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HomeMy WebLinkAboutPermit MI97-0153 - SOUTHCENTER CORPORATE SQUARE - REROOFCoPb RATE 3CPs a ►�I�7-o «3 City of Tukwila (206) 4313670 Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 WARNING: IF CONSTRUFi6FLbg'N MSBMWTAPPEAL PERIOD EXPIRES, 2266 APPLICANT IS PROCEEDING AT THEIR OWN RISK. ��11 I97 Pagrd�resos : b5�3R1�608fZR PK W Per�O�ati�os : T55UE8153 Suite No: Issued: 10/08/1997 Location: BUILDING #7 Expires: 04/06/1998 Category: AOFF Type: MISCPERM Zoning: TUC Const Type: REROOF Occupancy: OFFICE Gas /Elec.: UBC: 1994 Units: 001 Fire Protection: Setbacks: North: .0 South: .0 East: .0 West: .0 Water: TUKWILA Sewer: TUKWILA Wetlands: Slopes: N Streams: Contractor License No: WAYNE8R205 OCCUPANT OWNER CONTRACTOR CONTACT SOUTHCENTER CORPORATE SQUARE 655 ANDOVER PK W, TUKWILA, WA 98188 SOUTHCENTER CORPORATE SQUARE Phone: (206)575 -8500 C/0 JSH PROPERTIES INC, 1005 ANDOVER PARK E, TUKWILA WA 98188 WAYNES ROOFING INC Phone: 253 863 -4455 13105 HOUSTON RD, SUMNER WA 98390 ROD WETHERBEE Phone: 253 -863 -4455 13105 HOUSTON ROAD, SUMNER, WA 98390 k*************************************************** * * * * ** * *** * *** * * * * * * * * * * * ** * * ** Permit Description: REROOF JPS EP SINGLE PLY MECHANICALLY ATTACHED SYSTEM. k*************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Construction Valuation: $ 45,357.00 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 Time: 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******** k****************************************** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * ** TOTAL DEVELOPMENT PERMIT FEES: $ 543.25 k******************** * * * * * * *•k * * * * * * * * * * * * * * * * * * * * ** _ * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Center Authorized Signature: Date iO* -61r-/ I hereby certify that I have read and examine 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 any authorized to sign for and obtain this development per Signature: Date: /7.0/./Ar Print Name:__Tj.L 4✓.�ILP,'L 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. P.d'dre�s 4+55 ANDOVER u 1., Type M CPER11 Pa r;ce' 1 2 62304: -90 75 k •k 4. 4 •k 4 fir'* ;k 444444,4 .A.:4 k k 'N k * k k k * k k k v4 k ,� k k •Ak K k' ;k * •k k. k •k •M Perin it Cold i.) 's Permit No MI97 -0153 Status. ISSUED Aplr1 ied 09./.04/1997. Issued 10/08/1997 'k k•k•k•k•k k•k•k* k k•k k *•kk*k kt ** k•k k k kh* CITY OF TUKWILA REROOF CONDITIONS Permit No: M197-0153 Project Name: SUUTHCENTER CORPORATE SQUARE Address 655 ANDOVER PK W Suite: k kkkk *•k* *k ** *k** * *k *kkkk *k *' k' k****' k' k kMk` k itkk k** k' k** Akkkkkkkkk *kk **kkkkkkkk* THE FOLLOWING CONDITION'S ;WILL '�APPL. ' TO RC -ROOF PERMITS': `: 1. All re -roof in9 pro,j'ec:.ts will ,be. 3. compl fished :in cornp.1 iance with Appendl < Chapters 1`5 of the Uniform Building .`Code ,(UBC) . 2. Inspections: `N'ew'root coverings :'shall not be applied without firs. obtaining a pre - rooting. - inspection from the Building D i v i s; i'on and written approval from the Building ' Inspector. The, inspection shall pay particular attention to evidence of accumu'lation, of water: Where extensive ponding of water is apparent', ' an ; analys i of the roof str�uctu're for cunp:l�;iance with Section 1506, UBC, shall be made and corrective measures, such as relocation of root drains or . scu;p�pers, re,s 1 opi ng of root 'or° struc:tura 1 changes, ,sha l l be `a'ccomp 1 fi shed ; An, 'i aspect i un covering the above listed topics prepared`' by a qualified special' inspector;, as e •er.mine'd by the Building' Official, May be accepted In lieu at the pre-inspection by the' Building .Inspector... ::,final inspection and approval .shall be obtained tro»`.'the Building Division when the, re-roofing is. complete. As a eosidi t•ion of the final inspection for roots ..that require a f ire';- ;'retar;dant root covering under the provisions of Table 15 -A,' 1994 UBC, the root installer shall provide the inspector with a written statement indicating the following (or something similar): I HAVE INSTALLED A ROOF, MEMBRANE ASSEMBLY, 'INCLUDING INSULATION IF APPLICABLE, CONSISTING OF,.'MANUFACTURER), SPECIFICATION # , DATA SHEET ENCLOSED, WHICH MEETS OR' `EXCEEDS THE REQUIREMENTS FOR CLASS A OR CLASS B ROOFS. THIS ROOF WAS INSTALLED AT (ADDRES'S) , .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 ProJ4ct Number: Permlt.Number:•' 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 N mefTena %t: f Q /� f� '�% 5aL e i e/ ' c 94, 4 1 a% k lit 1 Value of Construction: sYS, 3 S% Site Address: / •/ City State/Zip: 4 Sc �-✓1 eia ✓..ci A r L "L✓.t 511- kL✓e. !/A fr a /.t- 9 5r1 f k Tax Parcel Number: 2-4 a 30 L/ —.7 v7 5 Property Owner: Low 1t/v (-441 (,./4-54- �-.) vt544a44' Qro &f f i'eS J L.L Phone: (3.c) (r) 5'75' -- p.0.0 - Street Address: City Stale /Zip: 66 U (A A r/<tt,ly 51._ S1.4,'1 e a.K.26 54# /t/ wAt 9810 / Fax #: ( ) 375r - //9 SI C,gntac) Per §on: r I� Phone: Street Address: City State /Zip: _ 13/0. I-/di.. xlin t'✓ SuM��i, Fax #: Contractor: /� i. i C 5 lec e, t 117 �Cn Phone: 0 5- .0 943 - sic( c Street Address: City State/Zip: 13/0 S Np &' i e,„a S1.�n„tt. h,✓.f- GS[3 go Fax #: case) Pe 3 -53 /( Architect: Phone: Street Address: City State /Zip: Fax #: Engineer: Phone: Street Address: City State /Zip: Fax #: MISCELLANEOUS•PERMIT REVIEW AND'APPROVAL REQUESTED:: (TO BE FILLED OUT BY APPLICANT) Desc ption of work to be done: Will there be storage of flammable /combustible hazardous material in the building? ❑ yes r 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 Pi IV ommercial 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 L_1 han Cnelization /Striping ❑ Flood Control Zone ❑ Landscape Irrigation ❑ Storm Drainage ❑ Water Meter /Exempt # Size(s): ❑ Water Meter /Permanent # Size(s): ❑ Water Meter Temp # Slze(s : Est. quantity: gal Schedule: ❑ Miscellaneous Moving Oversized Load/Hauling ❑ Curb cut/Access /Sidewal Fire Loop /Hydrant (main to vault) #: Size(s)* ❑ Land Altering: 0 Cut cubic yards 0 Fill. cubic yards 0 sq. ft.grading /clearing ❑ Sanitary Side Sewer #: ❑ Sewer Main Extension 0 Private 0 Public ❑ Street Use ❑ Water Main Extension 0 Private 0 Public 0 Deduct 0 Water Only MONTHLY SERVICE BILLINGS TO: Name: ( Phone: Address: City /State /Zip: 0 Water 0 Sewer 0 Metro 0 Standby WATER METER DEPOSIT /REFUND. BILLING: Name: Address: fPhone: City /State /Zip: Value of Construction - In all cases, a value of construction amount should be entered by the applicant. This figureNwill 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 appllcatlon accepted: q- 14-q1 Date application expires: 5 "14 -611. Application to ji;y: (initials) ALL MISCELLANEOUS PER APPLICATIONS MUST BE SUBMIT 0 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 PERMIT REVIEW Above Ground Tanks/ Water .Tanks - Supported directly upon grade Submit checklist. No M =9 exceeding 5,000 gallons and a ratio of height to diameter; or width which exceeds 2 :1 ❑ Antennas /Satellite Dishes. Submit checklist No: M-1 Phone: Phone: Awnings /Canopies.- No signage : Commercial :Tenant Improvement Permit `i i Fax #: �asIi $G ; --q3// Bulkhead/Dock Submit •: checklist . No M-10 1�f L� 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 ri 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 in Miscellaneous; Public Works Permits Submit checklist' No H -9 in 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 OWNER OR AUTHORIZED AGENT: Signature: Phone: Phone: Date: iv)..� L� 11,3- �lhlfS `i i Fax #: �asIi $G ; --q3// Print name: i /��.1 L„L��eib�2 ,/�,l/i1a! 5 gad 1�f L� Address: / o `i / / i u /c' // gel ' City /Stlale Zip: l i- / 91390 MISCPMT.DOC 7/11/96 r * * * ** * #** * *** ** * *kkkk *1! * ** *ii****k **4**? *** #kk** **k****k * * , ;TTY OF TUKWILA,~ WA % TRANSMIT rk *A * * * ***4 * * ***k•kAkA �`* * 9F T *#k*k A7F,4•k,4* ***kk*la*A* TRANSMIT Number: R9700637.Amount: 543.25 09/04/97 10 08 Payment' Methods CHECK, Notation: WAYNI:'S ROOFING init: SLN • Permit Not MI97.01$3 Type: MI5CPCRM MISCELLANEOUS PERMIT Parcel No: '262.304••9075 Site Address:. 625 ANDOVER PK N Location: BUILDING 07 Total Fees: 543.25 This Payment 543.25 Total ALL Pmts 543.25. • Balance: . .00. l***.****** A****• k** 0. AA** A*****• k• kA****, ***A *4( **A *•k * ***k. *k* * * *A* ** Description Amount BUILt)TNG NONRES H538.75 STATE BUILDING SURCHARGE 4.50 Account Code 000/322.100 000/386904 *ir- EC IV D SEP :O51997 f`:ci1UI, \ii13NfTV J15110.111,10.1%.0.. x.,..,.01... INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING D VISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 (206)431 -3670 Project: T o�� r 6ddress 5SAvct0,,v'i�lEu 41 - • - _, Special instructions: See_ HT C7... iOO 7 Date wanted: �yy �' W a.m. P.m. Requester: Phone: Approved per applicable codes. Corrections required prior to approval. COMMENTS: Al �, tr $47.00 REINSPECTIO !FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reins ection. 1 RLPCRInt No Date: 1 INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 9r-- ais� PERMIT NO. (206) 431 -3670 Project: s, C c� S©. T�Ipe.gf i ec 5ji 40 ��i�' o/ Address: / , p Date called: Special instructions: Date wanted: / r / qi : a Requester: Phone No.: Approved per applicable codes. Corrections required prior to approval. COMMENTS: (C1 / (S 1 aG . IInspector: Date:, % 7 $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 9818 PERMIT NO. (206) 431 -3670 ,Pro ct: r (' r" Ul(�, Y \Q T of inslfection:�-�I� ,:'�.- ,A . te cal ed :r A ss Special instructions: Date wanted: fin-' - g ri uest r: Phone ft -5 - 01/4L-kc-S--- Approved per applicable codes. 'Corrections required prior to approval. COMMENTS: 7--1 -1 *-�p o J o,�1G wY A1 _ f I ikL - 7 C'l Z-(N E7v -yL"" , .DPI -A- t i• is' ., a 0(F �6LAvnS ,o o N vl 14.4-0 AO - Inspector: Date: /6/9/57 $42.00 REINSPECTION FEE REQUIRED, Prior to inspection, fee must be paid at6300 Southcenter Bald., Suite 100.` Cali to schedule reinspection. WAYNE'S ROOFING, INC. May 17, 2000 Department of Community Development 6300 Southcenter Bldv., Suite #100 Tukwila, WA 98188 Attn: Bill Rambo Project Name: Southcenter Corporate Square WAYNE'S ROOFING INC., has installed a Thermoplastic Roof Membrane assembly, including roof insulation cover board consisting of J.P. Stevens, 45 mil EP Mechanically Attached System, which meets or exceeds the requirements for Class A Roofs. This roof was installed at: Building #7 — 655 Andover Park W City of Tukwila Permit No: #MI97 -0153 Dan Johnson, Operations Manager RECEIVIO CITY OF namitA MAY 1 8 2000 PERMIT CENTER City of Tukwila Steven M. Mullet, Mayor Department of Community Development Steve Lancaster, Director May 10, 2000 Rod Wetherbee 13105 Houston Road Sumner Wa 98390 RE: Permit Status MI97 -0153 655 Andover Park W Dear Mr. Wetherbee: In reviewing our current permit files, it appears that your permit for a re -roof, issued on October 8, 1997, has not received a final inspection as of the date of this letter by the City of Tukwila Building Division. Per the Uniform Building Code and /or Uniform Mechanical Code, every permit issued by the building official under the provision of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days. Based on the above, if a final inspection is not called for within ten (10) business days from the date of this letter, the Permit Center will close your file and the work completed to date will be considered non - complying and not in conformance with the Uniform Building Code and/or Mechanical Code. Please contact the Permit Center at (206) 433 -7165 if you wish to schedule a final inspection. Thank you for your cooperation in this matter. Sincerely, Bill Rambo Permit Technician Xc: Permit File No. M197 -0153 Duane Griffin, Building Official WAYNE'S ROOFING, INC. September 9, 1997 City of Tukwilla Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwilla, WA. 98188 RE: Roof Permit for building #5, 6, 7, 8 & Atrium, & 9 During our inspections of all building at Southcenter Corporate Park this is what we found: EXISTING ROOF SYSTEM: • Buildings #1, 2, 12, & Canopy One Roof: 28# base sheet, two plies of 15# felt, and gravel. • Buildings #3, 9,10, & 11 One Roof: Rosin, tow plies of 15# felt, and gravel. • Buildings #4 & 6 Two Roofs: rosin, two plies of Type IV plysheet, gravel, 1/2" perlite coverboard, two plies of cold process, and sprayed with granules. uildings #5,7, & 8 One. Roof Glass base sheet, torchdown membrane, and silvercoat. Buildings 1, 2, 3, 9, 10, 11,& 12 will have all gravel removed and new system installed. The weight difference is approximately 65 pounds less. Buildings 4 & 6 will have the top roof removed and a new system installed. Buildings 5,7,& 8 will have an additional roof installed. NEW ROOF SYSTEM: The new roof system will consist of a 1/2" Dow board mechanically fastened, and one layer of 45 mil white EP roof system mechanically fastened. Crickets will be install to improve current drainage. CITY oF TUKWILA SEP 1 1 1997 13105 Houston Rd. • Sumner. Washington 98390 Any wet or deteriorated decking will be removed and replaced, subject to building inspectors approval. Insulation is currently on the underside of decking and therefore will not be replaced. EXISTING STRUCTURE: The existing structure consists of 4" x 12" perlins spanning the beams and spaced 4' O.C., with 2x4 stringers spaced 2' O.C.. The deck consists of 1/2" plywood. If you have any questions, please feel free to contact me at (253) 863 -4455 ext. 2226. Sincerely, WAYNE'S ROOFING, INC. Rod Wetherbee. Sales Manager AVC itYSLT+.7.1,- $7, {!'ii4) ;.,Y iose.t kUit„y` tit le,: rr`..i +!•1F:mm m . +fvit,fril MEMORANDUM Date Wednesday, September 03, 1997 Number of pages including cover sheet 1 • To: i emit. Wayne's Roofing, Inc. 13105 Houston Road Sumner, WA 98390 From: City of Tukwila Rod Wetherbee Ref.: Southcenter Corporate Park re -roof Phone (206) 431 -3670 Fax Phone (206) 431 -3665 CC: Marketing Manager Phone 206 - 863 -4455 Fax Phone 206- 863 -8311 REMARKS ❑ Urgent ® For your review ❑ Reply ASAP ❑ Please comment During our inspections of all building at Southcenter Corporate Park this is what we found: • Buildings #1, 2, 12, & Canopy One Roof: 28# base sheet, two plies of 15# felt, and gravel. • Buildings #3, 9,10, & 11 One Roof: Rosin, tow plies of 15# felt, and gravel. • Buildings #4 & 6 Two Roofs: rosin, two plies of Type IV plysheet, gravel, 1/2" perlite coverboard, two plies of cold process, and sprayed with granules. • Buildings #5,7, & 8 One Roof: Glass base sheet, torchdown membrane, and silvercoat. Buildings 1, 2, 3, 9, 10, 11,& 12 will have all gravel removed and new system installed. The weight difference is approximately 65 pounds Tess. Buildings 4 & 6 will have the top roof removed and a new system installed. Buildings 5,7,& 8 will have an additional roof installed. RECEIVED CITY OF TUKWILA Rod Wetherbee Sales Manager SEP041997 PERMIT CENTER PLAN REVIEW / ROUTING SLIP ACTIVITY NUMBER M197 -0153 PROJECT NAME SOUTHCENTER CORPORATE PARR BLDG 7 DATE 9/04/97 DEPARTMENT: BUILDING DIVISION 111 FIRE PREVENTION ❑ PLANNING DIVISION a PUBLIC WORKS ❑ STRUCTURAL ❑ PERMIT COORDINATOR ❑ DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE COMPLETE ❑ NOT COMPLETE I4 NOT APPLICABLE ❑ COMMENTS p p< evne.w( s 2 'L 3 TUES /THURS ROUTING: PLEASE ROUTE ❑ NO FURTHER REVIEW REQUIRED ❑ ROUTED BY STAFF ❑ (If routed by staff, make copy to master file & enter Sierra.) DATE REVIEWERS INITIAL 4 APPROVALS OR CORRECTIONS: (ten days) DUE DATE 9/18/97 APPROVED ❑ APPROVED W/ CONDITIONS Ar NOT APPROVED (attach comments) ❑ (//.7 yip >, REVIEWERS INITIAL DATE CORRECTION DETERMINATION: DUE DATE APPROVED L I APPROVED W/ CONDITIONS ID NOT APPROVED (attach comments) Q REVIEWERS INITIAL DATE (Certiflcadoo of occupancy required. ) 09/11/1997 11:48 206863831„ WAYNES ROOFING INC( Post•it• Fax Note 7671 Date Pao a► Tos L U! „ ! )% , / c(.,f, Fro Co./Dept. Co, Phone 4, Phone 11 Fax • j— DE IACH TO DISPLAY DER11FICNTE" Z PAGE 01 DEPARTMENT OF LABOR AND INDUSTRIES THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A ' i Yr ,� •i. r: ,�a, r• .i:.•�. h .(8 1'f:.T �I � (y�• ., �.. sr � .{'. ,�'�• �r�,. �, c r r: • 11' r .1i f tiyih�•'�C�••,, "� 1 • {. f..�A. s .r�$frn�t•..:is`'�1f.: ^''F r {'!: '�j {l�� to r' ti Ycef pfa.R p���_•�! , {.c.:: i•::.:; r.,,..T�f', � � }i^••l`lin•'�I+• ff "rrt {!•Ti+ V. j.� rr •'�.: +'�f ;t ".•�t' +F{L•.� t�:NRt 1'•. •.'; r {' K {t•it r day , n; WA. pet 4W161.! sUkNOR STATE OF WASHINGTON