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HomeMy WebLinkAboutPermit PG11-133 - WESTFIELD SOUTHCENTER MALL - LUSHLUSH FRESH HANDMADE COSMETICS 507 SOUTHCENTER MALL PG1 1 -133 City A 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: 507 SOUTHCENTER MALL TUKW Project Name: LUSH FRESH HANDMADE COSMETICS Permit Number: PG11 -133 Issue Date: 10/21/2011 Permit Expires On: 04/18/2012 Owner: Name: WESTFIELD PROPERTY TAX DEPT Address: PO BOX 130940 , CARLSBAD CA 92013 Contact Person: Name: MIKE SLEVIN Address: 8920 SHAUGNESSY ST , VANCOUVER CANADA VGP -345 Email: SLEVY @LUSH.COM Contractor: Name: CRAIG'S BUILDING SERVICES Address: 11518 E ALKI , SPOKANE WA 99206 Contractor License No: CRAIGBS925NN Phone: 604 263 -6601 Phone: 509 - 927 -7279 Expiration Date: 08/22/2013 DESCRIPTION OF WORK: INSTALLATION OF (1) NEW ELECTRIC WATER HEATER AND (1) DEMONSTRATION SINK. Value of Plumbing /Gas Piping: $5,000.00 Uniform Plumbing Code Edition: 2009 Fees Collected: $137.81 International Fuel Gas Code Edition: 2009 Electrical Service Provided by: Permit Center Authorized Signature: Date: l V 6 f 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: Print Name: Date: /6 ? 2v 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 -133 Printed: 10 -21 -2011 PERMIT CONDITIONS Permit No. PG11 -133 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: 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. 12: 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. 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. doc: UPC -4/10 PG 11 -133 Printed: 10 -21 -2011 1 CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.qov • Building Permit No. Mechanical Permit No. Plumbing/Gas Permit No. Public Works Permit No. Project No. CPII -a�� (For 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*` SITE LOCATION Site Address: W4- King Co Assessor's Tax No.: "Tr( -:t.:ly "1' +'� 3 F t dirA l•\rA Suite Number: N bar: Ci Floor: Tenant Name: ><: C I) New Tenant: .....Yes Property Owners Name: Pi C Mailing Address: 1i .� -`� >; , ❑..No City State 41 Zip CONTACT PERSON — who do we contact when your perrnit is ready to be issued !M `a V-1 pf d' i C'C fv cf Name: Day Telephone: '�" t Mailing Address: li'ANco,'v''1 City E -Mail Address: 'Si =v yl ' iv J , Fax Number:'c' State Zip GENERAL CONTRACTOR INFORMATION — (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: W:4 -Tc? EN-1 r`-?, d ? Mailing Address: City State Zip Contact Person: Day Telephone: E -Mail Address: Fax Number: Contractor Registration Number: Expiration Date: ARCHITECT OF RECORD — Ali plans must be stamped by Architect of Record Company Name: f`t ;i`fl) '(cr =. pI N sFi P C- t rTe• (.7;7 Mailing Address: Contact Person: E -Mail Address: l i C.iA Y v'.''� 3t • (� i off s>- P1 = i , t\ %t' N4 "roN City Day Telephone: Fax Number: 5C 1 c State Zip e ;73 L; t CC7 CI I ENGINEER OF RECORD — All plans must be stamped by Engineer of Record Company Name: AYe-) c Mailing Address: City Contact Person: -) 01-1 t•4s4) ' 1 ) �' Day Telephone: E -Mail Address: .) tnkt-l' e ? i,v c J1C1 i i� Y^ a' s Fax Number: 4-1 4 2 M rn a v -; '`? '2 C' HAApplicationsWortns- Applications On Line\2010 Applications \7 -2010 - Penn,t Application.doe Revised: 7 -2010 bh State Zip a Cl Page 1 of 6 [LUMB1NG AND GAS PIPINCWRMIT INFORMATION — 206 -431 -3670 PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: Mailing Address: c, ( 7 n-14%...- 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): $ e Sr a a 0 Valuation of Gas Piping work (contractor's bid price): $ Scope of Work (please provide detailed information): /Ms7th't -LA 7( o N /"'A 'Z /E /,1 /Ars"7,21 -AT / o /v d F C1) /mot; -lti 0M o /b '7/ Y7? D N Sy/v F PHe Building Use (per Intl Building Code): Occupancy (per Intl 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 \ lp Industrial waste treatment interce for includin tra g p 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 HA Applications\Fonns•Applications On Line \2010 Applications N7-2010 • Permit Application.doc Revised: 7 -2010 bh Page 5 of 6 1 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). 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. BUILDIN -7 WNER R AUTHORIZED AGENT: Signature: iu Date: Vv //1/ Print N e: ja (21 5CD7 '712 ja$T P_ Day Telephone:5Z 3 _ .5 - 3S1 Mailing Address: 1 CO & $ o ✓D. l/g -wrcA t,JA `4-/s- - IDate Application Accepted: City State Zip 01 911 Date Application Expires: H: Applications\Fonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.dae Revised: 7 -2010 bb n 111- Staff Initials` II 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.TukwilaWA.gov RECEIPT Parcel No.: 9202470010 Permit Number: PG11 -133 Address: 507 SOUTHCENTER MALL TUKW Status: APPROVED Suite No: Applied Date: 09/07/2011 Applicant: LUSH FRESH HANDMADE COSMETICS Issue Date: Receipt No.: R11 -02315 Initials: User ID: Payee: WER 1655 Payment Amount: $110.25 Payment Date: 10/21/2011 11:54 AM Balance: $0.00 MICHAEL BECK (VIA PHONE) TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 193797 ACCOUNT ITEM LIST: Description 110.25 Account Code Current Pmts PLUMBING - NONRES 000.322.103.00.00 110.25 Total: $110.25 doc: Receiot -06 Printed: 10 -21 -2011 Cit 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 SET RECEIPT RECEIPT NO: R11 -01950 Initials: JEM Payment Date: 09/07/2011 User ID: 1165 Total Payment: 1,074.21 Payee: LUSH COSMETICS LLC SET ID: S000001574 SET NAME: Tmp set/Initialized Activities SET TRANSACTIONS: Set Member Amount D11 -306 890.11 EL11 -0838 70.83 M11 -125 85.71 PG11 -133 27.56 TOTAL: 890.11 TRANSACTION LIST: Type Method Description Amount Payment Check 19367 1,074.21 TOTAL: 1,074.21 ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PLAN - NONRES 000.345.832.00.0 70.83 PLAN CHECK - NONRES 000.345.830 1,003.38 TOTAL: 1,074.21 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION .6300 Southcennter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670 Permit' Inspection Request Line (206) 431 -2451 Plitt -13..3 Project:; ' '• • L,_J5►S • Type _of Inspecti9n: ,1.1.l /1 'b • Address: • • . , ..7. sc. �.�-y Date Called: Special Instructions: • • ii '! 2 � r-f � • Date Wanted:. A J ©O / a.m. N �J p.m. Requester: Phone 53 —3Y/—U7 OS (. Approved :per applicable codes. a Corrections required prior to approval. COMMENTS: • 1 Inspectorfs� IDate: 1 1 2 / REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit 9611 -t 3 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila: WA 98188 (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: _ LIA.Sin t reSk kl rA„actvvt Aft o Type of Inspection: 0 - i`.t Address: ()? C=Uui k lAeo v elm\ Date Called: 14 e L&) AM. . Special Instructions: O5LIc ,.ca Date Wanted:. .1' s- C?cTjla✓., a:m: Requester: Phone No: A53- 250 -2.1 £3S Ylapproved per applicable codes. J Corrections required prior to approval. COMMENTS: r rArtAAJe, tOGI/1-- -410 p✓cl■J� C/ alk--;,,•1/4) - 4W/IIVW 1------1---c:,e.07\ .trI) 14 e L&) AM. . -I A- k1 e Q w gYp6e..N. ...:•9 Tc_. pi F►.Jat .1' s- C?cTjla✓., (Date: it —f -% SPECTION FEE RE UIRED. Prior to next inspection. fee must be at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. City of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director September 8, 2011 Mike Slevin 8920 Shaugnessy St Vancouver, BC VGP -345 Canada RE: Letter of Incomplete Application # 1 Plumbing /Gas Piping Permit Application PG11 -133 Lush Fresh Handmade Cosmetics — 507 Southcenter Mall Dear Mr. Slevin, This letter is to inform you that your permit application received at the City of Tukwila Permit Center on September 7, 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 following comment. 1) Due to the addition of a sink a King County Non - Residential Sewer Use Certificate executed by owner /representative needs to be submitted. The form is enclosed. 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, <7s7j1) j„. Bill Rambo Permit Technician Enclosures File: PG11 -133 W:\Permit Center \Incomplete Letters\2011\PGI 1 -133 Incomplete Ltr # 1.doc 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665 HERMIT COORD COPY. PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG11 -133 DATE: 09/26/11 PROJECT NAME: LUSH FRESH HANDMADE COSMETICS SITE ADDRESS: 507 SOUTHCENTER MALL Original Plan Submittal X Response to Incomplete Letter # 1 Response to Correction Letter # Revision # after Permit Issued �DEPPARTMMEENTS: -baling 'D'vision N,b/ qcI cWiol Fire Prevention Structural Planning Division Permit Coordinator n DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete n DUE DATE: 09 /29/11 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 Structural Review Required No further Review Required n REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 10/27/11 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 IkERMIT COORD CORP PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG11-133 DATE: 09/07/11 PROJECT NAME: LUSH FRESH HANDMADE COSMETICS SITE ADDRESS: 507 SOUTHCENTER MALL X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # after Permit Issued DEPARTMENTS: Building pivislo MS 1644MA Cl" Public Works Fire Prevention Structural Planning Division ❑ Permit Coordinator ❑ DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete DUE DATE: 09/08/11 Not Applicable Comments: Permit Center Use Only 4-8-1t INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW Staff Initials: VW`- TUES/THURS ROUTING: Please Route ri Structural Review Required ri No further Review Required n REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved Notation: REVIEWER'S INITIALS: Approved with Conditions DUE DATE: 10/06/11 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 • • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite 11100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: hitp:f /www,ci.fukwila.wa.us Revision submittals Hurst be submitted in person at the Permit Center. Revisions will not be accepted through the nail, fax, etc. Date: 471 ('zo / 12-o I 1 Plan Check/Permit Number: PG 11 -13 3 ® Response to Incomplete Letter # 1 ❑ Response to Correction Letter # ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: Lush Fresh Handmade Cosmetics Project Address: 507 Southcenter Mali !�►N Ce 12�+IV E2'1 -2 14- °18 o 2 Contact Person: Phone Number: Summary of Revision: DV E - •dITi o N of A SIN K — A 1--me c'ov (v'-01 NN- perm OEN,' A'1. Ve w hie Vrf. a .-rtt�1 CA-ra & uTEta 13' awN Ev42. ( i4Ei°PfrSE NtOr To 1 SU $ A t-r re m-tE ca Net-v.-rev Fo 0.1,7 1 S -77,4 of/ ev, . Sheet Number(s): 1\1°N " 12e 5`t °W TI S'L::\M Cr T& °�� -rt Ft cpr-re. "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: in Permits Plus on lapplications\fonns- applications on linelrcvision submittal Created: 8 -13 -2004 Revised: it King County Department of Natural Resources and Parks Wastewater Treatment Division • Non- Residential Sewer Use Certification To be completed for all new sewer connections, reconnections or change of use of existing connections. • This form does not apply to repairs or replacements of existing sewer connections within five years of disconnect. Please Print or Type So Sov -ref c NT;E)+2. G9 0 Property Street Address —TV k w t t.rt WA- le t 89 City State ZIP Yt/•SrFf E(,10 1 (,C Owner's Noma Subdivision Name Subdiv. #t Building Name Soy -M-1 ce6rreK inert) l^. (it vocable) Lot It Block 4 ( ) Owner's Phone Number (with Area Code) t ) Property Contact Phone Number (with Area Code) Owner's Mailing Address H 60) wit.S'ti ti E t3t,vly, f,e S NNGet.e -P c) di a o 2 S tit PL. `133 For King County Use Only Account # No. of RCEs Monthly Rate Property Tax ID 4 Party to be Billed (it different from owner) City or Sewer District Date of Connection Side Sewer Permit 4 Please report any demolitions of pre- existing building on this property. Credit for a demolition may be given under some circumstances. Demolition of pre - existing building? OYes ONo Was building on Sanitary Sewer? O Yes 0 No Was Sewer connected before 2/1/90? OYes 0 No Sewer disconnect date: Type of building demolished? Request to apply demolition credit to multiple buildings? 0 Yes 0 No A. Fixture Units Fixture Units x Number of Fixtures = Total Fixture Units Kind of Fixture Wore Units no. or Fixtures Total Fixtuteunirs Public Private Public Private Bathtub and Shower 4 4 Shower, per head 2 2 Dishwasher 2 2 Drinking fountain (each head) 1 .5 Bose bilb (interior) 2.5 2.5 Clotheswasher or laundry tub 4 2 Sink, bar or lavatory 2 1 Sink, Clinic flushing 8 8 Sink, kitchen 3 2 Sink, other (service) 3 1.5 3 ISink, wash iounlain, circle spray 4 3 Urinal, flush valve, 1 GPF 5 2 Urinal, flush valve, >1 GPF 6 2 Urinal. waterless 0 0 Water closet, tank or valve, 1.6 GPF 6 3 Water closet, tank or valve, >1.6 GPF 8 4 Total Fixture Units Residential Customer Equivalent (RCE) 20 fixture units equal 1.0 RCE Total No. of Fixture Units 20 0,IC;, ]RCE 3 B. Other Wastewater Flow (in addition to Fixture Units identified in Section A) Type of Facility /Process: N e Estimated Wastewater Discharge: Gallons /days Residential Customer Equivalents (RC 187 gallons per day equals 1.0 RCE ERMITCENTER Total Discharge (gal /day) = f I RCE 187 C. Total Residential Customer Equivalents: (add A & B) RECEIVED envoFTHKNA SFP 2 6 2011 A BL 1 J RCE INCOMPLETE LTR# Pursuant to King County Code 28.84. all sewer customers who establish a new service which uses metropolitan sewage facilities shall he subject to a capacity charge. The amount of the charge is established annually by the King County Council at a rate per month per residential customer or residential customer equivalent for a period of fifteen years. The purpose of the charge is to recover costs of providing sewage treatment capacity for new sewer customers. All future billings can be prepaid at a discounted amount. All future billings can be prepaid at a discounted amount. Questions regarding the capacity charge or this form should be referred to King County's Wastewater Treatment Division at 206-684-1740. I certify that the information given is correct. l understand that the capacity charge levied will be based on this information and any deviation will require resubmission of correcte data for determination of a revised capacity charge. Signature of Owner /Representative Print Name of Owner /Representati 1058 (Rev. SW) F - $ c T1 pR rr. r Date /2 /1 White - Nino County Ve1!rm — Local Sewer Acenn• F :r.f. - Srwa Customer • Contractors or Tradespeople Printer Friendly Page • 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 CRAIG'S BUILDING SERVICES UBI No. 601899897 Phone 5099277279 Status Active Address 11518 E Alki License No. CRAIGBS925NN Suite /Apt. License Type Construction Contractor City Spokane Effective Date 8/15/2008 State WA Expiration Date 8/22/2013 Zip 99206 Suspend Date County Spokane Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company DEARHEART CONSTRUCTION INC es License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status DEARHCI022RN DEARHEART CONSTRUCTION INC Construction Contractor General Unused 12/15/1998 12/15/2003 Archived SWANSC'120JE SWANSON CONSTRUCTION Construction Contractor General Unused 4/5/1988 4/5/1999 Archived DEARHDH011NJ DEARHEART DESIGN HOMES Construction Contractor General Unused 8/11/1999 8/22/2009 Inactive Business Owner Information Name Role Effective Date Expiration Date SWANSON, ELAINE MAY President 08/15/2008 Bond Amount SWANSON, DONALD CRAIG Secretary 08/15/2008 CLB2713036 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 7 PLATTE RIVER INS CO CLB2713036 07/30/2010 Until Cancelled $12,000.0004/11 /2010 6 CAPITOL INDEMNITY CORP CLB1901292 07/30/2008 07/30/2010 $12,000.0007/22 /2008 5 AMERICAN CONTRACTORS INDEM CO 100029304 07/30/2007 Until Cancelled 08/15/2008 $12,000.0008/20 /2007 4 PLATTE RIVER INS CO 41074925 07/30/2006 Until Cancelled 08/20/2007 $12,000.00 07/26 /2006 3 CBIC FB8723 10/14/2004 Until Cancelled 07/30/2006 $12,000.00 10/25 /2004 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 6 Safeco Ins Co of America 01C148296510 05/13/2011 05/13/2012 $1,000,000.00 06/14/2011 5 AMERICAN STATES INS 01CH5752494 07/03/2008 07/03/2011 51,000,000.00 06 /25/2010 4 AMERICAN STATES INS CO 01CH575249 12/15/2007 12/15/2008 $1,000,000.00 12/03/2007 3 AMERICAN STATES INS CO 01CC649097 12/15/2003 12/15/2007 $1,000,000.00 11/30/2006 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 10/21/2011