HomeMy WebLinkAboutPermit MI97-0015 - TUKWILA STATION LLC - BUILDING DEMOLITIONUKWL
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City of Tukwila c.
(206) 431 -3670
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
MISCELLANEOUS PERMIT
WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES,
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands:
000580 -0038
16200 WEST VALLEY HY
Permit No:
Status:
Issued:
Expires:
DEMO
MISCPERM
DEMO Occupancy:
UBC:
001 Fire Protection:
North: .0 South: .0 East: .0 West:
TUKWILA Sewer: TUKWILA
Slopes: Y Streams:
Contractor License No: GILLEC*063ME
MI97 -0015
ISSUED
03/20/1997
09/16/1997
RESTAURANT
1994
N/A
.0
OCCUPANT TUKWILA STATION L.L.C.
16200 WEST VALLEY HY, TUKWILA, WA 98188
OWNER YURKANIA ANDREW & CAROL F
2963 4TH AVE S, SEATTLE WA 98133
CONTRACTOR GILLEN CONSTRUCTION Phone: 206 776 -8443
5525 212 STREET S.W., LYNNWOOD, WA 98036
CONTACT KEVIN GILLEN Phone: 206 776 -8443
5525 212TH S.W., LYNNWOOD, WA 98036
***************************************************** * * * * * * * * * * * * * * * * * *,r * * * * * * * * * **
Permit Description:
DEMOLITION OF EXISTING 5,415 S.F. STRUCTURE AND
CAPPING OF UTILITIES.
***************************************************** * * * * * * * * * * * * * * * *,r * * * * * * * * * * * **
Construction Valuation: $ 15,000.00
PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: JJS
Curb Cut /Access /Sidewalk /CSS: N
Fire Loop Hydrant: N No: Size(in): .00
Flood Control Zone: N
Hauling: N Start Time:
Land Altering: N Cut:
Landscape Irrigation: N
Moving. Oversized Load: N Start Time: End Time:
Sanitary Side Sewer: N No:
Sewer Main Extension: N Private: Public:
Storm Drainage: N
Street Use: N
Water Main Extension: N Private: Public:
**************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 96.50
**************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
End Time:
Fill:
Permit Center Authorized Signature:Albl.QQJLQ
LL.l..l.a d1:Q_ Date: 3 C - T J
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 provision of any other state or local laws regulating construction
or the performance of work. I am authorized to sign for and obtain this
development,, rmit.
Signature: 12.71"1—,,,
Date:
Print Name: JLL44,_aaatir
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.
CITY OF "IKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Miscellaneous Permit Application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
P o' ;, t Ka 1 /Tens &;'�'
. ...
V C.
Will there be storage of flammable/combusti hazardous material in the building? ❑ yes IP no
Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er Indicatln • • uantities & Material Safet Data Sheets
Valu ,p5f Construction:
Site Address:
%I1
�/
i ,� City Stet= i•:
,
1 411 .. AL f..i•• • / •/A •
T,t�apxyP�arce Number
DG ii• ^rD F
P ..: •�
r f
Phone
S(vriJddre's:
1 ►
11/ i Cit st z Zip:
Fax #:64t!, 6023 .... 7✓65-
Co ir t Person: //
i
Phone: 7 /�yn „//
St _ • ddress: . 1
,,
/
, , ' Vitr State /Zip
Fax #: .201 _g4/4/
Ckltra or:
/
Phone: ( Q'/
S reeet�ddress:
I. 1.
l
1,
,• J /I /I . .
Ci State /Zip;
I
PIN �- 4...d...; ;0 6
Fax #:
,V 06 774-g
hitect:
_•�: 0 ' :..
;
• ..al . _ :.r::
Phone
' C)(,
� bC `/5/ — 123-_
S r: Address: /
/ - .45
e 4 ' ..
Cit State /Zi •:
, ! ,i_:_. ,A.. - ) • ;
Fax #:
. 06 1/5'/ - /; 9
Engineer:
Phone:
Street Address:
I ct
City State /Zip:
MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT) .
Descriptio of work e done:
Will there be storage of flammable/combusti hazardous material in the building? ❑ yes IP no
Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er Indicatln • • uantities & Material Safet Data Sheets
■ Above Ground Tanks ■ Antennas /Satellite Dishes ■ Bulkhead /Docks ■ Commercial Roroof
• Demolition ❑ Fence ❑ Mechanical ❑ Manufactured Housing - Replacement only
❑ Parking Lots ❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems
❑ Temporary Facilities ❑ Tree Cutting
APPLICANT REQUEST FOR MISCELLANEOUS PUBLIC WORKS PERMITS
Channelization /Striping ■ Curb cut/Access /Sidewalk ■ Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Flood Control Zone ❑ Land Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft.grading/clearing
❑ Landscape Irrigation ❑ Sanitary Side Sower #: ❑ Sewer Main Extension 0 Private 0 Public
❑ Storm Drainage ❑ Street Use ❑ Water Main Extension 0 Private 0 Public
❑ Water Meter /Exempt # Size(s): 0 Deduct 0 Water Only
❑ Water Meter /Permanent # Size(s).
❑ Water Meter Temp # Size(s): Est. quantity gal Schedule:
❑ Miscellaneous ❑ Moving Oversized Load/Hauling
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /State /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name:
IPhone:
Address:
City /State /Zip:
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 extend the time for action by the applicant for a period not exceeding 180 days
upon written request by the applicant as defined in Section 107.4 of the Uniform Building Code (current edition). No application
shall be extended more than once.
Date application accepted:
Date application expires:
Application to 15: (initials)
ALL MISCELLANEOUS PE
APPLICATIONS MUST BE SUBM
D WITH THE FOLLOWING:
> ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
• BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
• ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
• STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON
LICENSED STRUCTURAL ENGINEER
➢ CIVIUSITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER
(P.E.)
Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the
permit is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than the owner, registered architect/englneer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
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 0 i NER OR AUTHORIZED AGENT:
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR PERMIT REVIEW
ri
Above •Ground Tanks/Water Tanks - Supported :directly un po grade''
exceeding 5,000 gallons and a ratio of height.to diameter. or width
which exceeds 2:1 .
'Submit checklist No:' M=9
O
Antennas /SatelliteDishes •
Submit checklist No: M -1
0
Awnings /Canopies - No signage
Commercial Tenant Improvement
Permit
ri
Bulkhead/Dock
'Submit .checklist . No: M -10:
in
Commercial Reroof,•
Submit checklist;- No M -6
��
'
Demolition.
Submit checklist ' .No:' M -3' M;3a
0
Fences•- Over 6•feet in Height
Submit checklist No: M-9
in
Land Altering/Grading/Preloads
Submit checklist No: M -2
O
Loading Docks
Commercial Tenant Improvement
Permit.. •Submit checklist No: H -17
0
• Mechanical-(Residential & Commercial)
Submit checklist ' • No M -8,
Residential only - H -6, H -16
El
Miscellaneous: Public'Works Permits •
Submit checklist ' No: H -9
El
Manufactured Housing (RED. INSIGNIA ONLY)' •
Submit checklist No: M -5
El
Moving Oversized.Load /Hauling
Submit checklist.' No: M -5
O
Parking Lots
Submit checklist No: M -4
Residential Reroof -, Exempt with following exception: If roof structure
to be repaired or replaced
Residential Building Permit
Submit checklist . No: M -6
Submit checklist No: • M -1
0
Retaining Walis• Over 4•feet in height
Q
Temporary Facilities _
• Submit checklist No: M -7
0
•TemporaryPedestrian Protection /Exit Systems ...... .
Submit. checklist No: M -4 '
0
Tree Cutting•
Submit checklist No M-2
Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the
permit is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than the owner, registered architect/englneer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
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 0 i NER OR AUTHORIZED AGENT:
Signature:
.Sle/4nL
• '
i .
Date: a, -J,
Print name: evj
L i1
• ‘...8,1/4
I.
Fax # :.2 ‘„,..,g114.3
Address:
55a
��
'
' '
I V.
City /State /Zip: �1 �� t bju
X d ' .. ga
MI'rnnnrnnr 7n1ie4
4.4h, * * ** * * * * *k **kki4r ir.k* kk *** kk #k * **k�kkkt *4* ** *** ** k a * *A* * ** A# **,kkk
CITY OF TUK41L;p. *k4 TRANSMIT
** * ** **k*kkk>4k *A *** k* AR7TrkM* *** ***k ***%* * ****A *k* k
'TRANSMIT R9700555 Amount: 42.00 03/20/97 13:04 •
. Payment •Methods CHECK Notation: GXLLEN• CONSTRUCT .nits SLU
Permit" No: MI97 -001 r Types MISCPERM MISCELLANEOUS PERMIT
Parcel . Na 4 00058p- 0038.
Site Address; 16200 NEST. VALLEY HY
Total Fees: 08.50'
This Payment 42.00 Total ALL Pints: 08..50;
Balances
00 .
* * **** ** *o4'•A *•A *1 * *. * *****•l *.* * * ** *A **•k ** ** ***•k *h * * * * *4 * * * *k ** ***** **
Account Code Der i pt i on Amount ,
000 /322.Y1`00 RUILD3NG.' - N,CNRES 42,00.
*AA * * *A *l ill + **A•k * * * * * *A * *A * *AA•k * * * *A *AA •A * * ** * *' * * * ** * * ** * * * ** *kA **
CITY OF. TUKWILAt .WA ti TRANSMIT
A *A * * * +t *A *Ak* *A4r* *.hi ** i c --1 -- * Alf* A* 4.4* * **•k * **A* **** *A•A* ** * * **
TRANSMIT Number: 89700548 Amount: 46.50 00/06/97 12 :50
Payment Method: CHECK Notation: CI:LLEN CONSTRUC 'nit: SLR
Permit No: MI97- •001.5 Type: MISCPERM MISCELLANEOUS PERMIT:
Parcel, No 000580.0038
Site Address: .16200 WEST VALLEY' HY
Total Fees: 46..50
This Payment 46.50 Total ALL Pmts: 46.50
Balance: .00
**•**•* * * * * *•k * * * * *A* * * * * * *A * ** * * * * *4* •A* *A * * * * * * * * *A * *•Aa **i* + *,t * **
Account Code Description Amount
000/322.100 BUILDING -• MONRES 42.00
000/386.904 STATE BUILDING SURCHARGE 4.50
CITY OF TUKWILA
=ERA'
1='
FW DCD 42.00
PW DO 4.50
CHECK 46.50
03/06/97 i'
16 :51 0097 029+
1 INSPECTION RECORD
J Retain a copy with permit
INSPECTION O,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd,, #100, Tukwila,..WA'T38 BB
ERMIT N
(206) 431 -3670
,Pro ect:
• ■ 11
dress:
• !
4 4
1111111.:
•I' se of Inspection:
.it OIL •
o _ '/
Special instructions:
Date warLteqr.?
.A quester: r- CU.,u0.W
P_ o, _ \2
54 Approved per applicable codes.
Corrections required prior to approval.
COMMEN.Tar-
6 Ta
Inspector: ' _ " 3/e.7
F-1 $42.00. REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd,, Suite 100, Call to schedule reinspection,
Date:
•
.MMrY+..wn W+,YpS
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Sout!hcenter Blvd., #100, Tukwila, WA 98188
INSPECTION RECORD
I Retain a copy with permit
PERMIT NO.
(206) 431 -3670
°i ct;5 -1"ruk i 1a 5.keoriori
l Afa -
Date called:
.:'_
Date wanted: 9
em a
"s _9.7
7. , 9 a,m)
A dr s �
At W* Va I1e.( K(
Special instructions:
/ p.m.
j I
/,,
Meg N: ( l len ( )610'e,
Phone No.:
n Approved per applicable codes. corrections required prior to approval.
COMMENTS:
'— a r 1`E• r}A$ Nti ► t4 A-0 ALL L u ► LD I /4
— 6 (1-13 t2..^zYKS\S'0 A1, i + r-- U tJSa v!`cr `
p i GtfiS 0c LvA l% t;,?fl— e t_,A vskleo -111n, 6-s —i - ` C4 Nam Cr;
t 1
e\9%.S TN C.- D r l Ao , ,P.¢' A-149 Yo-ti . C,6rw.,P(L--41S -� 4..S ,.
r
— 11.-A LM J 9 S CA-P i ►J C, Dee/Li S 'SALA1 ?9
1 401-Zu .y •C P 4E-, .-TpA .
t rooPra 0 WAS 4 IN! % 11-e" ;' r r 1 s NMI—
►J wWA tT i-w; -- s-Wm3 IS 0+-1 TH•E' ?FA, vr-
_y,,1.4
QT ts- -s--- S1ba - pi'.FS.
Inspector:
(n LJ
L..31
Date:9
( '97 _
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection.
Agency Case No, • ,°i:GET SOUND AIR POLU LION CONTROL 1ENCY
1 to Union Street, Suite 500. Seattle, WA 91510..,, .38
i C u 3% I J NOTICE OF INTENT
Age ley lire Only 'ID PERFORM:
C, l�- LT-
1.2.11-0 si•
ec I re: j .121, Ashes tns Removal 2. betas Remittal do Demolition
Date Received
NOV .1.. 1`,-)Vi:
Atwery Ma Only
3. i Demolition.. No Asbestos Removal
B. Property
Owner.
perty Owner' MMaailing Address: (U UV 2&4-5+ 1 o..k-- e-, ;..,,_,
•
e-
Phone:
aDG cr 23 — g-5/
dr.: W 04r
C. Asbestos PtA..fdrWI'CiiAeL7.MIS
%r 1 ANANiL Li. • Contractor
�Co 1.e. i ! CA-21'e--1 r,,,/ Owner/CEO: l'l e , C(Ac•.1e.
Contracto ,, •!v e)
r:
2
Manta Address: %0 ir13 e55 )� 5 3 a g
Phone: C7�vll I*e o10 -5.33 7
Contractor
Job No.:
L el. Z
City: L Q WOcC/
State: I ji 14-
I Zip: "7 8� g6
Fait: (2b(1 6 go —5-,C 9
D. Site
Address: I &
Project Manager or
Contact Person:
lA
E. bestas Surrey or
Matt Presumed:
AkiERA Building
Instrector Name: K., L 4 L
We S-f- ()talky 1-iwy city: Mi / a_ stale: w �-
No. of
Structures:
,w eer
C c<st 1SQci
I Date Survey was
I Conducted O -
6
Was Asbestos Found? des
0 If No, Attach Surrey
Expiration
Date. [ -2
Certification No.: 534_ ?cl 1.9V
F. Demolition
Information:
No. of
Structures:
Start
Date:
• Training Fire (LW Fire Dein. as demolition contractor below)
0 Ordered Demolition (attach copv of Order)
Demolldoa
Contractor.
1
:tad*
'14:. -PT LJ • •
s,
plats al.
1.71741
Phone: r
G. Asbestos Project
Inform /ton:
No. of 5truccures:
sae back if > 1
Start
Date: --2.5.-14,
Completio
Date: ( 25- ff 6
Wk Days g, T W Th F Se 5u
Hours:
Will all asbestos tnarr*ial be _ Yes
Total •tautity on be Removed: Linear FL i,$go Sauare Ft. 1 removed by rroiect completion'' 0 No
Thermal System Insulation:
I. RoilctiFurnace Ins. Duct Ina Pipe Ins. 1 Wen
goofing Paints Plaster Trstured Coatings I Wier yzioniimirr,
,
Surf tin.; Nat'l; '-
est s -r•'r L .
Misc. Mat'l: 1 Cratcnt Md. .1 Cement Pipe Flooring Matt Roofing Nisei I Omer:
H. Asbestos/Dem olition Project Categories:
1. 0 Owner -Occupied Residential Asbestos Removal Project
0 Owner-Copied Residential Asbestos Removal t Demolition Project
0 Owner - Occupied Residential Demolition Ptv'eet, No Asbestos Removal
Notification wattoP
PrOiCcliee
Period
Prior Notice
ON -R1 1NDA au,
525
2. All Other Demolitions With No Asbestos Removal Project
10 Days 5150
3. Cl 10 - 259 linear fat or 48 - 159 • • feet see back of form for o • • ors
3 Days I S150
4...7t '60 - 999 linear feet or 160 - 4.992_Nuare feet
10 Days _
10 Days
, 5300 -
5750
5. 1.000 - 9.999 linear feet or 5,000 - 49,999 square feet
0 10.000 - 49.999 li near feet or 50.000 - 99.999 • rase feet
10 Days 52.000
-__6.
7. r 50.000 - 99.999 linear feet or 100 000 - 149.999 • are feet
10 Days
55.000
8. 100.000+ linear feet or 150.000♦ saua a feet
10 Days
Prior Notice
510,000
Twice Project Fee
9. - Emeruencv Asbestos Project or mi Emergency Dearolition PPrOect
1070 Alt to Means of Co. • lion= for friable materials or U Demolitions
10-Dav Review Period
Twice Pro'ect Fez
- 11. 1111 Alternate Means of Compliance for nonfriable asbestos materials
Concurrent with Project 1 Twice Prejeet Fc=
L
I do trebs crtaty tme tAa iniamrasion cm:wooed in Nis ooC.P.cadaL and sopplzonsna t dira deaatted berein. u w to twat of c y kmm.tes:e
accurate and c Wp1c ,,4 shall rat cam or dlt1w any asteatoe ptvjeet sir danotiioo tsvlcket ro teem anal chs styratsisrs *acing woad Ss
m,peaa.
Signalling
c6 k.
Reg:wennrr
eta: or. [
PSAPG Form tit). 66.1E0 ()tarred 10196) AM
Ccmpkunar 'Per Ren,w
ftrrnfid8►: •
C.1- -1 I '
!
z 7i.
• ASen _Vii Oru'v
RECEIVED
CITY OF TUKWILA
FEB 0i1997
v.t ;!:itNs3 1144.1"..01g,C Walffiti- V Igi g.faaz�fWY nrr ISVLaSrYh'tiOlii1r
;Amwest
AUG 17, 1997
tt
RECEIVED
AUG 2 5 1997
COMMUNITY
DEVELOPMENT
CITY OF TUKWILLA
DEPT. OF COMMUNITY DEV.
6300 SOUTHCENTER BLVD.
SEATTLE, WA 98188
Bond No.:
Subdivider:
Amount:
Description:
Location
Effective Date:
Amwest Surety Insurance Company
9709 THIRD AVE., N.E.
SUITE 200
SEATTLE, WA 98115
TEL (206) 522 -3111 FAX (206) 522 -5554
1328524
TUKWILLA STATION L.L.C.
$16,500.00
DEMOLITION OF ANDY'S DINER BLDG. }"' 001.5
TUKWILLA, WA
1 -30 -97
AMWEST SURETY INSURANCE COMPANY is the Surety on the above bond. We would appreciate your
cooperation in providing the information requested below. Please return the form to us so that we may have
current status information on the above captioned improvements. Thank you for your assistance.
1. Have the improvements been completed? Yes XX No
2. If not, what percent has been completed?
3, Is the work progressing satisfactorily? Yes El No
4. Has this work been accepted? El Yes No
5. If so, what is the date of acceptance?
6. If not, what is the anticipated date of acceptance?
COMMENTS: The demolition work has not been completed as of this date. Please
see inspection report dated September 8, 1997.
Signed by:
Date:
September 9, 1997
Name:
Shellie Bates
Phone: ( 206 ) 431 -3671
;y,
�T.,!�'.��:::i;;y.:Ar:�: iii: J: �%. 1",:>:' JI��Y. it `;'a�';'id��tiiki;�Siv�,`Ci.` }'� 5unti%; +`S'S + °�il3ci ^'t,.;.•� ".;�tl�; '::
aG
INSPECTION RECORD
2-- ' I Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., U100, Tukwila, WA 98188
t' �-G: ?E
PERMIT NO.
G'
(206) 431 -3670
} jT10�1 t w t
Wit i5 ..�-0 ,,1 \a s 1
of inspect'' ,,rn
l no 1' .�C�11 '
Addr :ss•
\_• -M.► k . al ,
Special instructions:
Date called:
(3,5_9, 7
Date wanted: 9 _ c/ ,
l j�
9-7 a.m.
em.
uester:
a�).a u., "r1l€' 14A4.44a C� M- .
16icie
Phone No.:
rL1...wovs) wr4AT' T1° Z,IstkPRA 3 tS 'p+..1
Approved per applicable codes. 79-Corrections required prior to approval.
COMMENTS: r4- s 1 lt. 14A, S r• i 1�A
f M L e. u I iz 14
p 1 qc.1F3 Og L A h. ya.... e L,\ \•sti*0
W% 6`M. % C-41•) 19IA Cr;
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(A■AS TA c D r1 91(k" il'∎•
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T1'Nc' P611-ve c--
.r p j l?c—n— S i 1, tiI - pi-FS .
n
Inspector:
i
Dater
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
City of Tukwila
John W. Rants, Mayor
Department of Community Development Steve Lancaster, Director
September 25, 1997
Mark Nermo
AMWEST SURETY INSURANCE COMPANY
9709 Third Avenue N.E.
Seattle, WA 98115
RE: Bond No. 1328524
Dear Mr. Nermo:
The City of Tukwila authorizes the release of the above mentioned bond to TUKWILA
STATION L.L.C. in the amount of $16,500. The demolition of ANDY'S DINER
PROPERTY at 16200 West Valley Highway, Tukwila, WA had a final inspection on
September 23, 1997.
If you have any questions, please feel free to call me at (206) 431 -3671.
Sincerely,
Shellie Bates
Permit Technician
Enclosures
cc: Tukwila Station L.L.C.
City Clerk
File MI97 -0015
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DEMOLITION BOND
fd
Bond No, 1328524
KNOW ALL MEN BY THESE PRESENTS, that TUKWILA STATION L.L.C.
(hereinafter called "Principal "), and
AIVIWEST SURETY INSURANCE COMPANY, a surety licensed to conduct business
in the state of Washington (hereinafter called "Surety ") are held and firmly
bound unto CITY OF TUKWILA
(hereinafter called "Obligee ") in the penal sum of Sixteen Thousand Five Hundred
and no /100 -($ * *16,500.00 ** ),
dollars, lawful money of the United States of America, for the payment of which, well and
truly to be made, we bind ourselves, our heirs, personal representatives, legal
representatives, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the above - bonded Principal wishes to undertake demolition work
upon land located on property owned by TUKWILA STATION L . L . c .
16200 WEST VALLEY HIGHWAY, TUKWILA, WA
and located at x95 3}{XxtxxxxxsAxxx&x3MX.R8=11 (Andy's Diner Property)
and as a condition thereof, is required to obtain a permit and post security for good and
faithful performance thereof.
NOW, THEREFORE, the condition of this obligation is such that if the above -
bonded principal shall carry out the terms and conditions of said permit in every respect
within the time established therein including obtaining Certificate of Completion, then this
obligation shall be void; otherwise, this bond shall remain in full force and effect.
Signed, sealed and dated this 7th day of MARCH , 19 97 .
Principal
TUKWILA STATION L.L.C. Awest Surety Insurance e Company
By: G� G�:G� By: f Olt. 1443-
Mark Nermo, Attorney -in -fact
Surety
RECEIVED
CITY OF TUKWILA
MAR 1 7 1997
LIMITE'D . OWE .F ail T O RNEY
Amwest Surety Insurance Company
EXPIRATION DATE 12-19-98
POWER NUMBER 0000676452
READ CAREFULLY
This document is printed on white paper containing the artificial watermarked logo (4 ) of Amwest Surety Insurance Company (the "Company ") on the front
end brown security paper on the back. Only unaltered originals of the POA are valid. This POA may not be used in conjunction with any other POA. No
representations or warranties regarding this POA may be made by any person. This POA is governed by the laws of the State of California and is only valid until
the expiration date. The Company shall not be liable on any limited POA which is fraudulently produced, forged or otherwise distributed without the permission
of the Company. Any party concerned about the validity of this POA or an accompanying Company bond should call your local Amwcst branch office at
(206) 522 -3111
KNOW ALL BY THESE PRESENT, that Amwest Surety Insurance Company, a Nebraska corporation (the "Company "), does hereby make,
constitute and appoint:
DIANNE HANSEN
MARK NERMO
SUZANNE HOLDEN
AS EMPLOYEES OF AMWEST SURETY INSURANCE CO
its true and lawful Attomcy- in•fact, with limited power and authority for and on behalf of the Company a sur
thereto if a seal Is required on bonds, undertakings, recognizances, reinsurance agreement for a Miller Ac
the nature thereof as follow:
Small Business Administration Guaranteed Bonds up to S• "1,250,000.00
Bid Bonds up to S•65,000,000.00
Contract (Performance & Payment), Court, Subdivision S• •5,000,000.00
License & Permit Bonds up to S••5,000,000.00
Miscellaneous Bonds up to $••5,000,000.00
and to bind thc company thereby. This appointment is made undcr and by au
I, thc undersigned secretary of Amwest Surety Insurance Company, a Ne
force and effect and has not been revoked and furthermore, that the re
provisions of the By-Laws of the Company, arc now in full force an
Bond No 1328524 Signed & scaled thi 7
affix the seal of the company
or other written obligations in
tf[eh arc now in full force and effect.
-RT1FY that this Power of Attorney remains in full
h on this Power of Attorney, and that the relevant
This POA is signed and scaled by facsimile under nd by 3author
Company at a meeting duly held on December 1975:
RESOLVED, that the President or any a dcnt, In
authority as defined or limited in the inst vi cncin
of the Company to bonds, undertaking , nces,
revoke any POA previously grnnte person.
RESOLVED FURTHER, that an ond, unde suretyship obligation shall be valid and bind upon the Company:
(1) when signed by the President o any Vi rest ((and �• • and scaled (if a seal be required) by any Secretary or Assistant Secretary; or
(ii) when signed by the President or any ry or Assistant Secretary, and countersigned and sealed (if a seal be required) by a duly
authorized attorney -in -fact or age
(iii) when duly executed and sealed (it'a 11: require . one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced
by the power of attorney issue ompany to suc person or persons.
RESOLVED FURTHER, that the si at re of any authorized officer and the seal of the Company may be affixed by facsimile to any POA or certification
thereof authorizing the execution and deli cry of any bond, undertaking, recognizance, or other suretyship obligations of the Company; and such signature and seal
when so used shall have the same force and effect as though manually affixed.
Karen G. Cohen, Secretary
DIRECTORS • • * • * • * • • • •
utions adopted by the Board of Directors of Amwcst Surety Insurance
wit Secretary or any Assistant Secretary, may appoint attorneys-in-fact or agents with
tmcnt ' ac case, for and on behalf of the Company, to execute and deliver and affix the seal
p obligat q s of all kinds; and said officers may remove any such attorney -in -fact or agent and
IN WITNESS WHEREOF, Amwest Surety Insurance Company has caused these presents to be signed by its proper officers, and its corporate seal to be hereunto
affixed this 14th day of December, 1995.
g •���1
John E. Savage, President
Karen G. Cohen, Secretary
State of California
County of Los Angeles
On December 14, 1995 before me, Peggy B. Lotion Notary Public, personally appeared John E. Savage and Karen G. Cohen, personally known to me (or
proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is /are subscribed to the within Instrument and acknowledged to me all that
he/she/they executed the same in his/her /their authorized capacity(ies), and that by his/her /their signature(s) • n t in ru en he .er. • n( , o he nt' u • on • h
of which the nerson(s) acted, executed the instrument.
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.1`P1 \NSU '''�.,�� WITNESS rp hand and official seal.
tv��'pPpgq'9, I \J
1‘20 Is Signature 1995 )0 ( DEC.14, n
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6
_ 11VA, Lotion, Notary 19ttr 1SE
/Z1 A — - rovinwrer
(Seal)
Commilion #1011038
Nobly P — Collbtrtb
Los MgMs Cou*
My Comm. Expires Aug 4. 19*
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PLAN REVIEW / ROUTING SL
ACTIVITY NUMBER MI97 -0015 DATE 2/07/97
PROJECT NAME TUKWILA STATION L.L.C.
DEPARTMENT:
BUILDING DIVISION ❑ FIRE PREVENTION i ! PLANNING DIVISION Cli4
11 A � ppr o un l3 -'11 UR rn - - pr ?- c.f -c11
1'� PUBLIC ORKS . i X I STRUCTURAL PERMIT COORDINATOR iiii
Nfl
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 2/11/97
COMPLETE ❑
COMMENTS
NOT COMPLETE ❑ NOT APPLICABLE ❑
1
TUES /THURS ROUTING: PLEASE ROUTE ❑ NO FURTHER REVIEW REQUIRED El
I
ROUTED BY STAFF I (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (ten days)
DUE DATE 2/25/97
APPROVED n APPROVED W/ CONDITIONS . NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
DUE DATE
APPROVED ❑ APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) 0
REVIEWERS INITIAL DATE
(Certittcadon of occupancy required.
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PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M197-0015
PROJECT NAME TUKWILA STATION L.L.C.
DATE 2/07/97
DEPARTMENT:
BUILDING DIVISION II
PUBLIC WORKS
E
FIRE PREVENTION PLANNING DIVISION a
STRUCTURAL El PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS
NOT COMPLETE El
DUE DATE 2 11 97
NOT APPLICABLE
TUES /7IIURS ROUTING: PLEASE ROUTE NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF n (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL DATE "7-'/// 417
c
APPROVALS OR CORRECTIONS: (ten days) DUE DATE 2/25/97
APPROVED ri APPROVED W/ CONDITIONS
NOT APPROVED (attach comments) Q
REVIEWERS INITIAL DATE 7j
1
CORRECTION DETERMINATION:
APPROVED n APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) 0
(Certification of occupancy required. )
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PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M197 -0015 DATE 2/07/97
PROJECT NAME TUKWILA STATION L.L.C.
DEPARTMENT:
BUILDING DIVISION El FIRE PREVENTION PLANNING DIVISION p
PUBLIC WORKS p STRUCTURAL p PERMIT COORDINATOR p
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS •
DUE DATE
2/11/97
NOT COMPLETE p NOT APPLICABLE p
TUES /THTJRS ROUTING: PLEASE ROUTE p NO FURTHER REVIEW REQUIRED 2
ROUTED BY STAFF p (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS; (ten days)
APPROVED
DUE DATE 2/25/97'
APPROVED W/ CONDITIONS p. NOT APPROVED (attach comments) El
REVIEWERS INITIAL DATE
l
CORRECTION DETERMINATION:
DUE DATE
APPROVED fl APPROVED W/ CONDITIONS p NOT APPROVED (attach comments) p
REVIEWERS INITIAL
DATE
(Certiftcadon of occupancy required. )
1
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PLAN REVIEW / ROUTING SLIP
ACTIVI'T'Y NUMBER 14I97 -0015 DATE 2/07/97
PROJECT NAME TUKWILA STATION L.L.C.
DEPARTMENT:
BUILDING DIVISION FIRE PREVENTION C PLANNING DIVISION •
PUBLIC WORKS I STRUCTURAL El PERMIT COORDINATOR 0
i
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE 2/11/97
COMPLETE
COMMENTS '
NOT COMPLETE 0 NOT APPLICABLE El
TUES /THURS ROUTING: PLEASE ROUT
NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE 2 • r( 507
w
APPROVALS OR CORRECTIONS: (ten days)
APPROVED n APPROVED W/ CONDITIONS NOT APPROVED (attach comments
` (Cct1 v-er i-for•. Lt I C 3 - `)--9' -7
REVIEWERS INITIAL MCI DATE 21Z 0/11—
DUE DATE
2/25/97
f
CORRECTION DETERriIINATION: DUE DATE
APPROVED n APPROVED W/ CONDITIONS p NOT APPROVED (attach comments) El
REVIEWERS INITIAL
DATE
(Ccrtificadon of occupancy required. )
'
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PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M197 -0015
PROJECT NAME
DEPARTMENT:
BUILDING DIVISION
PUBLIC WORKS
TUKWILA STATION L.L.C.
DATE 2/07/97
FIRE PREVENTION PLANNING DIVISION
STRUCTURAL p PERMIT COORDINATOR p
r
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE p
COMMENTS •
DUE DATE 2/11/97
NOT COMPLETE p NOT APPLICABLE p
TUES /TH.URS ROUTING: PLEASE ROUTE
NO FURTHER REVIEW REQUIRED p
ROUTED BY STAFF p (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE off., leo
APPROVALS OR CORRECTIONS: (ten days) DUEDATE 2/25/97
APPROVED fl APPROVED W/ CONDITIONS IS NOT APPROVED (attach comments) �--J
REVIEWERS INITIAL
CJV DATE 2/.2 67, 7
1
CORRECTION DETERMINATION: DUE DATE
APPROVED ❑
REVIEWERS INITIAL
APPROVED W/ CONDITIONS p NOT APPROVED (attach comments)
DATE
(Certification of occupancy required.
Department of Labor & Industries
Contractor Registration Section
PO Box 44450
Olympia WA 98504 -4450
REGISTRATIOIVERIFICATION
TEMPORARY
(360) 902.5226
FAX (360) 902 -5228
(To
From
Olympia Headquarters
Registered name
Registration number
2ed-e-1
iexpires�re.�
Contractor: Your ertificate of Registration will be sent from the Olympia office and
should be received within 2 to 3 weeks. Please keep this record until you receive your
Certificate of Registration.
Receipt expires
F625-036-000 registration verification 2 -95
?hank you
r- DETACH TO DISPLAY CERTIFICATE
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DEPARTMENT OF LABOR AND INDUSTRIES
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
CONST C.ONT: ,.OFNERAL'
. „ REO1 TRAJIQN NUMBER gXPIIIATION DATE,'
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,IG.,IL• LEC *06 47%01,
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GIL,LEN CQN.STRUCT'OA
5525::212TH'ST.SW •
LYNNWOOD WA 98036
STATE OF WASHINGTON
F025- 052.000 (3.02)
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L DETACH TO DISPLAY CERTIFICATE_..