HomeMy WebLinkAboutPermit PG11-080 - MAJED MOAWADThis record contains information which is exempt from public disclosure
pursuant to the Washington State Public Records Act, Chapter 42.56 RCW
as identified on the Digital Records Exemption Log shown below.
PG 11 -080
Majed Moawad
6720 Fort Dent Way
RECORDS DIGITAL D- ) EXEMPTION LOG
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
Page # tode Exemption = 8rlef Explanatory DeSclriptiop �t�tutel ule
The Privacy Act of 1974 evinces Congress'
intent that social security numbers are a private
concern. As such, individuals' social security
Personal Information —
numbers are redacted to protect those
Social Security Numbers
individuals' privacy pursuant to 5 U.S.C. sec.
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
552(a), and are also exempt from disclosure
552(a); RCW
552(a); RCW
under section 42.56.070(1) of the Washington
42.56.070(1)
42.56.070(1)
State Public Records Act, which exempts under
the PRA records or information exempt or
prohibited from disclosure under any other
statute.
Redactions contain Credit card numbers, debit
card numbers, electronic check numbers, credit
Personal Information —
expiration dates, or bank or other financial
RCW
18
DR2
Financial Information —
account numbers, which are exempt from
42.56.230(5)
RCW 42.56.230(4 5)
disclosure pursuant to RCW 42.56.230(5),
except when disclosure is expressly required by
or governed by other law.
MAJED MOAW
6720 FORT DENT WY
Parcel No.:
Address:
Project Name:
City akukwila
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
2954900455
6720 FORT DENT WY TUKW
MAJED MOAWAD
Permit Number:
Issue Date:
Permit Expires On:
PG 11 -080
06/28/2011
12/25/2011
. y
owner:
Name:
Address:
Contact Person:
Name:
Address:
Email:
JOHN C RADOVICH LLC
2835 82ND AVE SE #300 , MERCER ISLAND WA 98040
DON WYCOFF
8425 219 ST SE #102 , WOODINVILLE WA 98072
D W YC O FF@ SAG ERM E C RANI CAL. C OM
Contractor:
Name: SAGER MECHANICAL INC
Address: 8425 219 ST SE, STE 102 , WOODINVILLE WA 98072
Contractor License No: SAGERMI088NK
Phone: 206 - 200 -3749
Phone: 425 402 -1930
Expiration Date: 08/10/2011
DESCRIPTION OF WORK:
PLUMBING: DEMO (3) SINKS AND ADD (3) SINKS. MEDICAL GAS PIPING: MODIFY
LOCATIONS OF (4) AIR OUTLETS (NON MEDICALTOOL AIR), MODIFY INLET LOCATIONS OF
(4) DENTAL VACUUM LOCATIONS, ADD (1) AIR OUTLET, AND ADD (1) VACUUM INLET.
PERMIT INCLUDES TESTING OF EXISTING 3/4" RPPA FOR SUITE ISOLATION
AND 1/2" BACKFLOW FOR EQUPMENT NEEDS.
Value of Plumbing /Gas Piping:
Fees Collected:
Electrical Service Provided by:
Pe Center Authorized Signature:
I•hereby certify that I have read and
governing this work will be complie
$5,500.00
$353.06
Jim?
Uniform Plumbing Code Edition:
International Fuel Gas Code Edition:
xan
wit
The granting of this permit does not preys
construction or the performance of work.
on the back of this permit.
Signature:
Print Name:
2009
2009
Date: IZ$I
Led this permit and know the same to be true and correct. All provisions of law and ordinances
whether specified herein or not.
ine 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 plumbing /gas piping permit and agree to the conditions
A)\772i-Yr Aja /14
Date:
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
PG11 -080
Printed: 06 -28 -2011
• •
PERMIT CONDITIONS
Permit No. PG 11 -080
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: AU 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: All new plumbing fixtures installed in new construction and all remodeling involving replacement of plumbing fixtures
and fittings in all residential, hotel, motel, school, industrial, commercial use or other occupancies that use
significant quantities of water shall comply with Washington States Water Efficiency and Conservation Standards in
accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code Section 402 of Washington State Amendments.
13: 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.
14: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
15: Prior to PW final inspection the existing 3/4" RPPA protecting the suite (in- premise isolation) and existing 1/2"
bacldlow for equipment needs shall be tested by a certified tester and pasing backflow test reports shall be submitted
to Mr. Dave Stuckle, Public Works Project Inspector @ 206 431 -2449.
16: Thereafter annual tests of both back lows shall be performed by a certified tester at owner's expense, and copies of
the test results shall be forwarded to Tukwila Water Department,
600 Minkler Blvd, Tukwila, WA 98188, phone (206)433 -1860,
fax: (206)575 -3404.
doc: UPC -4/10
PG 11 -080 Printed: 06 -28 -2011
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.ci.tukwila.wa.us
Plumbing/Gas Permit NO.P& 1 `'
Project No. (9 lAZ)
(For office use only)
PLUMBING / GAS PIPING PERMIT APPLICATION
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
King Co Assessor's Tax No.: 2954900455
Site Address: 6720 Fort Dent Way, Tukwila, Wa
Tenant Name:
Dr Majed Moawad
Suite Number: 120 Floor: 1
Property Owners Name: John C Radovich, LLC
New Tenant: ❑ Yes ❑ ..No
Mailing Address: 2835 82nd Ave SE #300 Mercer Island, Wa 98040
City
State
Zip
CONTACT PERSON — Who do we contact when your permit is ready to be issued
Name: Don Wycoff
Mailing Address: 8425 219th ST SE #102 Woodinville, Wa 98072
E -Mail Address: dwycoff@sagermechanical.com
Day Telephone: (206) 200 -3749
City State
Fax Number: (425) 402 -6721
Zip
PLUMBING / GAS PIPING CONTRACTOR INFORMATION
Company Name: Sager Mechanical, Inc
Mailing Address: 8425 219th St SE #102
Contact Person: Don Wycoff
E -Mail Address: dwycoff @sagermechanical.com
Contractor Registration Number: sagermi088nk
Woodinville Wa
City State
Day Telephone: (206) 200 -3749
Fax Number: (425) 402 -6721
Expiration Date: 08/10/2011
98072
Zip
ARCHITECT OF RECORD — All plans must be stamped by Architect 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 stamped by Engineer of Record
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Ft:\ Applications \palms - Applications On Line \2010 Applications \7 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised: 7 -2010
bh
Page 1 of 2
Date Application Accepted:
i ..----? - 6660 si
' Zl 6 S
Valuation of Project (contractor's bid price): $ 5500.00 � — ZPus @ M���` 74 Scope of Work (please provide detailed information): Demo 3 sinks, add 3 sinks, modify locations of four (4) air outlets (no�
modify inlet locations of four (4) dental vacuum locations, add one (1) air outlet, add one (1) vacuum inlet
Building Use (per Int'l Building Code):
Occupancy (per Int'I 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
3.00
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
0.01
'o
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
PERMIT APPLICATION NOTES -
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 grant one extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing
and justifiable cause . s - trated. Section 103.4.3 International Plumbing Code (current edition).
I HEREBY - RTIFY AT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY G PERJURY : Y THE LAWS OF THE S AT • b F WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDIN AUTH 1 RIZ . D
Signature:
Print Name:
D j' Wycoff
Date: 6 -1 -11
Day Telephone: 206- 200 -3749
Mailing Address: 8425 219th i/ E #102 Woodinville, Wa 98072
City
State
Zip
Date Application Expires:
121 01, I I.I
Staff Initials:
H:\Applications\Forms- Applications On Line\2010 Applications \7 -2010 - i'Iumbing -Gas Piping Permit Application.doc
Revised: 7 -2010
bh
Page 2 of 2
•
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.TukwilaWA.gov
Parcel No.: 2954900455
Address: 6720 FORT DENT WY TURIN
Suite No:
Applicant: MAJED MOAWAD
RECEIPT
Permit Number: PG11 -080
Status: APPROVED
Applied Date: 06/09/2011
Issue Date:
Receipt No.: R11-01324
Initials:
User ID:
Payee:
JEM
1165
Payment Amount: $280.87
Payment Date: 06/28/2011 11:40 AM
Balance: $0.00
SAGER MECHANICAL, INC.
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 15950 280.87
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
PLAN CHECK - NONRES
PLUMBING - NONRES
000.345.830 -1.58
000.322.103.00.00 282.45
Total: $280.87
doc: Receipt -06 Printed: 06 -28 -2011
N Q wq City of Tukwila
s
1` yZ Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.TukwilaWA.gov
RECEIPT
Parcel No.: 2954900455 Permit Number: PG 11 -080
Address: 6720 FORT DENT WY TUKW Status: PENDING
Suite No: Applied Date: 06/09/2011
Applicant: MAJED MOAWAD Issue Date:
Receipt No.: R11 -01174
Payment Amount: $72.19
Initials: TLS Payment Date: 06/09/2011 02:00 PM
User ID: 1670 Balance: $288.75
Payee: DONALD E WYCOFF
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 08187C
ACCOUNT ITEM LIST:
Description
72.19
Account Code Current Pmts
PLAN CHECK - NONRES
000.345.830 72.19
Total: $72.19
doc: Receiot -06 Printed: 06 -09 -2011
INSPECTION NO.
INSPECTION RECORD P6 i( 4O
Retain a copy with permit
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION I'
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 431 -2451
(206) 431 -3670
Project:
JAW
Typf�lnspectipn: �� • Alt
Add`, 7 J
.�
!
ate Called:
,
Special Instructions:
Date Wanted:c—_ - ( 2-----q a.m.
Requester:
Phone No :( i Q3. °5,s! l
Approved per applicable codes. a Corrections required prior to approval.
COMMENTS:
P`orIQ -C.X D'g A44(0
id A
Inspector: C
(Date— Z r f
❑ REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspectioh.
INSPECTION NO. •
/INSPECTION RECORD,
Retain a copy with permit.
:.PERMIT NO.
•
CITY OF TUKWILA BUILDING. D
6300 Southcenter Blvd., #100, Tukwila: WA 98188
Permit Inspection Request Line (206) 431-2451
IVE.SION
(206) 431-3670
ProjAcik4 AI
U-6--4 WA-WU
Type of Inspection: •
P
Address:
(e,r7E49
7----C-4kir-
...
Date Called:
SpWial Instructions:
0 2
1)1,r
Date Wanted: .
" • •
''-if.
--a.m.-
tr3-ril•
Requester:
Phone No:
•
Approved per applicable codes.
COMMENTS:
orrections reqUiied prior to approval.. • *,
•
Ff.(' er .11YrT: oAf
kgile 50 A-1/464v',
.0 to r 0 f p el
JAk? D f eok: rN, UAi
fre__A1( ir
Insptn‘tor:
• • •
1-7 REINSPECTION FEE REQUIR D. Prior to next inspettiOil. fee must be -•::
p4j41.at 6300 Southcenter Blvd. Suite 100. Call to sCheciUle reinspection:
•
--.
•
•
'•
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
PERMIT NO. .
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 teg,. (206) 431 -3670 .
Permit Inspection Request Line (206) 431 -2451
Project:
in ,Qf) ,/3'x!1 � to A I)
Type of Inspection: ,/
R,rw4 h .. i AJ
/Thil /- 40 - fr1/ 4✓J
Address:
.r 7 r'(J
es J'?f�.�6A/TG/ 7
Date Called:
Special Instructions:
Date Wanted:
Ci— 2- ..//
a.m4.„
tan.
Requester:
Phone No:
775 —V p:7.2
•
pproved per applicable codes.
Corrections required prior to approval.•: =:::
COMMENTS:
ej 74 klarnhil - i%,0/4/0/ /)(4., tilt 04 (f -
/Thil /- 40 - fr1/ 4✓J
At/ N 1 ",- if 07 _..7 A9"
NSPECTION FEE ' EQUIRED. for to next inspoi i;fee
id at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspectioa ia4ii
•
response to Letter of Incomplete Application #PG11 -080 Page 1 of 1
response to Letter of Incomplete Application #PG11 -080
Don Wycoff [dwycoff @sagermechanical.com]
Sent: Thursday, June 16, 2011 2:06 PM
To: Joanna Spencer
Joanna, in follow up to our phone conversation regarding the Letter of
Incomplete Application for permit * #PG11 -080 - Dr Majed Moawad *, the
RPBA assemblies are existing in suite. There is one 3/4" RPBA for suite
isolation and one 1/2" for equipment needs. I have explained to the
doctor taking the suite, and the contractor performing the build out
that these will need to be tested and approved by the health dept, and
the plumbing inspector before a final inspection will be approved.
Please feel free to call with any questions,
Don Wycoff, Sager Mechanical 206- 200 -3749 or 425- 402 -1930
INCOMPLETE
JUN 1]2011
LTR# PERMITCENTER
?GU-- Oso
https: / /webmail.tukwilawa. gov /owa/ ?ae= Item &t = IPM .Note &id= RgAAAACCtj bDOfmzT... 06/16/2011
June 14, 2011
•
City of Tukwila
•
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
Don Wycoff
Sager Mechanical
8425 219th St SE, #102
Woodinville, WA 98072
RE: Letter of Incomplete Application # 1
Plumbing /Gas Piping Permit Application PG11 -080
Dr Majed Moawad — 6720 Fort Dent Wy
Dear Mr. Wycoff,
This letter is to inform you that your permit application received at the City of Tukwila Permit Center on
June 9, 2011 is determined to be incomplete. Before your application can continue the plan review
process the attached/following items from the following department(s) need(s) to be addressed:
Public Works Department: Joanna Spencer at 206 431 -2440 if you have any questions
concerning the attached comment.
Please address the comment above in an itemized format with applicable revised plans,
specifications, and /or other documentation. The City requires that two (2) sets of revised plans,
specifications and /or other documentation be resubmitted with the appropriate revision block.
In order to better expedite your resubmittal a Revision Submittal Sheet must accompany every
resubmittal. I have enclosed one for your convenience. Revisions must be made in person and will
not be accepted through the mail or by a messenger service.
If you have any questions, please contact me at the Permit Center at (206) 431 -3670.
Sincerely,
c
Bill Rambo
Permit Technician
Enclosures
File: PG11 -008
W:\Permit Center \Incomplete Letters\2011\PG 11 -080 Incomplete Ltr # 1.doc
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
•
PUBLIC WORKS DEPARTMENT COMMENTS
DATE: June 14, 2011
PROJECT: Majed Moawad
6720 Fort Dent Wy, Ste 120
PERMIT NO: PG11 -080
PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the
following comments.
1) Due to the nature of the dental service business, which is considered a high hazard, a Reduced
Pressure Principle Assembly (RPPA) shall be installed as a backflow devise for cross - connection
control for in- premise isolation to protect the other tenants in the building from water cross -
contamination. Please show location diagram of RPPA installation and specify size, make and
model number of the backflow. Please submit RPPA cut sheet and circle the backflow to be
installed. Make sure that the subject backflow is from the WA State Department of Health
Backflow Prevention Assemblies Approved for Installation in Washington State list.
W:Other /Joanna /PG11 -080 inc
"PERMIT COORD GOPYM
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -080 DATE: 06/17/11
PROJECT NAME: MAJED MOAWAD
SITE ADDRESS: 6720 FORT DENT WY
Original Plan Submittal
Response to Correction Letter #
X Response to Incomplete Letter # 1
Revision # after Permit Issued
DEPARTMENT
B 1 ding Division
Pub Ic Works
Fire Prevention
Structural
Planning Division
Permit Coordinator ri
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete IA
Incomplete
DUE DATE: 06/21/11
Not Applicable
Comments:
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 DKJ Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 07/19/11
Approved ❑ Approved with Conditions Not Approved (attach comments)
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
� PERMITCOORD COPS
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -080
PROJECT NAME: MAJED MOAWAD
DATE: 06/09/11
SITE ADDRESS: 6720 FORT DENT WY, STE 120
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision # after Permit Issued
DEPARTMENTS:
Buildin Division is
1ic �"V)
Tu6
Fire Prevention
Structural
Planning Division
Permit Coordinator ri
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Incomplete Xi
Complete
DUE DATE: 06/14/11
Not Applicable
U
Comments:
Permit Center Use Only I
•
INCOMPLETE LETTER MAILED: (Q 4' t 1 LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW Staff Initials:
TUES/THURS ROUTING:
Please Route ri Structural Review Required n No further Review Required n
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 07/12/11
Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) ❑
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
r •
City of Tukwila
.Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -431 -3670
Web site: http: / /www.ci.tukwila.wa.us
1
REVISION
SUBMITTAL
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: Plan Check/Permit Number: PC1 I I — 08 V
Lt/ Response to Incomplete Letter # I
❑ Response to Correction Letter #
❑ Revision # after Permit is Issued
❑ Revision requested by a City Building Inspector or Plans Examiner
t g.. MA36D MOfWPt
Project Address: (ni4)
Contact Person:DIM. W1 WU- J MA+ ti Phone Number: 10& -2.00-37 49
Summary of Revision:
Project Name:
CREVsk
ITYOF CtuKIMtA
JUN 17 2011
PERMITCEqTER
400.14.1.0., co., I PL.))
-I�P4r + , l'e, . '' S , )LA.4-%.e_ 161 2011 P_A- “1-•`1 -11nA.t ,s
. 4 • 3 /4” 12P PA ;Ad - CA-4.--;ire isofa.f-.bt-t.
te.P for 514.4.evil f kG S
b
0044, Rpm .5, itvi,1 lae- k kI i 4P
he.c GeQ-w B /M 7 j
Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by:
h`k Entered in Permits Plus on ll1 l`
H:\ApplicationsWonns- Applications On Line\2010 Applications \7 -2010 - Revision Submittal.doc
Created: 8 -13 -2004
Revised: 7 -2010
Contractors or Tradespeople liter 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
Phone
Address
Suite /Apt.
City
State
Zip
County
Business Type
Parent Company
SAGER MECHANICAL INC
4254021930
8425 219Th St Se Ste 102
Woodinville
WA
98072
King
Corporation
UBI No.
Status
License No.
License Type
Effective Date
Expiration Date
Suspend Date
Specialty 1
Specialty 2
602234477
Active
SAGERMI088NK
Construction Contractor
8/12/1992
8/10/2011
Plumbing
Unused
Business Owner Information
Name
Role
Effective Date
Expiration Date
SAGER, ROBERT T
President
08/12/1992
Bond Amount
SAGER, ANDREW VINCENT
Vice President
08/12/1992
01/10/2008
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
TRAVELERS CAS Et
SURETY
104575403
07/19/2005
Until Cancelled
$6,000.0008/02/2005
04 /25/2011
2
OLD REPUBLIC
SURETY CO
YLI238326
08/12/2001
Until Cancelled
08/28/2005
$6,000.0007/09/2001
04/28/2010
Assignment of Savings Information
Savings
Assignment of Savings Account Number
Effective Date
Release Date
Assignment Type
Impaired Date
Amount
Received Date
1
8/11/1992
Until
Released
Bond
$4,000.00
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
11
Continental
Western Ins Co
CNP275882724
05/01/2011
05/01/2012
$1,000,000.00
04 /25/2011
10
Continental
Western Ins Co
cnp275882721
05/01/2009
05/01/2011
$1,000,000.00
04/28/2010
9
CONTINENTAL
WESTERN INS
CNP253520423
05/01/2008
05/01/2009
$1,000,000.00
06/27/2008
8
CONTINENTAL
WESTERN
GROUP
CNP2535204
08/10/2007
08/10/2008
$1,000,000.00
07/31/2007
7
CONTINENTAL
WESTERN INS
CO
CNP2535204
08/10/2005
08/10/2007
$1,000,000.00
08/07/2006
6
CONTINENTAL
WESTERN INS
CO
CNP2535204
08/10/2004
08/10/2005
$1,000,000.00
08/09/2004
5
AMERICAN
STATES INS CO
01CG2085973
08/10/2004
08/10/2005
$1,000,000.00
08/03/2004
Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx
06/28/2011