPermit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete V:1 Comments: Incomplete ❑ DUE DATE: 04/06/10 Not Applicable Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TOES /THURS ROUTING: Building Please Route Structural Review Required ❑ No further Review Required n REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved ❑ Approved with Conditions Notation: REVIEWER'S INITIALS: DUE DATE: 05/04/10 Not Approved (attach comments) n DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents/routing slip.doc 2 -28 -02 Contractors or Tradespeople Peter Friendly Page • General /Specialty Contractor A business registered as a construction contractor with L &1 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 Ridgeline Development Inc UBI No. 602670098 Phone 2068982558 Status Active Address 6418 22Nd Ave Nw License No. RIDGEDI933CN Suite /Apt. License Type Construction Contractor City Seattle Effective Date 2/15/2007 State Wa Expiration Date 3/12/2011 Zip 98107 Suspend Date County King Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status RIDGED*956CC Ridgeline Development Construction Contractor General Unused 2/3/2005 2/3/2007 Relicensed Business Owner Information Name Role Effective Date Expiration Date Nakamura, Travis D President 02/15/2007 Bond Amount Pagh, Carl J Vice President 02/15/2007 FS2951020 Bond Information Page 1 of 1 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 2 GREAT AMERICAN INS CO FS2951020 07/10/2007 Until Cancelled $12,000.0008/29 /2007 1 CBIC SG7985 02/15/2007 Until Cancelled 07/10/2007 $12,000.0002/15 /2007 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 4 UNDERWRITERS AT LLOYDS A1Q917411 03/11/2010 03/11/2011 $1,000,000.0003 /12/2010 3 CATLIN SPECIALTY INS 4600201389 03/02/2009 03/02/2010 $1,000,000.0007 /08/2009 2 ATLANTIC CAS INS CO 1001894 07/12/2007 07/12/2009 $1,000,000.00 07/18/2008 1 CBIC C11SG7985 07/10/2006 07/10/2007 $300,000.00 02/15/2007 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period https://fortress.wa.gov/lniThbip/Print.aspx 04/20/2010