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HomeMy WebLinkAboutPermit D10-190 - NORTH HILL APARTMENTS - UNITS C101, C201 AND C301 - DECKSNORTH HILL APTS UNITS C101, C201, C301 5840 SOUTHCENTER BL D10 -190 City otI'ukwila • 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 DEVELOPMENT PERMIT Parcel No.: 1157200351 Address: 5840 SOUTHCENTER BL TUKW Suite No: Project Name: NORTH HILL APARTMENTS - UNITS C101, C201, C301 Permit Number: D10 -190 Issue Date: 08/11/2010 Permit Expires On: 02/07/2011 Owner: Name: NORTH HILL APTS INC Address: 85 S WASHINGTON #308 , SEATTLE WA 98104 Contact Person: Name: GARY ANDERSON Phone: 253 - 377 -4491 Address: 5010 S TACOMA WY , TACOMA WA 98409 Contractor: Name: G P ANDERSON CONSTRUCTION INC Address: 121 BELLA BELLA DR , FOX ISLAND WA 98333 Contractor License No: GPANDCI033RP Phone: Expiration Date: 12/16/2011 DESCRIPTION OF WORK: REPLACE ROTTED DECKS Value of Construction: Type of Fire Protection: Type of Construction: $10,000.00 Fees Collected: $464.52 International Building Code Edition: 2009 Occupancy per IBC: 0021 * *continued on next page ** doc: IBC -10/06 D10 -190 Printed: 08 -11 -2010 City 64/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: Issue Date: Permit Expires On: D10 -190 08/11/2010 02/07/2011 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Number: 0 Flood Control Zone: Hauling: N Land Altering: Landscape Irrigation: Moving Oversize Load: Sanitary Side Sewer: Sewer Main Extension: Storm Drainage: Street Use: Water Main Extension: Water Meter: Permit Center Authorized Signature: I hereby certify that I have read and governing this work will be complie N Start Time: Volumes: Cut 0 c.y. Size (Inches): 0 End Time: Fill 0 c.y. Start Time: End Time: Private: Profit: N Private: Date: Public: Non - Profit: N Public: dp* ned s permit and know the same to be true and correct. All provisions of law and ordinances whether specified herein or not. The granting of this permit does not pre construction or the pe nce of work. e to give authority to violate or cancel the provisions of any other state or local laws regulating I am authorized to sign and obtain this development permit. Signature: "v v der Date: h Print Name: e e /4 S o el 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 -190 Printed: 08 -11 -2010 r � 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.: 1157200351 Permit Number: D10-190 Address: 5840 SOUTHCENTER BL TUKW Status: ISSUED Suite No: Applied Date: 07/22/2010 Tenant: NORTH HILL APARTMENTS - UNITS C101, C201, C301 Issue Date: 08/11/2010 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: 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. 6: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy can be obtained at City Hall in the office of the City Clerk. 7: 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 -190 Printed: 08 -11 -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 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: Date: Print Name: La(-]- o(us v,el ordinances governing or local laws regulating doc: Cond -10/06 D10 -190 Printed: 08 -11 -2010 CITY OF TUKV4 Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Building Pe o Mechanical Permit No. Plumbing/Gas Permit No. Public Works Permit No. Project No. bto -told For of ice use on 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 On t I9 (D1 2.0 130 101 cl cr C� Site Address: 5 �Y o 3 o� Cen k- 13) V of Tenant Name: /1% h, /01, II /900j King Co Assessor's Tax No.: [(E7)-0— 0 3.7-1 Suite Number: New Tenant: Floor: ❑ Yes ❑ .. No Property Owners Name: V) L i - f / ) / C, / " 1 /1c(5.01.) w) =" Mailing Address: City State Zip CONTACT PERSON – who do we contact when your permit is ready to be issued Name: 6401 /?'1d Y1 Day Telephone: City E -Mail Address: Fax Number: Mailing Address: X 53 37741e/9/ State Zip ,353 3 D ) o - f GENERAL CONTRACTOR INFORMATION – (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: G «5v , Co ,/- Mailing Address: o /0 5voitt Contact Person: So." E -Mail Address: Contractor Registration Number: City Day Telephone: Fax Number: Expiration Date: �1JA 9 s Yo, State Zip \5.3 377949/ d5'3 3 of ARCHITECT OF RECORD – All plans must be stamped by Architect of Record Company Name: Mailing Address: Contact Person: E -Mail Address: City Day Telephone: Fax Number: State Zip ENGINEER OF RECORD – All plans must be stamped by Engineer of Record Company Name: Mailing Address: Contact Person: E -Mail Address: H:\Applications\Porms- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh City Day Telephone: Fax Number: State Zip Page 1 of 6 BUILDING PERMIT INFORMATION 206 - 431 -3670 /9 000, Valuation of Project (contractor's bid price): $ Existing�lding Valuation: $ Scope of Work (please provide detailed information): Will there be new rack storage? ❑ ....Yes ❑ ..No If yes, a separate permit and plan submittal will be required. 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 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) 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 Safety 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\Forms- Applications On Line\2010 Applications17.2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of . Occupancy per IBC lst Floor rd Floor 3rd Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck 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) 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 Safety 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\Forms- Applications On Line\2010 Applications17.2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 PERMIT APPLICATION NOTES - Wicable to all permits 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 Intemational 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 OWNER 0 UTHORIZED AGENT: Signature: Date: 7 —X2"- Print Name: ec o 't Mailing Address: 5-0/0 So.) ffn 7 w w.t7 Day Telephone: d`CS 377 Litt C& I e•-4 City State Zip Date Application Accepted: —, - l) Date Application Expires: ( -t» -I/ Staff Initials: H:\Applications\Forms- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Revised: 7 -2010 bh Page 6 of 6 PLUMBING AND GAS PIPING PER' INFORMATION — 206 - 431 -3670 • PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: Mailing Address: City State Zip Contact Person: Day Telephone: E -Mail Address: Fax Number: Contractor Registration Number: Expiration Date: Valuation of Plumbing work (contractor's bid price): $ Valuation of Gas Piping work (contractor's bid price): $ Scope of Work (please provide detailed information): Building Use (per Int'l Building Code): Occupancy (per Int'1 Building Code): Utility Purveyor: Water: Sewer: Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: 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 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 H:1Applications\Forms- Applications On Line \2010 Applications17 -2010 - Permit Application.doc Revised: 7 -2010 bh Page 5 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 RECEIPT Parcel No.: 1157200351 Permit Number: D10-190 Address: 5840 SOUTHCENTER BL TUKW Status: PENDING Suite No: Applied Date: 07/22/2010 Applicant: NORTH HILL APTS - BLDG C Issue Date: Receipt No.: R10 -01388 Payment Amount: $464.52 Initials: WER Payment Date: 07/22/2010 11:52 AM User ID: 1655 Balance: $0.00 Payee: LEE ANDERSON TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 05503D ACCOUNT ITEM LIST: Description 464.52 Account Code Current Pmts BUILDING - NONRES PLAN CHECK - NONRES STATE BUILDING SURCHARGE 000.322.100 000.345.830 640.237.114 Total: $464.52 278.80 181.22 4.50 PAYMENT RFCE1VD doc: Receiot -06 Printed: 07 -22 -2010 • C , . 4 • INSPECTION RECORD' Retain a copy•with permit: INSPECTION NO. . 'PERMIT.NO: . CITY OF TUKWILA BUILDING . :DIV1SION:.,:. 6300 Southcenter Blvd., #100, Tukwila. WA•98188 "::(206).431'3610.. Permit Inspection Request Line (206) 431 -2451: `7' plict,itl t 1 applicable•codes� • . 'Corrections Tytie nspectio e Ad es 56 tf6 _5` t Date.Called: • . _ Specialflnstructions ••. C. 1O1 e • Date Wanted: • • 1 " ,•a:m: lift Requester: • Phone No'• �yf, n Approved per applicable•codes� • . 'Corrections required prior :to approval. COMMENTS. re Am ikJ% `Y PafP .t, • ..-1- 0 co a.t is 1 Op . /;Jt { • r• • SPECTION FEE REQ IRED rPrio to next inspection, fee must be at 6300 Southcenter Blvd.; Suite 100. Call'to schedule reinspection. e 1 REV EWER FOR CODE COMP IANCE µ X05210 Ci of Tul MIa BUILD ING D ISIfN 76 o Ea 0 .o w a a) To ct ▪ pO o. ' -o- a. 3 41114C CO t) CU b ets o. C CU 6 Ecorn14g c.. cn 0 afi Q2 o�� > ■■■• w — t> 1- .o im =c te .0 1-_, ca g w (1) � � N ~ Aalb -V5 CC s w t ta. I 2 gl z FILE Permit No. an review approval is subje and omissions Approval of construction doc ants d : s not authorize the violation of any adopted • • e or o finance. Receipt 0o of approved Field Copy . «, ditions i : acknowledged. By City Of ukwil BUILDING' DIVISI I.N Date: RECEIVED JUL 2 2 2010 PERMIT CENTER tot 0 1 96 BId E 304 303 302 301 204 203 202 201 104 103 102 101 Studios I, BId D 303 302 301 203 202 201 103 102 101 1x1 Std 515 »&)rZ-r I -1 ( Apr -fs , c.4 tA pl ( -4..til c\ Bld C 304 303 302 301 204 203 202 201 104 103 102 101 1x1 fw cr 0 ® <I sij O a ®et Won w ir0 Sicd e 303 302 301 203 202 201 103 102 101 Studios 5 3a 304 303 pr 302 301 204 203 202 201 104 103 102 101 1x1 A. cry lumber company A Century of Pen`ormance + Integrity 253.752.7000 fax 253.759.7560 graylumber.com 111)11,01N. ,,PRODUCT.V. SOLIDSTART To NO :4)1 9,1/ /4p I5 ::"?1; SPr14/ C'ea/k/e, From v ARC/4-1504 (0/1S1 Date 64^ti 95'3 377 yL1 ql 4gedil .1.44.djcs,(4:1c.4,51t6:, 13ue• C,elce- Drs l L A'Ifl h �5 art Z i1 5- 2-n /o ID/ w5b CQ `I post Fromm 3iPy '-t2" ax3 Cc - east fosr Hrecire,ti 3t« ih4rd,G ``J �P U5-e- J3CJ 2 j - a !/ „' 1,44u dia (� USA gG / z ,- aft 1/ f` o a n. cc.r,v s Use- I- U S a 2, JZ 41/ `K JOf S l `" �mGr Use- a 10 I re_4 gcr I4Ji fe t - /oc.. cp 4/ h, //a /2''Ot w4 f1 f-1/4s4(-2,9 is ).A 3 &4 /v Ft '"/1 radasedfc (, ec.k4 0 r S` n/00 r` All 4J I5i�:� RECEI`U re- /7;54i4 1 no ca rs, 0 e057 JUL 22 2010 PERMIT CENTER 4 y ike Harwick ENGINEERED WOOD PRODUCTS Sales Representative Office: 253.752.7000 mobile: 253.973.4419 harwick @graylumber.com Lf t qx4 <i.4p (psi REVIEWED FOR CODE COMPLIANCE AmmainVIED HUD 0 5 2U1U . .<(p)ct BUILDING DlvlclnN < L 4 111)11,01N. ,,PRODUCT.V. SOLIDSTART To NO :4)1 9,1/ /4p I5 ::"?1; SPr14/ C'ea/k/e, From v ARC/4-1504 (0/1S1 Date 64^ti 95'3 377 yL1 ql 4gedil .1.44.djcs,(4:1c.4,51t6:, 13ue• C,elce- Drs l L A'Ifl h �5 art Z i1 5- 2-n /o ID/ w5b CQ `I post Fromm 3iPy '-t2" ax3 Cc - east fosr Hrecire,ti 3t« ih4rd,G ``J �P U5-e- J3CJ 2 j - a !/ „' 1,44u dia (� USA gG / z ,- aft 1/ f` o a n. cc.r,v s Use- I- U S a 2, JZ 41/ `K JOf S l `" �mGr Use- a 10 I re_4 gcr I4Ji fe t - /oc.. cp 4/ h, //a /2''Ot w4 f1 f-1/4s4(-2,9 is ).A 3 &4 /v Ft '"/1 radasedfc (, ec.k4 0 r S` n/00 r` All 4J I5i�:� RECEI`U re- /7;54i4 1 no ca rs, 0 e057 JUL 22 2010 PERMIT CENTER 4 y ike Harwick ENGINEERED WOOD PRODUCTS Sales Representative Office: 253.752.7000 mobile: 253.973.4419 harwick @graylumber.com A. ry lumber awnpany A Centujv of Performance + integrity 253.752.7000 fax 253.759.7560 graylump r.com a___ ci Oa. I ELh `5 To /1/, r‘tk )4II is t o o J fn Len From 6 Pfd 4-c.v.\ Date 5=9oy rY 4153 377 9117/ l- 4 5+ cir i y v e /•� Q�5 t b p To ' I cr cA i L ., 3;J;, 04 bo: Ic 45 �y h ! (..17 74h ii4Shiet.5 Outs-' icotyte- . ENGINEERED WOOD PRODUCTS 4Thcht_o W, ] Lo c.. 1. CSC h REVIEWED FOR CODE COMPLIANCE A: ua�- fVED 117 AUb 0 5 2U1 +J City of Tukwila WILDING DIVISIMI RECEIVED JUL 22 2010 PERMIT CENTEF -' Mike Harwick Sales Representative Office: 253.752.7000 mobile: 253.973.4419 harwick @graylumber.com PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D10 -190 DATE: 07 -22 -10 PROJECT NAME: NORTH HILL APTS - UNITS C101, C201, C301 SITE ADDRESS: 5840 SOUTHCENTER BL X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEPARTMENTS: I • ing • [vision P1u 6 N -'1 lic W•r s 011 PlA 1 14k 011110 Fire Prevention Structural Ph 4'111 P Planning Division Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Comments: Incomplete DUE DATE: 07-27 -10 Not Applicable Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS RpUTING: Please Route Structural Review Required No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved Approved with Conditions Notation: REVIEWER'S INITIALS: DUE DATE: 08 -24 -10 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 Contractors or Tradespeople Printer Friendly Page • General /Specialty Contractor A business registered as a construction contractor with LEI 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 G P ANDERSON CONSTRUCTION INC UBI No. 601838669 Phone 2535497450 Status Active Address 121 Bella Bella Dr License No. GPANDCI033RP Suite /Apt. License Type Construction Contractor City Fox Island Effective Date 12/17/1997 State WA Expiration Date 12/16/2011 Zip 98333 Suspend Date County Pierce Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company ther Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status APEXCL'024B0 APEX CONSTRUCTION LLC Construction Contractor General Unused 1/20/1998 1/4/2003 Archived OLYMPVC055MP OLYMPIC VIEW CONSTRUCTION INC Construction Contractor General Unused 7/17/1995 9/30/1998 Archived OLYMPVC054R9 OLYMPIC VIEW CONSTRUCTION Construction Contractor General Unused 12/29/1994 9/30/1995 Archived ANDERC'086B2 ANDERSON CONSTRUCTION Construction Contractor General Unused 1/22/1992 1/22/1995 Archived Business Owner Information Name Role Effective Date Expiration Date ANDERSON, GARY Cancel Date 01/01/1980 Bond Amount ANDERSON, PEGEEN 3 01/01/1980 6382694 Bond Information Page 1 of 2 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 3 AMERICAN STATES INS 6382694 12/16/2005 Until Cancelled $12,000.0011/01 /2005 2 DEVELOPERS SURETY E INDEM CO 445696C 12/16/2001 Until Cancelled 02/06/2006 $12,000.00 12/22/2005 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 11 OOHIO CAS INS BH053575320 12/16/2008 12/16/2010 $1,000,000.00 11/06/2009 10 01-110 CAS INS 6H053575320 12/16/2007 12/16/2008 $1,000,000.00 12/12/2007 9 FIRST SPECIALTY INS CORP FGL22900572600 12/16/2005 12/16/2007 $1,000,000.00 12/15/2006 8 FIRST MERCURY INS CO FMIL000270 12/16/2004 12/16/2005 $1,000,000.00 12/23/2004 7 AMERICAN STATES INS CO 010E3166877 12/16/2003 12/16/2004 51,000,000.00 11/26/2003 https://fortress.wa.gov/lni/bbip/Print.aspx 08/11/2010