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HomeMy WebLinkAboutPermit MI97-0108 - CONSUMER READY PRODUCTS - REROOFIll- 0108 City of Tukwila (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: 262304 -9083 Address: 1024 ANDOVER PK E Suite No: Location: Category: ACOM Type: MISCPERM Zoning: TUC Const Type: Gas /Elec.: Units: 001 Setbacks: North: Water: N/A Wetlands: .0 South: Sewer: N/A Slopes: N Contractor License No: NORTHIC084C4 Permit No: Status: Issued: Expires: MI97 -0108 ISSUED 07/21/1997 01/17/1998 Occupancy: STORE UBC: 1994 Fire Protection: .0 East: .0 West: .0 Streams: OCCUPANT CONSUMER READY PRODUCTS 1024 ANDOVER PK E, TUKWILA, WA 98188 OWNER WASA:INC Phone: (206)622 -8835 DBA.TORINO'S SAUSAGE CO, 1024 ANDOVER PARK E, TUKWILA WA 98188 CONTRACTOR NORTHWEST IMAGE CREATIONS Phone: 206 940 -8113 P.O. BOX 1951, SNOHOMISH, WA 98291 CONTACT DAVE GRAY Phone: 206.979 -6500 3922 SIXTH AVENUE SOUTH, SEATTLE, WA 98108 ****** k**************** k***************************** * ** * * * * * * * * * * * * * * * * *** * *k ** *•k* Permit Description: REPLACE TORCH DOWN OVER AREA OF ROOF REPAIRED UNDER PERMIT #D97 -0214 AND APPLY EMULSION COATING. * k************************************************** * * * * * * * * * * * * * * * * **k * * * * * * * * * * ** Construction Valuation: $ 7,000.00 PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: Curb Cut /Access /Sidewalk /CSS: N Fire Loop Hydrant: N No: Size(in): . .00 Flood Control Zone: N Hauling: N Start Time: . End Timer Land Altering: N Cut: Fill: 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: *****•************ * * * * * * * *• * * * * * * * * *• * * * * * ** * * * *, ******* * * * * * ** * ** * ** * * * *•k * ** * * * * * * * ** TOTAL DEVELOPMENT PERMIT FEES: $ 129.25 ********* * * * * * * * * * * * * * * * ** ** * * * * * * * * * * ** .*******•**** * * * * * * * * * * * * * ** * ** * * * * * * * * * * * ** Permit Center Authorized Signature:_ 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 performan of work. I am ). uthorized to sign for and obtain this development p Signature / . r % Date : 74[�,2 Print Nam- / .a 6%41✓ 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. Address: 1024 ANDOVER Suite Tenant: Type: MISCPERM Parcel #: 262304- 9083. No:. MI97- .010.8 Status: ISSUED . Applied: 07(18/1997 Issued: 07/21/1997' . ********************• k* k*• k******** k.*******' k' k' k' k** * ** * **.k****• * * ** * * *** * * ** **** Permit,Cond.itions: No: changes will be made to the plans unless approved by the Tukwila. :Building Division 'All permits, inspection)_ r'ecor Ci,approved plans shall be - available at the j,ob�si;.te aprlor to the'.:- statrtof any con- struction. These documents .e to be maintai'ned;.,and avai 1 able until f i„nai' inspectA_on approval is granted x All eonstructl.on ta be `done in` conforrmance with approved plans and re- quirernents..o`f' the; Uniform Bui'ld'ing. Code (;1994 Edition) ya4s: arnen,ded, Uniform Mechariical::.Code (1994. Ed.ition), and Washington State Energy Code; (1994 Edition) , A statement 'f r orn the roof l ng ' c"on'tractor ver'1 fy i r g fire retardant ;class of =.' roof t,wi l l; be required prior , to f'iina.l inspept°ionr jsee attached `p�rocedur,e) . Val i "d'irty vf:n;Permi t. the issuance of a permit or'`'.approval plansr; specifications, .and co'rnputat.ions shall not -be:•.con- .st61ed to, be a: perms rf`for,,::o,r,, an approval of, any vio�,e,ti-o of ��,ar y .of the,;.provts�i ons.;ofs,the bui,ldl"ng .;code or of anv iffier` ordinance ofr_ he ju'r {fisdict.iar? No..permit presuming `, give3 authority °to..violate ' r cancel the provisions of this` codehit, 5 shad T.r,: be? va t i;d'. •. , k'`' ice. CITY OF TU WILA REROOF CONDITIONS Permit No: MI97 -0108 Project Name: CONSUMER READY PRODUCTS Address 1024 ANDOVER PK E Suite: ** 14*** *k **k *•k ** *kkk ***kkkkArk14k *.' * *114e* *ik' *k' *3k•*k*• fir** **kk*•k*4ft** *k *k**•k1 k.'k *kkk THE FOLLOWING coNavrIONS.WILL APPLY TO RE-ROOF :PERMITS: 1. All re roof ing projects will be accompl ished;�: in compliance with Append;lx�''Chapte'r 15 of the Uniform Building Code (UBC) . 4. In °sections:: ew roof coverings .sh'a11 not be applied without f,irs obtaining pre- roofing;.i_nspection from the BOIlding i:vi s °;ion ;and wri•:tten approval ::,f rom the Bu i l d.i nq Inspector. The pre= ;r•oofing'ins,peC•tion shell pay .particulartentian to evidence of ;accumulatiYon of ;.water:' • Where extensi,ve.'bon,ding of water i,s ap,parent,; ; an analysis of the root st,ructur,e ',for c.onp'1 fiance withSe,cti:an 1506; U,BC, shall be made' and corrective measures, ;such as relocation of roof drains Or scuppers, "resloping of'the roof .ur structural chengeo, s all be 'accompli rhed. 7 An;'insp.ect,.iun covering the above:,l isted topics prepared, by'a qual,if ied spacial. inspector:, as determined by the Bui lding>;Off icial, may be accepted in,'l ieu of ,the:.p're- inspection by the Building I.nspector. final inspection and approval .shall b'e obtained trnm the «i1ding Division when the re- r;ooting,..is. complete, ,:"Ay a 'co;n.dition.,,of `fhe final i•nspection.'•for .roots that require a fire,, ret,a'rdant roof covering under the provisions`:.a'f Table 154 ,,.1994 ` UBC, the roof installer ' shall provide the inspec',tor with a written `statement indicating: the following (or something s.imi lar) I HAVE INSTALLED A ROOF MEMBRANE AS3EMBLY, INCLUDING. INSULATION IF APPLICABLE, CONSISTING OF (MANUFACTURER), SPECIFICATION # DATA SHEET ENCLOSED, WHICH MEETS OR EXCEEDS THE REQUIREMENTS FOR LASS A OR CLASS B ROOFS. THIS ROOF WAS INSTALLED AT (ADDRESS), UNDER CITY OF TUKWILA PERMIT NO. (The statement shall .Include the name of the roofing company that installed the roof, signature of installer and date.) CITY OF TUKWILA Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwila, WA 98188 (206) 431 -3670 OR STAFF USE ONLY 'Project Number: • Permit Number:: cti-olog Miscellaneous Permit Application Application and plans must be complete In order to be accepted for plan review. Applications will not be accepted through the mall or facsimile. Project�e� ant: �L i� y/ eoorcr' Value of Construction:? 7 /o©a.e0 Tax Par el Nu ber: 2 '3d e/ 9v83 Site Address: City State /Zip: /42l.4✓DD P, e/e , ,- 71/,‹ Property Owner: 419 , //VC L Phone: S75 93 s3 Fax #: 575-- 93 S 5e Street Address: City State /Zip: g Z 4rif gv.6 Se. se � i„.)4.9'8' 0 2 y Contactrs 6 4 ( Phone: (06) / 5z O Oro —� 'D Street Address: City State /Zip: 39 Z Z &7I/ /Vs . �a'eg- 981og' S9 Fax #: #: to tV- 02/6 Contractor /V6M1 //1246e .Att, s Phoney` ,90 g /e....3 Street Address , 1_x �,/ 9/OJ� v '- y S1abeJ7jp5� !�J/ �J�/ �� ��G Fax #(j) 9v, v` /3 Architect: Phone: Street Address: City State /Zip: Fax #: Engineer: /� l l� /r�/477/ T-- - %174/YT�/ "2 c� Phon �i, ) � 2 "'�57/ Street Adrehs2 rizr�/ /C�iLy yekp: Fa % %A_ 2//� MISCELLANEOUS, PERMIT REVIEW AND APPROVAL REQUESTED:-(TO BE FILLED OUT BYAPPLICANT Description of wor k to be done: Ee,e.. T'd/LG // Z7,0 �l+ .✓ � O/e 7- e D mod., / / r ./,' 4 , y% r D .', ' r .. . //., CA Will there be storage of flammable /combustible hazardous material in the building? ❑ yes no Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er lndlcatin. • uantlties & Material Safet Data Sheets ■ Above Ground Tanks ■ Antennas /Satellite Dishes ■ Bulkhead /Docks ■7.■ Commercial Reroof ❑ 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 El 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 Sewer #: ❑ 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: CI Miscellaneous LJ 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: Phone: 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, lee 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: IQ� Application to 7p,by: (Initials) ALL MISCELLANEOUS PER' APPLICATIONS MUST BE SUBMI • 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 ➢ CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.) ❑ SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR Above Ground Tanks/Water Tanks - Supported directly upon grade exceeding 5,000 gallons and a ratio of height to diameter or width which exceeds 2:1 PERMIT REVIEW Submit checklist' NO: M-9 ❑ Antennas /Satellite'Dishes Submit checklist No M -1 ❑ Awnings /Canopies - No signage Commercial;Tenant Improvement Permit ; ❑ Bulkhead/Dock Submit checklist . No M -10 SI Commercial Reroof Submit checklist, No M -6" ❑ Demolition: Submit checklist .:•No; M -3; .M =3a . ❑ Fences - Over 6 feet in Height • Submit checklist. No M -9 ❑ Land Altering/Grading/Preloads Submit checklist No: M -2 ❑ Loading Docks Commercial Tenant improvement Permit.': Submit. checklist No H =1.7 ❑ Mechanical (Residential & Commercial) Submit checklist, No M -8,, Residential only = H -6, H-16 ❑ Miscellaneous Public Works Permits . Submit checklist' No: H-9 ❑ Manufactured Housing (RED INSIGNIA ONLY). Submit checklist . No: M -5 ❑ Moving Oversized Load /Hauling Submit checklist NO:, M -5 ❑ 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 ❑ Retaining Walls - Over 4 feet in height Submit checklist No; M -1 ' ❑ Temporary Facilities Submit checklist No: M -7 ❑ Temporary Pedestrian Protection/Exit'Systems Submit checklist No: M -4 ❑ 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 /engineer, 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 OW - •R AUTHOR ' AGENT: Signature: Date: 7 /,' 97 Print name: �/� G f�lil.�,71J j��.J o City /Stale / J �lIJ�C Fax #: /'f/� J ��/ /.�� Address: 927 to � �. ._! se) - Ag /Zip: , _ ,A e:i aS MISCPMT.DOC 7111/96 ********/ t *k*k• **A* *,** *.hhk*k *** *kh*** *kkk* **A *A * *k ** *k*4 * * * *A* **1 CITY OF TUKW LA. WA *:k no ' , TRANSMIT * *k+.k*kkk ** * * * ** * *kk t* *k** Fk **kkt*A * * * **A *k ** * ** ., TRANSMIT " Number: R9700bi5 Amount: 129,25 07/18/97 09:51 Payment Method: CHECK Notation: TORINO'S SPECIAL Xnit: SL13 Per Olt No.,/..M19/-01.08 Type+. MISCPERM lISCELLANEDUS. PERMIT PHr^:cel - Nae . 262304'�0f33 Site. Add.r °es.e . i'024 'ANDOVER PK E Total Fees: 12. '4,25 Total ' ALL :Pmts 12'„x.,25 palancea .'00 * * ** * *. *kfi * *,kk*{� * *. ** * * * ** ***` * *. k*** * * *iA *.* * **** *,∎ * * *k * *•k **k ** * ** Account: Code ' . t est:r^ i pt i on Amount, .000/322, 100 ' BUILDING "- NONRES 124,75'' ' ' 000/386.:504 : STATE BUILDING SURCHARGE 4.50 , INSPECTION RECORD Retain a copy with permit INSPECTION NO. CIT1(4OF TUKWILA BUILDING DIVISIO 6300 Southcenter Blvd., #100, Tukwila, 206) 431 - Rro'ect: •'m JrA► a .... ep ; of ins, :ction: , __.1..∎tr I ...OS, Da e cane.' dd ess: Special instructions: Date wanted_—� a,m. .. L. RgG3. ,Phone No.: q( — Q f � �Ci f . C�LtT�- 114 Approved per applicable codes. COMMENTS: . 1 Corrections required prior to approval. ., • • Inspector Date: $42.00 REINSPECTIO % EE RECIUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 1.00. Call to schedule reinspection. INSPECTION RECORD —,� Retain a copy with permit INSPECTION CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 Proje : 0-N• _ Type of inspection: Address: 10 2.-1/4-\ A • P. E • Date called: Special Instructions: Date wanted: r O /���� a.m. 057) ) Requester: I! Phone No.: Approved per applicable codes. COMMENTS: /1 Corrections required prior to approval. 1 f (100o(_ C rOrt- it-b41 r3(7 Inspector: Date: al qq? $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 Project: c+ CI hsutiva_p_ %LEAS Y P of inspection: Type s .1,,14.t._ �ucr Address: /O2(.4.4�.. called: / 0/e/ei 7 Date wanted: /0E47 a.m. Special instructions: Requester: ,r, Phone No.: 3,0_2 7 ,3z., Approved per applicable codes. Corrections required prior to approval. COMMENTS: Inspector: Date: k fr $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali to schedule reinspection. INSPLGIi17N NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 WOOLMISIO.IWOJOsim.eonraoaranapousrat. fJ61kel INSPECTION RECORD Retain a copy with permit Projectrn Type of ins• = ction. ■ Address: oP �X ) .,, �, Date calle.: F Date wanted: y /z..— I qTri...) Spec al instructions: /0:00 /VAS Requester: p Approved per applicable codes, rections required prior to approval. COMMENTS: A 4/ InspectordIW 4, A $42.0 INSPECTIO FEE OUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Date: 10 -08 -1997 3:35PM .October 8',1097 Pat Faze :Il, 1018 N.E. 941 Seattle, WA 98115 5234532 Re; • Consumer Ready Products ' 1024 Andover Pk E., • ' . . • Tukwilla, WA • 'See Attached Firestone specification sheet. ' Fields Roef 'Service has installed it roof.membrane'assemble, including insulation where it was necessary. The root assembly installed is•a Firestone 17.102 -3 UL Class B. See enclosed manufactures specification. • , • This•roof assembly Was installed at 1024 Andover Park East, Tukwilla WA., under permit number MI 97.0108, by Fields Roof Service. • • 10 -08 -1997 3:35PM FROM FIRESTONE SPECIFICATION 71- 102 -3(#) U.L. Class B Type File R9516 (N) . REROOFING SMOOTH SURFACED ADDED INSULATED This specification 71- 102 -3(#) is applicable for the Firestone APP -160 membrane applied to the following substrate: Decks: Smooth Surfaced Built U Slope: 1 /4 ",1 /2'•'"or 1 max.* Insulation: A. Wood Fiberboard 8, Perlite •• C. Iiocyanurate • 0. Fiberglass • F. Gypsum • Base Sheet: U.L. labeled 02 • Fasteners: A. 1.C.B.O. or F. M. approved Coating: A. Karnak Type II triD 1 gal. per 100 B. Karnak Type III 1.5 gal, per 100 ea p Roof 1/2' rasa. t/2" 1' min. 11/16' min. 1/2' min P. 2 The application procedure, general requirements and other information in the Firestone APP sp- ecification manual are an integral part of this , specification. 1. Remove all debris and repair blisters, cracks, and mem- brane irregularities that would impede a smooth recover application. Existing roof system is to be dry and properly attached to a structurally sound substrate. 2. Fasten the recommended insulation over the properly prepared roof dock following insulation manufacturer's specifications. 3. Fasten a layer of base :beet over insulation board using the approved screws, plates and fastening pattern. 4. latitall the membrane onto the surface using the sum- dud installation method. Side laps shall be a minimum of 3' and end laps a minimum of 6'. S. Complete all flashing details. 6, Prepare membrane followtngthe coating manufacturer's specifications. 7. Spread coating uniformly over the roof surface moving In one direction. Care should be taken not to over work the coating. 1/91 Specific bands, produeta and of combinations may b. nscaaury to ac.t or .shape. the U.L. titles and maximum slope,. •a May require multiple tayc cd inaulatioa spsainaations or doubts bass :bast a/aembito. to mat U.L muss, NOTE; These ilk►strstioaa ats to convey a general usderwadiag of the bask stomata of the roofing systems. The stops restriction Is for the firs rutinn only. CO11iIlVIERCIAL REROOF PERMIT APPLICATION. CONSUMER READY PRODUCTS 1024 ANDOVER PARK EAST TUKWILA, WA 98118 (206) 575 -9353 COPE OF PROJECT: Reroof area over construction work (structural repair) effected under permit number D97 -0214. Apply weather resistant emulsion over roof. ►3'IVE Off' ACTIVITIES AND MATERIALS USED: 'Area of approximately 37' x 26" to receive torch down membrane to cover area opened in roof to effect structural repairs. A non toxic "Pro's Choice" weather resistant emulsion will be rolled on over the new and existing torch down roof to effect a continuous "complete roof' weather seal: All materials will be industry standard and applied utilizing best building practices in conformance with applicable building codes by licensed contractor, RECEIVED CITY OF TUKWILA ,JUL, 1'81997 }1'.•:.Crt:: i ...,: Si r ,. �r_� },:: s'.i.'l::t:.,. ,. �Ca)�'.S':55:2::. � ? ;; r::J7.:r+:'.' .....�: )n':. � . �+r ?S 1Y. +:rr^:f.:h' ^H��• +S*',ri".t'R7�:: h' SVe■'%1!•17 S:re'.t: it <.r.2n:R PLAN REVIEW / ROUTING SLIP ACTIVITY NUMBER M197 -0108 PROJECT NAME CONSUMER READY PRODUCTS DATE 7/18/97 DEPARTMENT: BUILDING DIVISION FIRE PREVENTION El PLANNING DIVISION a PUBLIC WORKS D STRUCTURAL 0 PERMIT COORDINATOR 0 DETERMINATION OF COMPLETENESS: (T,Th) COMPLETE COMMENTS NOT COMPLETE DUE DATE NOT APPLICABLE 0 TUES /TIIURS ROUTING: PLEASE ROUTE n NO FURTHER REVIEW REQUIRED L=.1 ROUTED BY STAFF El (If routed by staff, make copy to master file & enter Sierra.) REVIEWERS INITIAL DATE 7- c7 APPROVALS OR CORRECTIONS: (ten days) APPROVED n APPROVED W/ CONDITIONS REVIEWERS INITIAL DUE DATE 8/01/97 NOT APPROVED (attach comments) 11 DATE - 1C ^q7 CORRECTION DETERMINATION: APPROVED 0 REVIEWERS INITIAL DUE DATE APPROVED W/ CONDITIONS El NOT APPROVED (attach comments) 0 DATE (Certiticadoe of occupancy required. ) Li 'Ca t. Snohomish, WA 9829V • .(206) 940 -8113 ��.r. I/K /J • _T M' '.: i //•1I /ti"l.•.� "^' -�N- /if(+�il.'Lll= f1^'••w..'. i /iY- //Y!!!1 l! ••-• •7. DEPARTMENT OF LABOR AND INDUSTRIES • THIS CERTIFIES THAT THE PERSQN JA'16 EPECSN I5 REGISTERED AS PROVIDED BY LPN AS A `1`,.t; r ,i {^ s::,:� r; •rlr, }) - ..•y�f�i ,7 z;� 4N.f :yc ��,1r.;1••titar:et''t yl: l.: ' t:,•it'a.i l {• ' :Gy:rl.l, j 5 +' d'I'>r,�u•,• N� tiZ•f,: rj•r ��,: •r•u�,'oya'yvtic'i: ' t� • y I S t:•0 ' \ `'' it .l :� dlRCrt,S:'' , A �: V .r; S1 lr •;:y,,� ,;/,.4 04* i{ .;: i)1 Ij(rfiJjM.!Aiq',e�.. IT; 5, :et'est•' f ';�' ''ij l� ; ,kl,'69 i�;�,� ' "'�j���,• + l''', +e r 11 7 v #i� Y3,A l 1; , , :0 ` tij,fit. o'3: • '::,4:00.61 2f i � il " (to a, " 4. A' : y r' : '! .y': i,'''t } .i 1...nH :+. ' � IS06 7,11 h $ 1•• Ad.rrC..aT'. /Q,1"" $; > 1 ,. A flrV ;P X Y . .: .. n e..t 31,$, :,i