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Home My WebLink AboutPermit PG11-055 - WESTFIELD SOUTHCENTER MALL - FOOTLOCKER - CCSFOOTLOCKER - CCS 974 SOUThCENTER MALL PG1 1 -055 City ofiI'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.TukwilaWA.gov PLUMBING /GAS PIPING PERMIT Parcel No.: 9202470010 Address: 974 SOUTHCENTER MALL TUKW Project Name: CCS Permit Number: PG11 -055 Issue Date: 05/12/2011 Permit Expires On: 11/08/2011 Owner: Name: WESTFIELD PROPERTY TAX DEPT Address: PO BOX 130940 , CARLSBAD CA 92013 Contact Person: Name: KENT FAHEY Address: 3019 HOLLINWELL DR , KATY TX 77450 Email: RTLPERMITS @YAHOO.COM Contractor: Name: L & L RETAIL CONSTRUCTION LLC Address: 3750 W MAIN ST STE 4A , NORMAN OK 73072 Contractor License No: LLRETCL954QQ Phone: 800- 556 -8641 Phone: 405 360 -2775 Expiration Date: 11/30/2011 DESCRIPTION OF WORK: INSTALL INSTANTANEOUS WATER HEATER Value of Plumbing /Gas Piping: $500.00 Fees Collected: $59.06 Electrical Service Provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: Uniform Plumbing Code Edition: 2009 International Fuel Gas Code Edition: 2009 Date: `c - i-G' t 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 performance of work. I am authorized to sign and obtain this plumbing /gas piping permit and agree to the conditions on the back of this permit. Signature 51- ' )r OP fU Date: Print Name: Pie Pk-qe A This permit shall become null and void if th ork is not commenced within 180 days from the date of issuance, or if the work is suspended P y or abandoned for a period of 180 days from the last inspection. doc: UPC -4/10 PG 11 -055 Printed: 06 -20 -2011 • • PERMIT CONDITIONS Permit No. PG 11 -055 1: ** *PLUMBING AND GAS PIPING * ** 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas Code. 5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection. 7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall be insulated to minimum R -3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be protected by steel nail plates not less than 18 guage. 9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No plumbing piping shall be directly embedded in concrete or masonry. 10: All pipes penetrating floor /ceiling assemblies and fire - resistance rated walls or partitions shall be protected in accordance with the requirements of the building code. 11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin layers to twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, cinderfill, frozen earth, or construction debris. 12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the jurisdiction. doc: UPC -4/10 PG 11 -055 Printed: 06 -20 -2011 City oillfukwila 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 PLUMBING /GAS PIPING PERMIT Parcel No.: 9202470010 Address: 974 SOUTHCENTER MALL TUKW Project Name: CCS Permit Number: PG11 -055 Issue Date: 05/12/2011 Permit Expires On: 11/08/2011 Owner: Name: WESTFIELD PROPERTY TAX DEPT Address: PO BOX 130940 , CARLSBAD CA 92013 Contact Person: Name: KENT FAHEY Address: 3019 HOLLINWELL DR , KATY TX 77450 Email: RTLPERMITS @YAHOO.COM Contractor: Name: HORIZON RETAIL CONST INC Address: 1516 S GREEN BAY RD , RACINE WI 53406 Contractor License No: HORIZRC072N5 Phone: 800 - 556 -8641 Phone: Expiration Date: 04/15/2013 DESCRIPTION OF WORK: INSTALL INSTANTANEOUS WATER HEATER Value of Plumbing /Gas Piping: $500.00 Uniform Plumbing Code Edition: 2009 Fees Collected: $59.06 International Fuel Gas Code Edition: 2009 Electrical Service Provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: aDate: 05�/,zPi 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 performance of work. I am authorized to sign and obtain this plumbing /gas piping permit and agree to the conditions on the back of this permit. Signature: Sys Print Name: /f/;2i 7' E{ • (L Date: 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. doc: UPC -4/10 PG 11 -055 Printed: 05 -12 -2011 • • PERMIT CONDITIONS Permit No. PG11 -055 1: ** *PLUMBING AND GAS PIPING * ** 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas Code. 5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection. 7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall be insulated to minimum R -3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be protected by steel nail plates not less than 18 guage. 9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No plumbing piping shall be directly embedded in concrete or masonry. 10: All pipes penetrating floor /ceiling assemblies and fire - resistance rated walls or partitions shall be protected in accordance with the requirements of the building code. 11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin layers to twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, cinderfill, frozen earth, or construction debris. 12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the jurisdiction. doc: UPC -4/10 PG11 -055 Printed: 05 -12 -2011 • CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, W 98188 Contact Ap i.tukwila.wa.us Kent Fahey 809- 556 -8641 Fax 281- 579 -2227 0 0 0 Building Permit No. 'k \: '4413 Mechanical Permit No. N` t‘ 0 4c Plumbing /Gas Permit No. tO 6 t'- OS-S-* Public Works Permit No. Project No. (For office use only) r ahot�� ons and plans must be complete in order to be accepted for plan review Trt1pC , gilltl5 Applications will not be accepted through the mail or by fax. ,�' * *Please Print ** f SITE LOCATION Site Address: �-cti� ��1-�ft5�•rr.. Tenant Name: C k Property Owners N Mailing Address: `` King Co Assessor's Tax No.: Suite Number: 9300 Floor: New Tenant: 14 Yes ❑..No City State Zip CONTACT PERSON - who do we contact when your permit is ready to be issued Name: Mailing Address: E -Mail Address: {L; twits _(TS C es(AA Day Telephone: ` C Y-C , 0 City State Zip Fax Number: 28( -S-4-'; GENERAL CONTRACTOR INFORMATION - (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: - a Mailing Address: Contact Person: E -Mail Address: Contractor Registration Number: City Day Telephone: Fax Number: Expiration Date: State Zip ARCHITECT OF RECORD - All plans must be stamped by Architect of Record Company Name: -r tC....11/412-t. 00 it Gt+t D .1 t) lair Mailing Address: S•Z y Contact Person: (■ 'r 72 -t-[. -t CO l -Li MS" OHO City State Zip Day Telephone: Cn-3-- Z- -'OZZZ- E -Mail Address: Fax Number: q -3 -0c02, —0 -7-72.3 ENGINEER OF RECORD - All plans must be stamped by Engineer of Record Company Name: ? 4A Mailing Address: City Contact Person: Day Telephone: E -Mail Address: Fax Number: State Zip H\Applications \Forms-Applications On Line \2010 Applications \7 -2010 - Permit Application.doc Revised: 7.2010 bh Page 1 of 6 BUILDING PERMIT INFORMATION— 206- 431 -3670 Valuation of Project (contractor's bid price): $ tOf On 0 Existing Building Valuation: $ Scope of Work (please provide detailed information): �t Will there be new rack stora e? ....Yes ❑ .. No If yes, a separate permit and plan bmittal will be required. Provide All Building Areas in Square Footage Below, PLANNING DIVISION: Single family building footprint For an Accessory dwelling, pro of the foundation of all structures, plus any decks over 18 inche e the following: d overhangs greater than 18 inches) __ Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentat that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls ' ovided: Standard: Will there be a change ' use? ❑ Yes FIR P ' ! TE ON/H I OUS 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 ata Sheeta. Compact: Handicap: No If `yes ", explain: 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 Lme12010 Applications\7.2010 - Permit Application.doc RCA used. 7 -2010 bh Page 2 of 6 Exist. ' Interior Remodel Addition to Existing Structure - New. Type of Construction per IBC Type of Occupancy per IBC 1St Floor 23' Z re Floor 3'd Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint For an Accessory dwelling, pro of the foundation of all structures, plus any decks over 18 inche e the following: d overhangs greater than 18 inches) __ Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentat that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls ' ovided: Standard: Will there be a change ' use? ❑ Yes FIR P ' ! TE ON/H I OUS 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 ata Sheeta. Compact: Handicap: No If `yes ", explain: 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 Lme12010 Applications\7.2010 - Permit Application.doc RCA used. 7 -2010 bh Page 2 of 6 r PLUMBING AND GAS PIPING PERMIT INFORMATION — 206 -431 -3670 PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: -1 : i3. Mailing Address: City Contact Person: Day Telephone: E -Mail Address: Fax Number: Contractor Registration Number: Expiration Date: State Zip Valuation of Plumbing work (contractor's bid price): $ SOv Valuation of Gas Piping work (contractor's bid price): $ —V — Scope of Work (please provide detailed information): l� 11--)srJ724-N L5 Building Use (per Int'l Building Code): ► v 1 Occupancy (per Int'l Building Code): Utility Purveyor: Water: Sewer: Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: Fixture T •e: • Fixture T 'e: • Fixture T se: • Fixture T 'e: • 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 i 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:\ Applications \Fortes- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc Retised: 7 -2010 bh Page 5 of 6 • • PERMIT APPLICATION NOTES - Applicable 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 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 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR AUTHORIZED AGENT: Signature: Print Name: Mailing Address: IDate Application Accepted: 144-__. Date: CI Day Telephone: 210 ` SS c.' COLk] City ate Zip Date Application Expires: H \Applications \Fonns - Applications On Line \2010 Apphcations\7.2010 - Permit Apphcation.doc Resised: 7.2010 bh -�l Staff Initials: Page 6 0 6 �1 . • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us RECEIPT ParcelNo.: 9202470010 Permit Number: PG11 -055 Address: 974 SOUTHCENTER MALL TUKW Status: APPROVED Suite No: Applied Date: 04/08/2011 Applicant: CCS Issue Date: Receipt No.: R11 -00961 Payment Amount: $47.25 Initials: LAW Payment Date: 05/12/2011 01:46 PM User ID: 1632 Balance: $0.00 Payee: HORIZON RETAIL CONSTRUCTION TRANSACTION LIST: Type Method Descriptio Amount Payment Check 213708 47.25 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts PLUMBING - NONRES 000.322.103.00.00 47.25 Total: $47.25 doc: Receiot -06 Printed: 05 -12 -2011 Ci, 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: /hvww. ci. tukwila. wa. us SET RECEIPT RECEIPT NO: R11 -00684 Initials: Payment Date: 04/08/2011 User ID: 1655 Total Payment: 1,025.18 Payee: RETAIL PERMIT SERVICES INC SET ID: 040811 SET NAME: CCS SET TRANSACTIONS: Set Member D11 -093 M11 -045 PG11 -055 TOTAL: Amount 957.06 56.31 11.81 957.06 TRANSACTION LIST: Type Method Description Amount Payment Check 1372 1,025.18 TOTAL: 1,025.18 ACCOUNT ITEM LIST: Description Account Code Current Pmts PLAN CHECK - NONRES 000.345.830 1,025.18 TOTAL: 1,025.18 •• INSPECTION RECORD Retain a copy with permit p6,« -6 • PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 F., (206) 431-3670 Permit Inspection Request Line (206) 431-2451 Projprzt-: (----1:2-7 J ejelj Type nf Inspectio{—n: Pi Al 4— p( t i etZ e Address: 59 Date Called: Special Instructions: Date Wanted: ...----... -7— Lc-- 1/ _a.m. ••••arilow• P.m. Requester: *{Z Approved per applicable codes. Corrections required prior to approval. COMMENTS: /er4///-_A,o1/ spec Date: R SPECTION FEE REG IRED. P ior to next inspection. fee must be id at 6300 Southcenter B d.. Suite 100. Call to schedule reinspection. • . ,_• ..�- ; r,,r/T INSPECTION RECORD Retain a copy with permit INSPECTION NO. P6(( PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 I . (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Projec Typ of Inspection: Af J. Address: �� A4 Date Called Special Instructions: Date Wanted: t •K a.m. - 7- 'rS3--,/ p.m. Requester: Phone No: 0Er _3n3 -{( it7 Approved per applicable codes. EJCorrections required prior to approval. COMMENTS: 7— 1 ecto 4w4A L , f .l e e PECTION FEE R QUIRED. Ppor to next inspection. fee must be at 6300 SouthcenteJ- Blvd., Suite 100. Call to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit p6.(( --as- PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 12. (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Projec Type of Inspection: Add s; ,. et r/4 Sc- Date Called: Special Instructions: --� - cb.. W.4# - L. 1.111 Date Wanted: � a.m -7 --if -t/ p.m. !! Requester: Phone No: 6$ "3'1S- 11117 Approved per applicable codes. a Corrections required prior to approval. COMMENTS: Date; / ❑ I sPECTION FEE R QUIRED. Pri6r to next inspection. fee must be . 'd at 6300 Southcente Blvd.. Suite 100. Call to schedule reinspection, V v/ v 1/ L v 1 1 VI. J V I n /\ L U I J I V L L L I June 7, 2011 IlL I nyL I LI�Iny I u • vu tlly t/. VV I/ VV I O O RETAIL PERMIT SERVICES, INC. A National Permit Service Company TO: Bill / Jennifer City of Tukwila Building Department 306 - 431 -3655 / 433 -7165 Fax 431 -3665 RE: CCS South Center Mall PROJECT NUMBERS — D11 -093, M11 -045, EL11 -0321 & D11 -138 �C i1� -4SS� Bill / Jennifer, Horizon Retail Construction originally pulled the Building Permit(s), however Footlocker, Inc. has selected another GC (L &L Construction) to perform the work. Please re -issue an updated/amended Building Permit to L &L Construction. If you have any questions or problems, please give me a call at 281 -579- 2226. Thank you. Kent Fahey a RECEIVED JUN 07 2011 PERMIT CENTER 301nU.,,�:w__.,.,, .,____ T .... - -.. _ _ RECEIVED 06 -07 -' 11 11:46 FROM- 2815792227 TO- publicworks /dcd P001/00127 • PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG11 -055 DATE: 04 -08 -11 PROJECT NAME: CCS SITE ADDRESS: 974 SOUTHCENTER MALL X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: Building Division Public Wdi'ks Fire Prevention Structural Planning Division ❑ Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Comments: Incomplete n DUE DATE: 04-12-11 Not Applicable Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES /THURS ROUTING: Please Route Structural Review Required n No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 05-10-11 Approved Approved with Conditions Not Approved (attach comments) n Notation: REVIEWER'S INITIALS: 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 Prj,ier Friendly Page 1 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. Business and Licensing Information Name Phone Address Suite /Apt. City State Zip County Business Type Parent Company L & L RETAIL CONSTRUCTION LLC 4053602775 5601 Hunter Drive Norman OK 73069 Out Of State Limited Liability Company UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602372596 Active LLRETCL954QQ Construction Contractor 11/18/2005 11/30/2011 General Unused Business Owner Information Name Role Effective Date Expiration Date LISCHKA, STEPHEN C Partner /Member 11/18/2005 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 1 TRAVELERS CAS & SURETY CO 104644232 11/10/2005 Until Cancelled $12,000.00 11/18/2005 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 5 LIBERTY SURPLUS INS CORP DGLSF0803121 07/11/2010 07/11/2011 $1,000,000.00 07/20/2010 4 CENTRAL MUTUAL CLP8454110 07/11/2008 07/11/2010 $1,000,000.00 07/10/2009 3 CENTRAL MUTUAL INS CO CLP8454110 07/11/2007 07/11/2008 $1,000,000.00 07/10/2007 2 PEERLESS INS CBP8163861 07/11/2006 07/11/2007 $1,000,000.00 07/07/2006 1 AMERICA FIRST INS CO CCP9741366 07/11/2005 07/11/2006 $1,000,000.00 11/18/2005 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period https: // fortress .wa.gov /lni/bbip /Print.aspx 06/20/2011 Contractors or Tradespeople Fitter Friendly Page 1 General /Specialty Contractor A business registered as a construction contractor with LW 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 HORIZON RETAIL CONST INC UBI No. 601483044 Phone 2626386000 Status Active Address 1500 Horizon Drive License No. HORIZRC072N5 Suite /Apt. License Type Construction Contractor City Sturtevant Effective Date 8/25/1993 State WI Expiration Date 4/15/2013 Zip 53177 Suspend Date County Out Of State Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Business Owner Information Name Role Effective Date Expiration Date HENDERSEN, JON E Cancel Date 01/01/1980 Amount GUSTIN, ROBERT L 7 01/01/1980 5919211 HENDERSON, JON E 03/29/2012 01/01/1980 JAWORT, DAN Agent 01/01/1980 ZURICH AMERICAN INS CO 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 4 HANOVER INS CO 1592447 04/10/2002 Until Cancelled $12,000.00 04/15/2002 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 7 ZURICH AMERICAN INS CO 5919211 03/29/2009 03/29/2012 $1,000,000.0004 /04/2011 6 ZURICH AMERICAN INS CO 59192110001 03/29/2006 03/29/2009 $1,000,000.00 03/24/2008 5 GENERAL CAS CO OF WISCONSIN CC10245522 03/29/2002 03/29/2006 $1,000,000.00 02/28/2005 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period https://fortress.wa.gov/lni/bbip/Print. aspx 05/12/2011