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Permit MI98-0093 - CSM HOTEL - DEMOLITION
C:5 M Noftl Dumb 'of is4. BIdjs: Mi9i?7. 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: 000580 -0005 Address: 16038 WEST VALLEY HY Suite No: Location: Category: DEMO Type: MISCPERM Zoning: TUC Const Type: Gas /Elec.: Units: 000 Setbacks: North: Water: UNKNOWN Wetlands: .0 South: Sewer: Slopes: Contractor License No: NUPREI *148PU Permit No: Status: Issued: Expires: MI98 -0093 ISSUED 07/06/1998 01/02/1999 Occupancy: DWELLING UBC: 1994 Fire Protection: N/A .0 East: .0 West: .0 Streams: OCCUPANT CSM HOTEL /DEMO OF EXIST BLDGS 16038 WEST VALLEY HY, TUKWILA WA 98188 OWNER NELSEN HELEN B 15643 W VALLEY HYWAY, TUKWILA WA CONTACT EVAN CASEY Phone: 612- 646 -1717 2575 UNIVERSITY AV, #150, ST PAUL MN 55114 ENGINEER PACIFIC ENGINEERING Phone: (206)431 -7970 130 ANDOVER PK E #300, SEATTLE, WA 98188 CONTRACTOR NUPRECON INC Phone: 425 - 881 -0623 14540 NE 91ST, REDMOND WA 98052 k********* * * * ** * * * * ** ** * * ** * * * * * ** * * * * *** ir************ ** * * * * ** * * * * * * * * * * * * * * * * * ** ** Permit Description: DEMOLITION OF EXISTING WOOD STRUCTURES: BARN (2,275 SQ FT), GARAGE (375 SQ FT), HOUSE (1,200 SQ FT), HOUSE (1,200 SQ FT), APARTMENT (1.625), APARTMENT (1,625), APARTMENT (1,625). UTILITY CAPPING OF SEWER AND WATER LINES, REMOVAL OF 1" PERM. WATER METER AND HAULING. k*************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Construction Valuation: $ 30,000.00 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: Y 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: N Public: N Storm Drainage: N Street Use: N Water Main Extension: N Private: N Public: N k*********************, k***************************** * * * * * * * * * * * * * *** * * * * *** * * * * * * ** TOTAL DEVELOPMENT PERMIT FEES: $ 71.50 k**************************************/ tl************ * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** Permit Center Authorized Signature:_ Ei'" Date: _' 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 perfor,pLce of work. Iam authorized to sign for and obtain this developmen Signature: Print Name:_ 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 fnr a nerind of 180 days from the last inspection. Date: CITY OF T' •KWIL4CEIVED Permit Center CITY OF TUKWILA 6300.Southcenter Boulevard,fta iOf 1998 Tukwila, WA 98188 (206) 431 -3670 PERMIT C k 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 Name/Tenant: C (' 1 Iza �. Description of work to be done: Value of Construction: 3c i Site Address' City State /Zip: I6'() f, _ u..). OA 1 14-1.01 Sou.t■&V►Mgoc_sy Sete Tax Parcel Number: 2057,- Phone: 6„/2 - `/a -/7/7 Property Owner c 4'h Lc, h G ; w y UT. Street Address: City State /Zip: as? LAIA1',vevs;.hy Aof tiso St PA„1 Ynto Fax #: ��_�03 -- /��/ Contact Person: j -Vtkw GUsey s$`I(y Phone: 6/c2- .i/o ^ /7/7 Street Address: 11s u.yn/6r Z City State /Zip: Fax #: — l n 3 — 7 7/ Contractor: Nb(PRecod, //IX Phone: X25-- ee /- (X%'ZIPD Street Address: / �l5Yo ,c% '151- /� M Inc A City State /Zip: /80 c;- Fax #: 47.5"---- c / - 935� Architect: j O if7J5cx% B 31 Phone0266, - Y3/ _ 796, a 7 Street Address,* City State /Zip: /30 1w on/6e ✓77.Y g. 4 I .5C_nze, WA- 96196 Fax #: 0.2O2 -- z-145/ -- 7% 0 Engineer: -P, --Ie, 4i/it,/1/F�� Phone: a20(9 -- 3) -- 79 70 Street Address: 41660 City State /Zip: /0 ' O' eg 'f £r CASIVW, WAi, 7e/g8 Fax #: c>20& -- `7' 3 / -- 7,7S- MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT) Description of work to be done: - b--7147)1 ,/ T/Pti r9P . 757 7/I.JG WOOL) (l% 7C-C?/A)4 S Will there be storage of flammable /combustible hazardous material in the building? ❑ yes Mno Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er indicatin • • uantities & Material Safet Data Sheets ■ Above Ground Tanks ■ Antennas /Satellite Dishes ■ Bulkhead/Docks ■ Commercial Reroof ❑ Fence ❑ Mechanical ❑ Manufactured Housing- Replacement only ❑ Parking Lots ❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems ❑ Temporary Facilities ❑ Tree Cutting APPLICANTREQUEST.. FOR MISCELLANEOUS PUBLIC WORKS PERMITS'', ❑ Channelization /Striping ❑ Flood Control Zone ❑ Landscape Irrigation ❑ Storm Drainage ❑ Water Meter /Exempt # Size(s): ❑ Water Meter /Permanent # Size(s): ❑ Water Meter Temp # Size(s): Est. quantity: ❑ Miscellaneous gy Moving Oversized Load/Hauling ❑ Curb cut /Access /Sidewalk ❑ 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 gal Schedule: MONTHLY SERVICE BILLINGS TO: Name: ,.5/U% ziec.7/40% Liz, City /State :- Phongr /2 - / 7/7 i ��-` /� f // Ai/t/ 0 Standby Address: 2� 5 Gri✓i►� s�7✓y Viso 0 Metro �, .0 Water /6 Sewer WATER METER DEPOSIT /REFUND BILLING: Name: ( /V/ /. 7c, /A)(j Lz t Addresses- AV/ y $ /7Y yq& '75 I Phone(o /? —62 9/ % 7/ City / ate /Zfh"'ll //. 5_57/ 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 Dale apple, I. Appl (Initials) ALL MISCELLANEOJS PEA IT APPLICATIONS MUST BE SUB ED WITH THE FOLLOWING: ➢ tt.ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN D. BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED ➢ ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT D. STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED STRUCTURAL ENGINEER D. CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.) O SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR PERMIT REVIEW Submit checklist No: M -9 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 0 Antennas /Satellite Dishes Submit checklist No: M -1 in Awnings /Canopies - No signage Commercial Tenant Improvement Permit P ps :QQ �y 1 5INUI�O� -J Bulkhead /Dock Submit checklist No: M -10 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 Land Altering/Grading/Preloads Submit checklist No: M -2 J Loading Docks Commercial Tenant Improvement Permit. Submit checklist No: H -17 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 0 Moving Oversized Load /Hauling Submit checklist No: M -5 0 Parking Lots Submit checklist No: M -4 73 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 in Temporary Facilities Submit checklist No: M -7 Temporary Pedestrian 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 1 /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 ME SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THfrC WS OF THE STATE OF WASHINGTON, AND / AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR A EIMRIZED AG NT: Signature: , I' �� Date: ZR 98 Print name: I �r�Q��j,� a fi ,'_(��,,L P ps :QQ �y 1 5INUI�O� -J Ft"--819) //, ,�f Address: i5iO h6 9 5� Div f1/v9 (44 Q �8 r2- City /S_/l 7 0/� (�-S93 996,502 ■1..0 w V " «} Si 1. w �;G..'" w-trr cITY OF TUKWILA Address: 1.6038 WEST VALLEY HY ' Permit No: MI9870093 SuAte': Tenant:, :, S,tatps: ISSUED. . -1.1.toe: MISCPERM: .. . ApP1 :led: 06/01/1998 , Parcel 41'-. 000580-0005 _ Issu04::07/06d998 **********4(44*****************Ak*4*A*******11i*****4141,A******** Perm i t Monti I t ions : 3 Temporary eros i on contro 1 measures s ha 1 1 be 1 m01 emented aS the f 1 rst order of bus ineSs t,o.:„..prewnt sedimentation off-. s te or into exisvin9s05:0md4y1q4c fi0411ti es 2 . The s i te sha 1 1 ha..041):e1:.:a46E e ro s) ii—e61100easures lace as soon as Do.Jb1e after f tna 1 grad'I'iWh0: been comp 1 et e d an 1,61-. FO 01 P ec t lan 3 . ALL, CONSTRUOTON A1'TIVIpS,S6CIATED „,,WITH.90q1 0EO6LITION c' HALL BE LlOitED'jOAWTHIN 10 OF THE ticifiL04gxtEWT: 4. Sewer a n0a't ut)l4r1 t s ha VI 0 .11.1!1g0 d -at ma i f they a r.;.0,po 00 abandoned. If they w i 11 be used _ the near•future, for„ra new bui 1 din:91, they sha.1:1 b0oapped at thel4Yroperty 1 Inc and at t he water meter respe-Ctlyely 5 . APPLIONTSHALL COORDINATE WATER METER REMOVAL 'WITI-LTOKW10( MINOER SHOPS. CONTACT MR DAYID,AREGE @ (206)4334180, 6. No ,*ange*S'-vilf be made to the olans or scope of .Wori3Onlei,sA apPrO'vedpy the enqiner- and,Tukw tja Bui 1 d irio Divib 7. `Al 1 permi ts. inpect 1 an records faid. approved p 1 aril: shajj be:J:1 a val 1 ab le at ther:lok site Drior t the ,start of any •co'n strAc t on . Thee. q 4:.6mOn eS are to 60ADa i pia ined anti avail- a001, urit 11 f Ina.l insoect 1,i) 2:a PP rOd.1) e d 8. ,RemOyeal1 weeds. :concr,ete 1..,4tone foundations. f 1 at6dn'l crWt0. 666.crete Oat ios AilanS6nry 1,404s qa ag e floor:S vakS).1 and tpalar s tr 4;uo cre.es ahti',6,31,400se-,:mtsce 1 1 aner4iS ma ter lal Pr aper cap san itarYsewer,„.ari-toAter conne- 01)i \, fluDer1y t i l l or otherw se/0r0e.ot ,a11j,ba3eMentiy: ce 1 lars 1(,s!)t lc A:ta.riks v4e1 1 s .and ather 6‘A C aV4 i . Vali dtty af Perriii t . The i ssuanice of a Derrnit orf app roi'a 1 btiti , o 1 ansVtiSpeci t i ca ttons , and com04ta t40 6), s1;10j.;';.pot be cOn ,struedto be a ,sf,erM tt, for. or an apprbv*I-I'c'f" a hyy101a0Wil: - of any '.0)2!yisiorls of the 1)6 i 1 d ing „code 01 01 6 other orAAnancer,.0, the Airltp.,0 1 , 4146'p erm ' to ?i tee authority to 'violate or" 6 c41*W the provisions s.0,,thls: .code sh al 1 -0eve 1 i d 4 svA,,, PLAft'VIF1N /RI NG'SUI P ACTIVITY NUMBER: M198 -0093 DATE: 6 -12 -98 PROJECT NAME: CSM HOTEL Original Plan Submittal XX Response to Correction Letter # 1 Revision After Permit Is Issued Response to Incomplete Letter ,. // uild•ng Division . °r 17-cf0 E W IVo ire Prevention „ • inJ Planning Division 0 °eFrkft C�lordin c f ��(( DETERMINATION OF COMPLETENESS: (Tues, Thurs) Complete Comments: DUE DATE: 6 -16 -98 Incomplete n Not Applicable TUES /THURS ROUTING: Please Route El No further Review Required Routed by Staff C (if routed by staff, make copy to master file and enter into Sierra) REVIEWERS INITIALS: DATE: APPROVALS OR CORRECTIONS: (ten days) DUE DATE: 7 -14 -98 Approved Approved with Conditions fl Not Approved (attach comments) E] REVIEWERS INITIALS: DATE: CORRECTION DETERMINATION: DUE DATE: Approved E Approved with Conditions 0 Not Approved (attach comments) Q REVIEWERS INITIALS: DATE. \PR•ROUTE.000 CITY OF TUKWILA Department of Community Development Building Division-Permit Center 6300 Southcenter Boulevard, Tukwila, WA 98188 Telephone: (206) 431-3670 REVISION SUBMITTAL DATE: 641...4:1 ( f--; PLAN CHECK/PERMIT NUMBER: P"U. PROJECT NAME: PROJECT ADDRESS: t."-Ci JA- 6.1 CONTACT PERSON: V-: PHONE: (.200 46 1:1 .7 REVISION SUMMARY: 4 .1--) f.) ?7!.* 'qui; Ri Li\•14t L X 61; ti:C;-.S Vbt,, ') ) - -rt. RiFirtFiNfrn • (;SHEET NUMBER(S) E.--:-G-'- 1,..i trri-5-;:: k p„..) TUKWILA PUBLIC. WORKS "Cloud" or highlight al! areas of revisions and date revisions. SUBMITTED TO: mthAd ,t4) PLAQE LIP ACTIVITY NUMBER: PROJECT NAME: CSM HOTEL XX Original Plan Submittal Response to Correction Letter # Revision After Permit Is Issued M198 -0093 DATE: 5 -29 -98 Response to Incomplete Letter DEPARTMENTS: {` S P) Building Division ❑ Pu c Work J4 [aph d o F're Preevention (o -3r4 Structura t \l isf:f DETERMINATION OF COMPLETENESS: (Tues, Thurs) Complete 2, Incomplete Comments: j)10 11111513 ivision n Per it o rclinaior DUE DATE: 6 -2 -98 Not Applicable TUES /THURS ROUTING: Routed by Staff Please Route No further Review Required (if routed by staff, make copy to master file and enter into Sierra) REVIEWERS INITIALS: DATE: APPROVALS OR CORRECTIONS: (ten days) Approved _ Approved with Conditions ❑ DUE DATE: 6 -30 -98 Not Approved (attach comments) p1&). Correo-iavt. Lfr-1 m6LiPecP REVIEWERS INITIALS: DATE: CORRECTION DETERMINATION: Approved E Approved with Conditions ❑ DUE DATE: Not Approved (attach comments) ❑ REVIEWERS INITIALS: DATE: \PR•ROUTE,DOC 6/96 ���i'•.I.R'l. •i'i'm+S1.. �;'1= . {_eQ(fa¢i�; •iTS.i)!TC2` .�i.'I���� "S1Y�nt •+n.. �' n» �iab "2M:P.t1CCY:�''("^}'�!'ijV; INSPECTION RECOR , a Retain a copy with pelt INSPECTION NO CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100,• Tukwila, WA 98188 M T-99-009.3 PERMIT NO. (206) - 4313670 Project: S�� Type nspecti /"" 7 Addres • > / D e called: Special instructions: e ,61.'e (lac/ �� 1 M -6,7 Date wanted: � a.m. p.m. Requester: Phone No.: Approved per applicable codes. Corrections required prior to approval. COMMENTS: ___//679 e)4 /-7(A/e, fae-1 ,tALQ k/ePt4 IIInspecto 1I Date: Ci S42,OYJ"REINSPECTIONuFEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection, INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECD n Retain a copy with p.-lit (206) 431 -3670 eislyi Opel ito-,ryin TYperr ...1 ' Ad rer534 1 1 , io / ` 1 rq Q Date called: 9 , i i Special instructions: Date wante q a. m. Reques r V Ph n ass/533 Approved per applicable codes. Corl'ections required prior to approval. COMMENTS: 40 ei/ ;/e.4 Inspector: Date: cf....",2„:2,1f. 1 T] $42.00 REINSPECTION REO IRED.'•-Prior to inspection, fee must be paid at 6300 Southcenter Ivd., Suite 100, :Celt schedule reinspection. ' c'.l nl' p'! eM1`. r' �^ ai! b. t�} �..' wf .IWf'/'S'9�^!.f'.�Si'itM„f�.�"w y`rw•..'.• •r ka}'%LN.+lki l�� INSPECTION RECD" Retain a copy with INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 St•�A•t Ytyt�, -ooe 3 ERMIT NO. (206) 431 -3670 Project: Hd4e. / Type of inspection• J 4J 1-7; "10, / Address: 1663 S- 14- Hr Date called: 9-/6-9E Date wanted: r� T-72-7 eo a.m. p.m. Special instructions: Requester: ai C Phone No.: • e-13I- 7970:: Approved per applicable codes. • Corrections required prior to approval. COMMENTS: IInspector: Date: ri $42.00 REINSPECTION FEE REQUIRED. Prior to irfspecti n, fee must' be paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection.. + �+. s. t+- ^^_a.�...".'Y'.a'7"e�••,� -`r..: a ^xega...r..- �r�+.w INSPECTION RECO 7 Retain a copy with p .lit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 f\A‘9?)-0,D93 Project6 s w\ Vx.O Type of inspection: II �� D V) MT Address: Date called: Special instructions: Date wanted: G lirD�1b a.m. p.m. Requested; A TCM C`-lis-Ci/--S Phone No.: 0/Jt% (17( r Approved per applicable codes. Corrections required prior to approval. COMMENTS: `I /143 OAC r- c 4 11 ■_. f CI A`'-"`NeA— —' —C1 — )JQ S o•- e/ 1-0 TCM C`-lis-Ci/--S __ G 106kQ C-eXtei 0/Jt% (17( r ____LALccrwt L%&QL Q St s,aiLQQ 4 0_, k lb (2 C co i 51 c `■..iNt,.,& (," ,-. I Inspector: ` r I Date: F-1 $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 permi CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 GG MIT NO. 431 -3670 Project: C Type of inspection: 14 Address:' (4,44 (t4 Y Date called: Special instructions: / Date wanted: a.m. p.m. Requester:` Geri ` /��r01/41 Phone No.: Approved per applicable codes. Corrections required prior to approval. COMMENTS: 11,--770 7/2/6 [Inspector:. .QL,Lo IDate: $42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to . schedule reinspection. INSPECTION RECO, Retain a copy with pek.,lit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Mi96-1c2;9_3 PERMIT NO. (206) 431 -3670 Project: , 71 Type o spectiol}� / txw O A . resspj ,,� ��4 r.t i Date called: dam Special instructions: i wanted: a.m. 7 -2s-f-9f P.m. Requester: hone No.: a ��G —663 -2. 64-le, Approved per applicable codes: Corrections required prior to approval. COMMENTS: .:r•i- 27 #(61-- 4 C� r iu 710 r t (Inspector: - V Date: y� [1 $42,00" IINSPECTIOM"FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection. fl nrw wr.ro +:t: t��; ?�; ^� ���'7,1"':�i/�M�� %�TS��p*.�, >�r �ry.�itr'. fit. J l k• a• kkk*• k*• kkkk: tlr A•Ak:k:k•A4••.kAk•kA4••Ak`k:Fk AkkA.: k•. 4: tAA••• 4k• A..{ r :.•kk•h•k•kk'A- kA.•.l**.:k•AAA. CITY OF TUKWILA. Wit .i 2 ,NOM1'1'. * k: 44•. k• k•kk Air,tkkkkA4*kA•kA•kk•A;4Ak•kkA Akk*AdtA4 —Ai *A* *4cA•k•k•kk•A**A i*ak': I Rr•INSMI1 Number: R92007 '42 Amount: 71.,b0 (Y /, O6 / {9Ei 09:48 VIRG i 1 : Method: CHECK Oot t i oti a WUPRECON 1 ti:. • Per rn t • No 14I`:313-00 3 Tvpcli: MI'3CPL1M: MI 33CELt.(ThL•OU , :•I'I�RIIIT: Pair oe'1 ;No. 0095E3070005 Si Ge Oddrrs•<; c 16038 :,WEST 'r .V(dLL1IY '.IiY .rata.1 .Fee-s': ' • 71~13 • Th is PEtvneht 71-.50 1 til1. ALL Fliit si:. :` 71 .1;9;. *a k•kA•k klc.Afi.AA lcfit•a k•k#44..kAilt.•k+tkAA ic.• *•k*k•k **A•*I tM. 11.k1 e•k *.*kA * *•kof•kii * * :: i4cc.c }1Ant ' Codr Des.c , i qt fon (i111Q.U.nt ::. 000/�3:.�2 t00 13U11. DING - NCINREB 42.',C 000/343»1330 PLAN, 1;HLCK -, IJTI,LI rY . 10' ~0()`' 000/386.904 STATE LL3L,OINt'SURC4 RAE 4;50. 000/342'400 Iii 3I' FEE? •-• urILI•rY 1 ()0:','. 4;C!'76 f Al /A1 riti ,05/29/98 11:21 FAX 208 433 1833 CITY OF TUKWILA CITY OF TUKWILA HOUSE MOVER'S LICENSE APPLICATION Tukwila Municipal Code, Chapter 11.28 Annual License Fee: $50 PLEASE NOTE: Applications must be completed in full and fees attached prior to processing. Name of Company tm002 Ntiprecon,Inc. (.425)8R1 -0621 .Phone Business Address 14540 NE 91st St. Redmond WA 98052 City Statc Zip Local Manager John J Hennessy Is Company: Individual Partnership Corporation X List Owner, Partners, or Officers of Company: John J Hennessy 3532 207th Ave. SE Issaquah, W 98072 (42.51.91 -155 Name Residence Address Phone Have you ever had a Tukwila House Mover's License? YPs Previous License No. 00319468 Washington State UBI Number: C 600 640 239 Submitted with Application are: x , a. $50 annual fee )C b. Surety bond in amount of $5,000 X, c. Statement of inclusion on public liability insurance « * a * * * * * * 4 4 * * * * * * « « 8 s * * * « .s * * * * * * * * * * * * * * * * * * * s N * * • * I hereby certify under penalty of perjury that the statements furnished by me on this application are true and correct to the best of my knowledge and belief. ROW Signature of Applicant Date / 1 Approved By: FOR OFFICE USE ONLY Clerk: Public Works Director Date Issued: License Number: Reliance RELIANCE SURETY COMPANY Philadelphia. Pennsylvania RELIANCE INSURANCE COMPANY Philadelphia, Pennsylvania UNITED PACIFIC INSURANCE COMPANY Philadelphia. Pennsylvania REIANCE NATIONAL INDEMNITY COMPANY PMiladelpeia PMn,ylvania KNOW ALL BY THESE PRESENTS: That we, Nuprecon, Inc . BOND No. 273 14 05 LICENSE OR PERMIT BOND United Pacific Insurance COMPANY,a to transact surety business in the State of Wash i n g ton cif Tiiksriln Pennsylvania as Principal(s), and corporation authorized as Surety, are held and firmly bound unto • _.. _a. ■. OM as Obligee. in the penal sum of (S2. 000 .00 - 1 DOLLARS. (awful money of the United States of America for the payment of which, well and truly to be made, we bind ourselves, our heirs, legal representatives, successors and assigns. jointly and severally, firmly by these presents. WHEREAS, Principal has applied to the Obligee for a license or permit to do business as streets hauler on public NOW THEREFORE, THE CONDITION OF THIS OBLIGATION (S SUCH. That if the said Principal(s) shall comply with ail .applicable Ordinances. Rules and Regulations, and any Amendments thereto. then this obligation shall be void. otherwise to remain in full force and effect PROVIDED. HOWEVER, That this bond shall continue in force until: 0 1. - , 19 or until the expiration date of any Continuation Certificate executed by Surety, at its sole option. OR 2. Cancelled by Surety giving 30 nate its liability hereunder. SIGNED AND SEALED this 17TH day of i days written notice to Obligee and Principal of its intention to termi- July .19 97 i is Insurance I ■COM NY JA°V Assmey -m -Paa • THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER SIJRETY.COMPANY • • mrANCE INSURANCE COMPANY CIFICINSTJRANCE COMPANY •1' RELIANCE NATIONAL INDEMNITY COMPANY ' ADMINISTRATIVE OFFICE. PHILADELPFIIA„ PENNSYLVANIA . .• • POWER OF ATTORNEY - - *No W ALL MEN BY THESE PRESENTS, that RELIANCE SURETY COMPANY is a corporation duly organized under the laws of the State of Del- aware,:.and that RELIANCE. INSURANCE.COMPANY and UNITED. PACIFIC INSURANCE COMPANY, ara corporations duly organized under the laws 'of: the Commonwealth. of Pennsylvania-and that RELIANCE NATIONAL INDEMNUM COMPANY is a corporation' duly organized under the laws of the,iState of: VVisconsirc (herein collectively.. called the Companies!). and that the-Companies by virtue of signature and seals do hereby make, "constitute_ and-appoint Pat: Russell. -Reg- Branston; -Kris Hamar.. Pamela. Ahem. 'Jarighe, of Bellevue, Washington their true and lawful Attarney(s)-in-Facr, to make execute. seal and deliver for and an their behalf; and as their act and deed any and ail bonds and undertakings of suretyship and.to:bindthe Companies thereby as :fully and to the same extent as if such bonds and undertakings and other wrrtings obligatory in the nature thereof were- signed by an. Executive Officer of the Companies and sealed and attested by one other of such officers, and hereby ratifies and confirms all that their said Attorney(s)-in-Fact may do in pursuance hereof: • • , _ ., ... .. -This Power, of Attorney. is granted- under and by the authority of Article VII of the By-laws of RELIANCE SURETY COMPANY, RELEANCE:INSURANCE,COMPANY',. UNITED PACIFIC INSURANCE COMPANY,.-and RELIANCE NATIONAL INDEMNITY COMPANY which provisibni are now: irr fulL farce and:effec-m'reading•" .asfollowsr-;•-,- • 4...i:-!...'..."•----1:7•"•.',.....,::::, 4,',. --. - ..:- • ... " " -:-. • -.4.1.7.7.'.': --.-..-47,--.;gi"..-.:_s 1;;;:;:::-L..;;:;;.. '..:,4' t--;:_.4.7.:, . . . ..-: ........-1.-:- ... -.:1-‘,..I.0:•.itz'!•-....T-,. . -,-"„....!•;);:.••••••• - • • • '•!-• -- • ' • r.' -:„... ._•,' • --...': ,-• • '• • . r.. 7:-.•;„.-,. '.,: p,_,--,- :-. ,....--,:,•;•-'s,4'vt:I-- . ...' r4.1,..._.."-, iy-Te.-7-7.7.7.. ARTICLE Vitt- IXECUTION" OF' 90 ND ANC1' UNDERTAKIfiGS:s,',.. ' .. 7- ..-.7.:-‘?-.."14.4 40.•-•• ._._ 77,-..-.:-'' ,',:7•''''''':.:,.i:;:".3. --'"• '41i% -ir,-;,,•,:.'••• — -":„,7,:3`4,iikt,;•:.v.,71,./_-,:a--••,-,,,3-1.r.-.,7--„,..,,,..7..-., ,7-, .,..'4---.: '".,*::•••• •,, • , ,': ....., -:„...:E.,...,.....__ ........,:r.,„tie - -c.,-...%-....,7,. 3.,..----k.,;.,....,,s...73:,..:;_,.......if.;,K,e.-...:.ri,rtf..,---.4......4- .•• '41,•,-,-,,.- ' .-e-:-•r*--..,..-;:;;','..,...-1:1`1.'1;;;.,.:—.',,i2J-:e;::.v.,-,.-'"..i".-.."....:.,,--4'. :--ii.5., •1•••=.:;".,-4..,-" - •`;';17t Y . . • • • 4 ' . . 1 7 ; • : T b e t . F l o a r c r oC oierctori,.yle Piesidene.the Chairman or Our Board:•ifrr Senior Vice President; 'enyi.V1Pa. President or Assistario..1:hie President at -other olnoaa...q•saan,d b?ti'l!re4antnrq ._ Oirectots shall hays pow eiC'indautricaitY• tcS7-tatTprioirib..Atti3Weyagn:Fact enet-id itirWrizer thlit Co iiie-ctits oribelieteof the 'Cceniiany:liandiand Under takinal,:leoligi'lzancas;-aantraCti. °i. riWI;inntr;;':". and bitter writings abligstorY in tbS nanMe theneoKand (4 ttz' rernivilii. sny ... itichAtainirylsl-in-F:edt. a any— timeendrev-okiethe power andrin,idiy given to therm:: •,•,i•••••i;'t•-..-.•i7-I-..";',., ------.7-r4lViS , .45,...;•.;' - -•:,',...-• ' -,•--,...--,- ••!-!•:,'"',.-.".•-•%:i•,. . ' • '' •"...- .. ....._-• .--...,••••__ .. .,:-.• ;_, ••,-. ; "... -....: • ....1.'• -,- .•:. -...• !..*.4.:, l'•:. +., ..' • '• -t ."., ... • . • :. , : 2:.,. AttorneyLs/ -1n-Faliihall hava-pc;;ver. and authorine. subject ta- the teirris "and Irrnitatians-Pr the POwer.ae ttorneyuer/Ars them:. to'executedeilveron boned' at the Company; bonclyz.: •• ancrtndertakings, recognirancez, contracts of Indemnity and other wntingse obligatory ire the. nature theeeot-,Thes corpotate mai i... no necassarf fet the .yiirctl.ty ot any, Wands andundertaking..• • ' • 1. •Attomeylsr-in-Facr shab have power and' authority to execute- aftldsviti recfPin;c1,'I'd be'ettacKeircis bonds, recognirinces. coMiecta or IndarilnitY ••• ...,.. recognizancai. =Mr :ICU 0i indemnity and °thee yin-Prigs obligatory. in the nature- thoreoe-, --,•:;;i:.„..• ....Z.,:i..,,,v;,,...„„ '2:3,;„,....,•,,,-, „„ . , ..,, ..„ ,i,.., _ ‘.. ., „. j; , „, .,........ •-. , . .. • „. -, . -;,'' ,:.' .. • . ..'... • ,„ „ „•,_ -- . .,,- . . . . undertakings and they. slier also have power and authority to certify the financial. Statement of the Company and it'Soogres. of. tne 9Y-Laws of the Company or any article or. smthars thereof.. ;•••;,,,i,f., • • ._ . ., , ••:‘,...;.•:-.....i.,;,,r•-:,:lii. !,,,,..!.'-',.?'",::::•:.--..:-.'- ...;,. • - • -. oe other 'conditional, or obligatory ... . . • • ' r - ' ' .. ' 4 ' . - • • .•: - • •••.• • . •• • • • , I'••I .7 ,..•!,,,,,-,•,;•,,•...,,,'•,., , ..' ,„....„ This. Power of attorney le signed and. sealed by lam imile under and by authority at the (Mowing resol titian adopted by the Executive and Finance CcOMIttses of the Boards Of Directors of Reliance- - '. ' • insurance Company, United Pacific Insurance Company and Reliance Nationer IndaninitY Coantnirr b'e Unanimous Consent dated as of February 21. 1994 and by the ExecutIv• and Financial Committee a f, the Board of ()tractors of Reliance Surety Cam deny by Uner,snous Camera. dated- aa oe March 11....1994-• - • • ..• • -:, .: . , ,..': .- ..::: ,-.- - .:......•,,,',-+':::4..-.•••:' • : 4 . '`..!. :1:•••.`,7‘;' i,-,-.•;_•-•.51- '.4...'I:i• • .-'•-:•-•':" - +.7. 3,":....YI.C"?.,. re;Q*,•,•skti ---e7 ,.13,•••••aatNi./cser:#1,:•;,,,,-is -- ,•„,t:,?::.21-• .. , • • : , • :.:--.. 1.-... ' ' : ' • • -. • - .._: :- „*„:„.: •_, • .4;:flesolvect that the: signatures at sucndlrectors at KV.otficers and the Seal tit the- Conipsery- may be, affixed to any such Power at Attoeney or my certificates relating thereto by :•.'....'; fad:mar:4nd any such Power at Atom or certificate bearinwstich facsenfle signamiess OcfaCtim-ila 'seat Shill be. valid and binding. iiixin 'Ow Company and anY such Power 10 .;.""'".....aeitaitied and certified by facsimile signatures 'and facslmile- seat sPalI be valid and nng upon the Comperiy,n CUB (um, with respect to MY •• • bond Of undertaking. to which. it is .. .., . . attached: . • • N. WITNESS' WHEREOF ; the. Cam-panies-. havei"catiSect these presents • to • be signeEand.their.corporate seals ...to be hereto affixed ,...this:Auguit 23.. • •- • • •.... • •. -;:-.:Yft ':)1APtetr...1.•!'.47tit.t--; ..!0.....- .-,-....',...' 7 :egZ!1-24.t.„,`"Z,:,t:;!...•.....,'•• 11;•-c:oe;i4t.i. '-'r' '' 4, ":. • ..;•';' '''''.'';'*;;.*:".: 1996..11 - ":.tr :" •-'7•. '!..;:.'•,.:.• ', .;-:!-:--,x2:- .;• :„..:f:;•.•••*•-•,•;:••:•rf;.h . 4r.-x• ..:- • :: -.7-.:t.'•'-.!:.-7,..-m-4::.;--Yt,,,,....:-,- • ••• - • - .. •••,.,, - . ., .•-.• . •• •••-; ....1,:„•:•-1-s.r•LeT,• •.,-.1..,"! •••••• - - ,;.4.• •",.::••-;•I'F:'•,•; •-•-'...:-'•c•,......rr'44::•-•:•f - • "• •.•••••'''''''",.t•••••,....: • •:.1' :.-..::•,‘:,,1-t':•:. :....:•:- • . • • ••,•" • • ••, ...'.:‘. :;'•:•;,.,••:y.;..-;-.)-,..".-r:,:v.:-:,;•••?. •.. • . • 7-••• ::, - :-• ., - ...--•••;'-:.:f:" '7' '.:.'"--'7••;••••.'-•••'••ii. • . •-•-.---P-. •••,e .:•:.-..` 'et.-+"•';'-':' >*•'"'' '.• • • . ' • .---.2:"......,..`• , RELIANCE SUREr?..-CON&ANY '--- •-.....,,...,4',..,''..-1'...,;';'1f"■•;:i.;ii;Cr.cs,....--.44,% -fr- • • •:"•:e:4 a " ' - ;,-.....!...•• • ••••“ •••••.?...,-.-ta.„. r-•• . • -,4 .. • . • . :'-'• ' '"5:'' :::ir'''+77:Thf'• ::7•••24'.1.";:•:::7?:::a.•::-/1:7.-'..•':'1441';;"'4).1.:..-...."'•`4..Z.•":-.-. .f'-ft.•;...1:4-7-,.,1 ••••••••:.:?..:,.*:1.:1.!,..%::::-.; ,::_' ... • %...,..,t......:,R44AcICEqiiitNiSsuUllieNCcEgrOMPrvipANYANy.•,..,...::.,. •• •:5•'•fit;.1--i•TTAY'.17,',7.:,•..-•'gf.'•-•••• ,45.1,1,-.J.,; ,',?-"- •• •, . . , • ..r. -.I.- UN/TED PA ". ,. .. • --.-. ,:r;.1..,:.-...-_-.C.A.:.;:-•,..-%•-7- ' - ".•:- 7 •••.1!. 4 : ....e,,,......; • . <•• .... to...."'!,-M:77...:4-,"..-2,.:. : . . . z4,41 - : ' ; . :R..ELLAN;s. .....:, ,C.Er.IVAITI....ON'i AZ. INDtivEMNITr.,0%.7C,6_(‘NIPs.:, ...._,ANY.ii:. .;,...;;.{..1,1.)..;.• .-.'" ••••-•f•i.r.C.'71-:',.i.."-,4tt."1::ii,k"..V.4.1.,.........:.:,- i-.7)4;,,iv-,:„.1-.•:.;-2..;-:•:-.,.. .. ,e_.2..... -.-.0...., ..,...;,,...,,,....>.,......te.....,-"!:*,...Ah...,,-..::•,...r.,-.. . •rt. •!•••:,-,i,..:i ,„.%-....' -I, .. ' ....7 • -, . •........,..,.. . ..."3,.....-. ,.1.1.. ,1,...i.t..• ..*.• .. ...p ,,,.4,:....,,... v. ...-.-!•- --7.- • • • ,,ii..1, • •■•... ....-f au- Yag. /',,,-;.: ' " ••• ;•,..:. Y ., ,i..f . • ''' ' • r'-1•' .......1.7. -7.: ■ e."..''' .., .•:. 7 ....,<I,..:0,6,4„;:..r..1._.,:y.:.:<.7....•.:•:,..--;:;,..:;,.;.:40•_,. . ....t.., ,.7.. .-....,!C.:.,;?)..• , - .1,.. • -- • ''••••,.-. -:. .....,1' : • .. .••,.:, - •Li..-• ' 14c, . , „C.O. ■•••rti',1"-•1".‘"C • :At 5 .!;■ .1-14i.:' . ' 4 2 i".7: • _ i'besi:ob •• ..A, .,_,..4.... .:,../. •- • 2,1,?;*•••.• 1, .. . ' . ''' "'"44-5 4 ...t, _?4--X:;:.,i4, lile.■:.;:-.."il • . •::4:1"S,.....1; •••-• 7 .*••••,).■"'':::',J V! , ..."4...:*;?4:, • . : ,4 -•"• • 1. ;TA TE '0 F was hingto n;::- l',:" '." 1:::.r.:1:4:::;*,. .;s:•.`t-v.7"-c,t7-:',g.ktev:1-,;,•:"t4.-Ps.r00. , .,0-11g-TufIt7.4........--. 74..."".. i.t".-• 4"..7.i3.--:•.`"":, ;,.?1;.:.: ''' • 'AI°. . . .".''....''' '" ""' ""' " :OUNTY- OF Kin g:r...F.:q4',17:1; r'ss-::,.s.:54;,",77:7; . ":2":_•••;.'2.41:4:-,a1.11,7;--..--;:d.t1,, -tc'ovp'.;":''''C.:•'^'-1-.7-.2'••••;'-'-'i 7•':%•-::;•.1-7.•! ". .":„.. _ .,";•:':: '"'."'s : - •••• ,..:••::-;)i-.7'..--4:4'00fT.k.-:••,;::•,,..,:.•1,.7,-,;--,-,,,.,• ,....„.-z.r.,..•-••:-...7,r, 4.q._•••■••••.7,-..;-,.....•••• • • • • :••••e•-•:- I! 2": ' ' , .. .....'•,, •:' • .• ' • a f :4,.. ... ,,,g,„ 4 .... :7 •,. • .r.,. . ..-_ .- li;.'''.•_,.:45-1.; • .• .;---,1*t.."i.::'•:;:,-, , •• : ': Z-7', .•,'?.,i-7;:?....,;_...Ii-, ';::::,--1•■•;*^;;•••••••••?---4."...-:. "._-;■;:-:.4...-,..-.1-f2-::.-r-,7-;•-..-.- ..N.".r-l...-c:2-..-P.4t!::77.-7,` 4'.1, j''.'1,1.:1-7jt7i;ri,_... * •••=:4'•:717"A-, )n this,..August 23199G before me:Janet' Blankley-,.personallyappiiai-ect4iikW::Al'sud.Who acknowledged himself. to ba. the- • Vice. president of ..••,,;. he. Reliance..Surety.-Company:Ilieliancer, InsurancterCompany;.". Unite& E*ifi-c..li.titiranactcompanyand . Reliance National indemnitylCafnpany and ....;.1...2: hat- as SUcn .',.. being authorized to" do., so ,.• execute& the. foregoing,;Tristriirnentiftw/the'Curpose therein Contalnid by..signing-,the:liarne of the -•e:•;': orporauorr by himself as its duly authorizeci, officer- 7.:7...-.=-'..-,,'.,.::.:..r,1•*".. -Yry.c.1,-,c;,-.;;,•:,...;..,;..,...• .., ......., .1 :....... • , .'" 2: .....,077. ".:.• , • t:7, .. 4.:..7.,f,,..•-i. :t..,L.:.. ;;',..1............,..,.,_ ." . ." 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INSURANCE COMRAgY•;;;TINITED f AtairrieeZticunict bie:la said Companies-,.... which- iiiitilLir'quir forcrtand.-effect:'--aiif7,;;;;.....,' r.•.:ve:". 4. ,1': 7 ..„-;,1471.-_.-,;)..!,....,."..._7:1,.,.,..4",;.1 f .. ,i 1...i.,'..--re‘Z.T444:•:ZZ.-:(...ViTE•4,1±7.7.,..;1'`''';7.,i ''•••••*3%L. 4ris.,kia•.-1.,71.4..-!". -rf .'• .7 .2; .1-f.:-",,-5.pt.10‘ .:)..iVY'1?■.:f.Z.Z■••■••:;4■1■■`'..... `,`..Pr:....l''" . ‘.."4''io:s°27'.'...r...7';.::`!'... .:A.41..r"..A:,',,, .-.%.-..".4r, J WITINJESS..WHEREOF;••1: have hereunto, set,rr*.hancilaiid-affixecrthesel"&bEiaitt:Cortipaieekthis '...-1. T Oily ot . Till T - .1.'". . •••*!'-ixvi!". 7.5,1"...,1' T'....'. 4,:;',.., -, .....,-- o .-.;-, via: , ..,::. ,....-:: 7.. ..,,,,-. ;,: ,: ...:. ..:. ..;,.;., ;;;,..,;-; 4'. ti•-ytiri,;:s7.:,,;: .7.7.•,. • . . ;. : - _ • • ••• ---. "' 'OW .yr- .......... • • • .• ..", •• 1' ' '`''' . 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"to 1.--'..AreTr4s4--1--- • • `rik•-'1-4i• Porrr,-:•-si:.:A• ..:,...Y..A44:.::-.,,, . ....,. ....,. ...z-» 7+-c1;"'lirll.";74.:4',,.1.7.' :".41*-1-":"...i)F:-'144.4,4:4. 7:14(.1c ."-*.'" °"71a4-t-i„4-fft.'.13 •••,',....”,47,..,,,',h--t,'-.';i:t1.1.4,It'-t, ..--;•S;...: .,...:.•7:;-,; ":•.ki...r.-.7.re, l'''' ''.." ..4e.- • . •.:;,.............-.4 . .,..i, ',....■:: ,vt,.t,2“...e..••■• ..„,.;),:k4.!•,,..,,t;&,,,,I,,,,pAor.1.•. yt,.... el,o, •••■• • xj,,vitzwit, "'CI-4.Y_I ''''-.-'.* V-4,-•%,t'i'.1-2.-enA...,,:•-• , 7.7.•7•. .;';...'4,W e:1:, ,'••,r......:■P '''•-•••• . • - '::: ... ...571,17 ''..r g ''....":1"." ...; l .. . . . •••.• ....7!” 1.7"17..;..f‹,i...; 76. :Vei,'",,t',:t . ofV,.. • • L • THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW MAY- 2 -�c, Reliance ( Bond No. dated in the amount of RELIANCE SURETY COMPANY PNHadelpAia. Pennsylvania RELIANCE INSURANCE COMPANY Pfeladeipnie. PentSyMnia UNITED PACIRC INSURANCE COMPANY Med( Pennsylvania . RELIAILE NATIONAL INDEMNITY COMPANY Ph4Iaedpnla. PeRHSylvsnm CONTINUATION CERTIFICATE In consideration of premium charged, United Pacific Insurance COMPANY hereby continues in force 273 14 05 July 17, 1.997 Two Thousand and no 100's on behalf of Nuprecon, Inc. in favor of beginning City of Tukwila Dollars , as Principal, for the period July 17, 1998 and ending July 17, 1999 • subject to all the terms and conditions of said bond; PROVIDED that the liability of United Pacific Insurance COMPANY shall not exceed in the aggregate the amount above written, whether the loss shall have occurred during the term of said bond or during any continuation or continuations thereof, or partly during said term and partly during any continuation or continuations thereof. Signed and Sealed May 29, 1998 110-1 4 6l .4 United.•acific Insurance COMPANY Kris Hamar Aoomey- in•Pad ORIGINAL - o81JOEE PINK • *RANCH CANARY - AGENT ACORD CERTIFIC `'E OF LIABILITY Inc. -3467 FaxNo.425- 646 -9616 DATE (MWDDIYY) INSU' \ PRE 1 05/29/98 PRODUCER Bellevue Western, dba : Ribble & Prentice P.O. Box 3467 Bellevue WA 98009 Phone No. 425- 454 -2445 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Reliance Insurance Company INSURED Nuprecon, Inc. Fax #881 -5935 Attn: Wendy Pare 14540 N.E. 91st Street Redmond WA 98052 COMPANY 8 COMPANY C COMPANY D COVERAGES'. :.. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MM /DD /YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PROT SJ3002447 06/23/97 06/23/98 GENERAL AGGREGATE S 1, 000,000 X PRODUCTS • COMP/OP AGG S 1,000,000 CLAIMS MADE 1 X 1 OCCUR PERSONAL. & ADV INJURY S 1 , 000,000 X OWNER'S & CONTRACTORS PER PROJECT AGG EACH OCCURRENCE S 1,000 000 X FIRE DAMAGE (Any one tire) S 100,000 MED EXP (Any one person) S 1, 0 0 0 A AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS SJ3002447 06/23/97 06/23/98 COMBINED SINGLE LIMIT $ 1, 0 0 0, 0 0 0 X X BODILY INJURY (Per person) S X X BODILY INJURY (Per accident) S X PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT S — OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ _ AGGREGATE $ S A WORKERS COMPENSATION EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE AND INCL EXCL 5J3002447 WA STOP GAP ONLY 06/23/97 06/23/98 WC SMBS X O ` % > .• " EL EACH ACCIDENT S 1 , 000 , 000 — EL DISEASE• POLICY LIMIT S 1,000,000 EL DISEASE • EA EMPLOYEE S 1,000,000 OTHER DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLESISPECIAL ITEMS RE: Hauling Permit CERTIFICATE MOLDER .. ....... .... ;:.::..,.......;......... • TUKW -01 City of Tukwila Permit Center 6300 Southcenter Blvd Tukwila WA 98188 ANCE LA ION.........., SHOULD ANY EXPIRATION 20 DAYS ::::...:. .::..:. ;:. ,:.:. :. :..:.,.................... ....:. • ::::: •:�•:�::.,•.::::::•:......::.. OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY THE COMPANY, ITS AGENTS OR REPRESENTATIVES. BUT FAILURE OF ANY KIN4_U•PON AUTHORIZED REPRESWTATIVE THE FACE OF T. S DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER RELIANCE SURETY COMPANY ( UNITED PACIFIC INSURANCE COMPANY .ELIANCE INSURANCE COMPANY ; RELIANCE NATIONAL INDEMNITY COMPANY ADMINISTRATIVE OFFICE, PHILADELPHIA, PENNSYLVANIA POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that RELIANCE SURETY COMPANY is a corporation duly organized under the laws of the State of Del- aware, and that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, are corporations duly organized under the laws of the Commonwealth of Pennsylvania and that RELIANCE NATIONAL INDEMNITY COMPANY is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called "the Companies ") and that the Companies by virtue of signature and seals do hereby make, constitute and appoint Pat Russell, Reg Branston, Kris Hamar, Pamela Ahern Jardine, of Bellevue, Washington their true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver for and on their behalf, and as their act and deed any and all bonds and undertakings of suretyship and to bind the Companies thereby as fully and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the Companies and sealed and attested by one other of such officers, and hereby ratifies and confirms all that their said Attorney(s)-in-Fact may do in pursuance hereof. This Power of Attorney is granted under and by the authority of Article VII of the By -Laws of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which provisions are now in full force and effect, reading as follows: ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKINGS 1. The Board of Directors, the President, the Chairman of the Board, any Senior Vice President, any Vice President or Assistant Vice President or other officer designated by the Board of Directors shall have power and authority to (a) appoint Attorney(sl•ln•Fact and to authorize them to execute on behalf of the Company, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof, and (b) to remove any such Attorney(si•fn•Fact at any time and revoke the power and authority given to them. 2. Attorney(s),In•Fact shall have power and authority, subject to the terms and limitations of the Power of Attorney issued to them, to execute deliver on behalf of the Company, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof. The corporate seal Is not necessary for the validity of any bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof. 3. Attorney(s).in•Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances, contracts of Indemnity or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and to copies of the B•Laws of the Company or any article or section thereof. This Power of Attorney Is signed and sealed by facsimile under and by authority of the following resolution adopted by the Executive and Finance Committees of the Boards of Directors of Reliance Insurance Company, United Pacific Insurance Company and Reliance National Indemnity Company by Unanimous Consent dated as of February 28, 1994 and by the Executive and Financial Committee of the Board of Directors of Reliance Surety Company by Unanimous Consent dated as of March 31, 1994. 'Resolved that the signatures of such directors and officers and the seal of the Company may be affixed to any such Power of Attorney or any certificates relating thereto by facsimile,end any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such Power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company, in the future with respect to any bond or undertaking to which It Is attached.' IN WITNESS WHEREOF, the Companies have caused these presents to be signed and their corporate seals to be hereto affixed, this August 23, 1996. STATE OF Washington COUNTY OF King RELIANCE SURETY COMPANY RELIANCE INSURANCE COMPANY UNITED PACIFIC INSURANCE COMPANY RELIANCE NATIONAL INDEMNITY COMPANY )n this, August 23, 1996, before me, Janet Blankley, personally appeared Mark W. Alsup, who acknowledged himself to be the Vice President of he Reliance Surety Company, Reliance Insurance Company, United Pacific Insurance Company, and Reliance National Indemnity Company and hat as such, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing: the name of the :5,..;' orporation by himself as its duly authorized officer. - ?.-::::: !.,..,: " c ; , �i 1t0e` 'f�� s�:,ly.., t:::.,,, , :::-M" :41,jfr t.'x,, -S±+ . witness whereof, I hereunto set my hand and official seal. �+s 4r _ r � i >: s OT ('%;) ~ G - ¥TTfl12.47 ,44 Nota Public in and for the State of Washingto Reside g at Puyallup • I Robyn Layng, Assistant Secretary of RELIANCE SURETY. COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMP - NY, and RELIANCE NATIONAL INDEMNITY COMPANY do hereby certify that the above and foregoing is a true and correct copy of the Power f Attorney executed by said Companies, which is still in full force and effect. -. . 1 WITNESS WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 29 thday of • May'. 19 %98,. Assistant Secretary g:= -'r,� ' -as , "•f }� »' �'a`� +_:,. S;s _fi�tt • i:_i , -it •fir :�•.' •r1 y•� �.�xh. L. ' 05/27/98 WED 13:09 FAX 612 603 7671 CSM CORPORATION 11001 mlag -eOI3 CSM Corporation 2575 University Ave. W., #150 St. Paul, MN 55114 -1024 612/646 -1717 Fax 612/603 -7671 FAX COVER SHEET Date: Wednesday, May 27, 1998 To: Kelcie Peterson City of Tukwila Phone: 206 - 431 -3672 Fax: 206 - 431 -3665 From: Evan D. Casey Project Manager # of Pages including cover sheet: 3 Subject: PSAPCA and Demo Permits for CSM Hotel Kelcie: please find attached our application to PSAPCA. Long services corporation has been retained as the asbestos contractor. Our demolition contractor is Nuprecon and they will be applying for the demolition permit tomorow. RECEIVED CITY OF TUKWILA MAY 2 7 1998 PERMIT CENTER ' 05/27/98 WED 13:09 FAX 612 603 7671 CSM CORPORATION _ 0002 Agency Case No. PUCIST SOUND MR POLLUTION CONTROL AGENCY -. 110 Union Street, Suite 500, Seattle, WA 98101 -2038 9 8 0 2 7 4 6 Tu nas Mamas !(OT11Ca OF n NT . ; ± r Use Oei L• d ' , `• . • t;�+�+ a nao 1'' N ' 1279 enc Use • - A. Project Type: * . _• - . •. 2. ` Asbestos Removal A Demolition 3.0 Demolition, No Asbestos Removal -- B. Property Owner: CSM C • • oration Phone: (612) 646 -1717 Property Owner's Mailing Address: 2575 Univerai Ave. W. Suite 150 City: St, Paul State: MN Zi • : 55114 C. Asbestos PLEASE PREY? CLEARLY, MS 0E1 se YOUR RETURN HA1LINC Coatreetor: Long Services Co • . LABEL Contractor Owner . /CEO: Mike Cassidy Mailing Address: 8230 5th Ave. South Phone: (206) 763 -8433 Contractor N Job No..: : 822002242 City: Seattle State: WA Zip :98108 Fax: (206) 768 -9580 D. Site Address:160th and W. Valley Highway . State: WA Zi • :98188 Project Manager or Contact Person: Evan D. Casey Phone: ( 612 ) 646- 1.717. E. al Asbestos Survey or 0 Il11t'1 Presumed: No. of Structures: 6 Date Survey was Conducted: 8/97 Was Asbestos Found? Yes ■ If No. attach Survey AHERA Building 41""" E' As1 11 RYE' 'S REQUIRED WORE ALL DDrounQNPROJECTS In&pectar Name: Jennifer Wolfe Certification No. 94 -1613 Expiration mate; 6/9/98 R. Demolition Information No. of Structures; 6 Start • Training Fire (List Fire Dept. as demolition contractor below) Date: 6/8/98 • Ordered Demolition (attach copy of Order) Demollitioa Pam TM4ME NMI, £W RAWL/NOA DRiSSWROX1ONBACK. IP TRAINING BLIRNBXTERPZ/PEDEPT HERS Contractor: CSM Corporation Phone: ( 612 ) 646 -1717 G. Asbestos Pro jest Information: No. of Strictures: (ace back if . 1) 6 Start ompletion Date: 6/1/98 J ate: 7/1/98 t] M T Hours: Barn e 0TH • F • SA • S Barn - 4 :30 m Total Qty. to be Removed: Linear Ft, 1 = : = Square Ft. removed as • -stos material be • Yea by project completion? ■ No Ti erinal 9 =te • Inau , o f: ■ Boiler \ Furnace Ins. ■ Duct Ins. ■ Pi • Ins. • S rf - • - M : t'1: • 'Fire • roofinn : ■ Paints ■ Plaster =' Textured Coatin: s Other: Misc. Mat'l: ■ Cement Bd. ■ Cement Pipe •:• Floorng Mat'1 ■ Roofing Mat'1 Other: B. Asbestos/Demolition Project Categories: , 1. Q Notification Waiting ProisgtFee, • _ Period 0 + - - 4 14 t' . =. 525 Owner - Occupied, Single- Family Residence Asbestos Removal Project • Single•Ramily Reaidence Demolition Project Prior Notice 2. ! All 0 , er Dell • •too W _, ■ • : s • t • . R •_ Pre act 10 Days $150 3. In 10 -259 linear feet or 48 -159 square feet (see back of form for options) 3 Days $ 150 4, _ 260 • 999 linear feet or 160 - 4 999 - • are fret 10 Da a $300 5. 0 1,000 - 9 999 linear feet or 5,000. 49,999 e • • re feet 10 Days 5750 6. ■ 10,000 - 49,999 linear feet or 50,000- 99,999 square feet 10 Days 52,000 7, • 50,000.99,999 linear feet or 100,000 - 1.49,999 *guars feet 10 D s 15,OG1 8. 4100,000 +linear feet or 150,000+ uare feet 10 Days $10,003 • • Ems : -nc Asbestos Project or a Emer ncy Demolition Project !! • .t tCl• 10. ■ Alternate Means of Corn • fiance for friable materials or ■ Demolitions 10 -Da Review Period L 1. MO Alterna •_ Means of Corn •liana for :sent b c asbe•toe materials Concurrent with Pro'•ct Twice Pro'•ct Foe I.idobenby w bei.Le ssimanerbslilmindtolmanls ow- etyma Rolm o, ed ,. f / //;I/ . Ci smidmdtabsdbmi ,iet ate edastltrmbels Ewa eiliwitil meossrttsl men sspastaids edbmsitamstebunitnewspOrmitis atethseamd. Iang Services Corporation 5/20/98 /�c1r.T1.11i .1 ,.J. 1 " ,4%. . r • f� ���• 05/2'7/98 WED 13:10 FAX 612 603 7671 CSM CORPORATION The Puget Sound Air Pollution Control JE ncy ( PSAPCA) is the local air pollutiot( ithority for Snohomish. Kingi�j, 003 Pierce and Kitaap Counties. PSAPCA Regulation III. Article 4, requires advance notification be submitted to PSAPCA, on Agency - approved form no, 66-160 (Revised 10/96). for any asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet and for any demolition project, regardless of asbestos content, involving structures with a projected roof area greater than 120 square feet. Notices of Intent should be mailed or hand delivered to ,PSAPCA (address on reverse aide) with the appropriate project fee, A PSAPCA representative will review the notification, and if it is completed correctly a copy will be returned by mail within 3 to 5 days to the :sailing address entered in box C and box J. The returned bopy will be your valid notification. Asbestos a. • - y,• olition . "ects ',volvin: mat als - structures below otification thres o . s listed above Bre still subiecUo all other requjternents of PSAPCA Regulation III. Article 4. Demolition PRINT cr. wR.r. THIS WILL 116 MAILING ' . RN J. Demorl Contractor. CSM Corporation Mailing Address: 2575 University Ave. W., Suite 150 Owner /CEO: Evan Casey Phone: 612 646 -1717 City: St. Paul State: MN Nip: 55114 Fax: 612 603 -7671 Contractor's JobO: 822002242 o wruiIRS FOR SUBMITTING AN Asa2$T09 /OENOIir1ON NOTIFICATION lox A. Cheek the appropriate project type. Sox D. Enter the legal property owner information. For Owner- Occupied Residential Removal Projects (category P1) where the property owner's mailing address differs from the site address, a Letter must be submitted explaining shy the addresses are different. Sox C. Enter the asbestos contractor and mailing address or other properly trained company or person performing he asbestos project. Contact the Washington State Dept. of Labor & Industries or OSIIA for worker raining /certification requirements_ Lox D. Enter the project site address for the asbestos project or demolition. Include a designated project manager 11" contact person. lox E. Check asbestos survey or material presumed. If asbestos survey is checked, fill out all information equested. All demolition with or without an asbestos removal must have an asbestos survey performed by an ■HERA Building Inspector. Demolition with no asbestos discovered in the survey must submit a copy of the urvey along with the notification. Asbestos removal projects only may check the material presumed box if all aaterials are to be removed and disposed of as asbestos- containing materials in accordance with PSAPCA regulation III, Article 4. Los F. Enter the demolition project information. If the structure is to be used in a training fire, list the fire epartment responsible for conducting the burn as the demolition contractor in box J. If the property owner has een ordered to perform a demolition by government official, submit a copy of the order from the appropriate fiicial. lox G. Enter all asbestos project information requested, All multiple structure asbestos project notiecations lust be submitted with a work plan including a map of the area, site address for each structure, type and arnount f asbestos in each structure, and a detailed work schedule. ox 0. Check one project category in boxes 01 -8. The project fee includes the demolition fee. Asbestos removal rojects and demolition with an asbestos removal involving less than 10 linear feet or 48 square feet may be filed s project category 03. An emergency asbestos project or demolition may be requested by checking the appropriate lb size category in boxes 02 -9 and letter from the property owner explaining the necessity for the emergency. mergency demolition notifications must be submitted with a letter from an authorized government official or a tensed structural engineer documenting that the atructuree is in imminent danger of collapse. To request an ltemative means of compliance 'for friable or nonfiiable materials, check the appropriate job size category in ddition to the applicable box in categories 010 and 011. A work plan must be submitted by an appropriately 'wined individual along with the notification. ox I. Sign the notification certifying the accuracy and completeness of the information provided on the form. ox J. Enter demolition contractor mailing information (on back). !andatory aznendmentq are required for changes that increase the project type, job size category, the types of 'best= materials to be removed and work schedule changes. No fie is required for work schedule changes if the =tractor is participating in the Agency work schedule fax program. A $50.00 proceeding fee is required for all her amendments. • Ir technical assistance, contact Torn Hudson at (206) 689 -4058. Larry Vaughn (206) 689 -4035 or Kwame Agy►ei 06) 689-4054. For inquiries concerning notification and amendment status contact Anne Morgan (206) 39 -4090. APA Wen-en Pain _e !.a_/an ,v..d-.w ,n /OR1 •ry TO: FROM: DATE: SUBJECT: City of Tukwila John W. Rants, Mayor Department of Public Works NOTIFICATION OF UTILITY PERMIT ACTION Permit Center Public Works Engineering TuNe•17,1998 CSM Hotel Demolition of Existing Structures 16038 West Valley Hwy Project Number: PRE97 -020 Permit Number: MI98 -0093 Contact Person: Evan Casey Phone: (612) 646 -1717 Ross A. Eamst, P. E., Director THE FOLLOWING PUBLIC WORKS PERMITS HAVE BEEN APPROVED FOR ISSUANCE IN ACCORDANCE WITH THE PLANS APPROVED ON JULY 17,1998: PERMIT FEE Hauling 25.00 Sanitary Side Sewer - Capping Only Water Line - Capping Only TOTAL: $25.00 Two copies of the confirmed Utility Permit Application and approved plans are attached for inclusion in the permit file. Also attached are copies of Certificate of Insurance, $2,000.00 bond and 5 copies of haul route map. JJS /tkf CF: Development File (with copy of application, plans, and haul permit documents) PW Utilities Inspector (with copy of application, plans, and haul route map) City Clerk (with copy of NUPA haul route map & original Certificate of Insurance & Permit Bond) Finance Dept. (with copy of application) 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: (206).41330179;'• Fax (206 ) 431.3665 Haul Route for Marriott Tukwila Demolition Estimated 16 Toads of material (debris, concrete, masonry & asphalt). ..awn Wolk • Streets98 Copyright m 1988-1997, Microsoft Corporation and/or Its suppliers. All rights reserved. Please visit our web site at http: / /maps.expedia.com. 0.4 RECEIVED 0,8 CITY OF TUKWILA M AN 2 9 i991twe PERMIT CENTER ACORD. CERTIFIC4'""E OF LIABILITY !NSW' 4NCp, DATE(MMIDDnY) IPRE1 05/29/98 PRODUCER Bellevue Western, Inc. dba : Ribble & Prentice P .0 . Box 3467 Bellevue WA 98009 -3467 Phone No. 425- 454 -2445 Fax No. 425-646-9616 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Reliance Insurance Company INSURED Nuprecon, Inc. Fax #881 -5935 Attn: Wendy Pare 14540 N.E. 91st Street Redmond WA 98052 COMPANY B COMPANY C COMPANY D COVERAGES •- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE ( MMIDDIYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY SJ3002447 06/23/97 06/23/98 GENERAL AGGREGATE 51,000,000 PRODUCTS • COMP/OP AGO 51,000,000 PERSONAL & ADV INJURY S 1,000,000 CLAIMS MADE X OCCUR EACH OCCURRENCE 51,000,000 X X OWNER'S & CONTRACTOR'S PROT PER PROJECT AGG FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one person) $ 1,000 A AUTOMOBILE X X X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS SJ3002447 06/23/97 06/23/98 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) 5 PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE 5 EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE 5 AGGREGATE $ 5 A WORKERS COMPENSATION EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS /EXECUTIVE OFFICERS ARE: AND — INCL EXCL SJ3002447 WA STOP GAP ONLY 06/23/97 06/23/98 I TORY' L MITS 1 j X I MR ' EL EACH ACCIDENT 51,000,000 EL DISEASE• POLICY LIMIT $ 1,000,000 EL DISEASE • EA EMPLOYEE 5 1 , 000 , 000 OTHER DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLESISPECIAL ITEMS • RE: Hauling Permit CERTIFICATE HOLDER TDRW -01 City of Tukwila Permit Center 6300 Southcenter Blvd Tukwila WA 98188 .CANCELLATION '. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINQ UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES1NTATIVE 1 THE FACE OF •. S DOCUMENT HAS A COLORED BACKGROUN ! • N WHITE PAPER RELIANCE SURETY COMPANY UNITED PACIFIC INSURANCE COMPANY % RELIANCE INSURANCE COMPANY RELIANCE NATIONAL INDEMNITY COMPANY ADMINISTRATIVE OFFICE, PHILADELPHIA, PENNSYLVANIA POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that RELIANCE SURETY COMPANY is a corporation duly organized under the laws of the State of Del- aware, and that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, are corporations duly organized under the laws of the Commonwealth of Pennsylvania and that RELIANCE NATIONAL INDEMNITY COMPANY is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called "the Companies ") and that the Companies by virtue of signature and seals do hereby make, constitute and appoint Pat Russell, Reg Branston, Kris Hamar, Pamela Ahern Jardine, of Bellevue, Washington their true and lawful Attorney(s) -in -Fact, to make, execute, seal and deliver for and on their behalf, and as their act and deed any and all bonds and undertakings of suretyship and to bind the Companies thereby as fully and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the Companies and sealed and attested by one other of such officers, and hereby ratifies and confirms all that their said Attorney(s)-in-Fact may do in pursuance hereof. This Power of Attorney is granted under and by the authority of Article VII of the By -Laws of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which provisions are now in full force and effect, reading as follows: ARTICLE VII • EXECUTION OF BONDS AND UNDERTAKINGS 1. Tho Board of Directors, the President, the Chairman of the Board, any Senior Vice President, any Vice President or Assistant Vice President or other officer designated by the Board of Directors shall have power and authority to (a) appoint Attorneyls)•In•Fect and to authorize them to execute on behalf of the Company, bonds and undertakings, recognlzances, contracts of indemnity end other writings obligatory in the nature thereof, and (b) to remove any such Attorney(s)•in•Fact at any time and revoke the power and authority given to them. 2. Attomeyls)•in•Fact shall have power and authority, subject to the terms and limitations of the Power of Attorney Issued to them, to execute deliver on behalf of the Company, bonds and undertakings, recognlzances, contracts of indemnity and other writings obligatory In the nature thereof. The corporate seal Is not necessary for the validity of any bonds and undertakings, recognizance's, contracts of Indemnity and other writings obligatory In the nature thereof. 3. Attorney(s)•in•Fact shall have power end authority to execute affidavits required to be attached to bonds, recognlzances, contracts of Indemnity or other conditional or obligatory undertakings and they shell also have power and authority to certify the financial statement of the Company and to copies of the By•Laws of the Company or any article of motion thereof. This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Executive and Finance Committees of the Boards of Directors of Reliance Insurance Company, United Pacific insurance Company and Reliance National Indemnity Company by Unanimous Consent dated as of February 28, 1994 and by the Executive and Financial Committee of the Board of Directors of Reliance Surety Company by Unanimous Consent dated as of March 31, 1994. 'Resolved that the signatures of such directors and officers and the seal of the Company may be affixed to any such Power of Attorney or any certificates relating thereto by fecsimlle,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such Power so executed and certified by facsimile signatures end facsimile seal shall be valid and binding upon the Company, in the future with respect to any bond or undertaking to which it Is attached.' IN WITNESS•WHEREOF, the Companies have caused these presents to be signed and their corporate seals to be hereto affixed, this August 23, 1996. TATE OF Washington } OUNTY OF King } ss. RELIANCE SURETY COMPANY RELIANCE INSURANCE COMPANY UNITED PACIFIC INSURANCE COMPANY RELIANCE NATIONAL INDEMNITY COMPANY 704 41, 04471 On this, August 23, 1996, before me, Janet Blankley, personally appeared Mark W. Alsup, who acknowledged himself to be the Vice President of the Reliance Surety Company, Reliance Insurance Company, United Pacific Insurance Company, and Reliance National Indemnity Company and that as such, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the corporation by himself as its duly authorized officer. En witness whereof, I hereunto set my hand and official seal. CriY,S.:(1) IC44CD—Li Nota Public in and for the State of Washington Reside g at Puyallup I Robyn Layng, Assistant Secretary of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMP- ANY, and RELIANCE NATIONAL INDEMNITY COMPANY do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force and effect. I WITNESS WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 29 thday of May 19 98, Assistant Secretary THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK HOLD AT AN ANGLE TO VIEW 06/18/98 THU 10:25 FAX 612 603 7671 0:/21/1998 15 ;36 206- 768 -9' 25/2134Wi 321 ° g" 82:5kM WU 'f ~BIND AIR Ay a i+to. ?802746 CSM CORPORATION PUQST 3OUi D 11Qi P0LW TOM CONTROL AGENCY 110 Unie* 84w1, Sake 500. Beanie, wA 98101 -2038 Tows' iseest Mr= ar am= • 002 i iltylitift1998 k..W:st Type: 11.0 Aissfas 111eausee1 . AMsetes 11we—m16B oes.a1 tioo B. PesrMeet, IN. Oesreivim CSC! Carlsorradesen Property O+enes's Mailing Address: 2575 UDies ei Ave. W., Wll+te 1150 Gi : St, Paul C�Aslieerdses R+ �r►aatar. 7w AU Mr now eetu��w.uw use. Co very Lsnot_Sereices Corp. Mailing Address: 8230 5th Ave. South City: Seattle State: WA Zip: 911108 D ite a.. Aetdeesaa:160th and W. Vary MIittwsey 9.[] D.v aRtI i, Ire a•baa es seese at Plsm e: ( 612) 046 -1717 State: MN Zi - : 55114 antract9r Owner/CEO: Mike Cassidy Phone: (206) 7b::3-9433 Eeiit: (206) 768 -9.580 Crreit tenor Job No.: 822002242 Project s or e: acetate Pbnen: gvsi D. Gamy s. 111 Aabee scss *sessy ear CI man i i...e■ el Na. of City: Duke, la Date Stanley sssa , Structures: b Conducted: 6/97 AHERA Stranding MAMMY seaers, e ASNASSC Moon ata.blietrOCIIPealren inspector Mum: Jeaeill er Wake rT. DaSSOIAl a Plo. of I,ai s:ae:laa earetoTuros: State: WA Zip: 98/88 F F1wr1e: ( 612 )646.1717 "et Wag Aataescos Faund? Eyes ❑ If No, swath Sunray Expiration Dom: 6/9/96 Certification No. 94 -1513 Start Delay --- 601/ 96 DP-Worm Flee (list Firs Dept. es dernoil5on contactor below) © Oriared Carnelilku: lemma copy of Order) pia NNW, awill MOM wsr OOSIWOD MOWS 111101 oil MACS. ,r rewroc atarr toffee Ow Wit Mmes COW Corpser.i:ion G. Asbestos lireifj.ortt No. of Stsuct:unros: k mtkieu (see bock if 1) 6 ntapletion ate: 7/)/98 otai Qry. to Ise ilemoned: Linear Pt. 8gllei" Pt. Thorne! System .sst� unison_ ■ Heiler \PtUtiaos Lts. Duet Iris. . ❑ - . ang ❑ Plante ■ Meter Teircured Cason _ • Other: Misc. Nat'l: ■ CaOZe.pt Hd. ■ Cement Pipe Plosernt Marl ■ ilaae&iriti Mat'l Other: Notification Wei' jg tralasi Phone: ( 612 ) 646 -1717 )4 lOadVT ®W ❑TH ❑F ❑6A DS Hours: 8aa1i - a:30 i 1 all subsists* tt atcrrlai be removed by project com$etion? Pipe ins. Other; �. Aswetse /lbs attl�s 4s■prias: [? aufnes- Caerapied, knells •icy SeDisiCiant Sifbri erns Seen rrili Av$,aee Q 9iaglapPo ogy Rasddessas Lieso.iittaer PeolOwc 2. A11 Otber Gimagioao Witt No _Pnlise t 3, 0 10 -259 linear Goat or 48 -159 moan feet We heck of form for opium 4. 260 999 Reeser Beet or 160 - 4,999 er ante fest 0 1.000 - 9,pao linear feet or 5,000 40.999 strum feet 6, ❑ 10,000 - 49.999 linear feet or 60.000 - 99.999 equate feet 7. C330,006.99.999 i ats.r toot or 100.000.149,999 eeWaree roes r, B.-E] 100,000•1irseer feat or 1!0 00 _ 91s+: s. Esec n Ast eneKO/ lore e or ate cane ofC 1 L. Atoorba -- Menem of Cm iE or MOW able /brown • ar Deosorisioek. Prior Notice 10 boys 3 Days 10 Days 10 Days 10 bay. to Curs 10. Day N Yes No i iIJ;iT 16-Da Renew period 133 $Ise 5150 5300 $ ?S0 52,000 WOOD $10,0a3 c , ate Pee ere..' t tree seoneo aalbnlWnlW►eael ioresRiarerestrrarfseyMaww oesnoo Caw oto rw .aarelieesarti.ieualles.lkviises -hose lnsp tmilt oil= Long !lseNose Corporatism 5/20/98 ..101 1 1 w 06/18/98 THU 10:25 FAX 612 603 7671 CSM CORPORATION 2003 101* LIMO SERVICES CMMAiNll June 12, 1998 CSM . - - • . 2575 University Ave. W., Suite #150 St, Paul, MN 55114 Attn.: Mr. Evan Casey RE: Tukwila Mamot Dear Mr. Casey, COMMERCIAL • INDUSTRIAL • MARINE RESIDENTIAL = 1998 This will acknowledge that Long Services Corporation has completed abatement of the asbestos containing materials per Asbestos Survey for the 5 buildings located at this location. These asbestos materials have now been removed from this location per Long Services contracted scope of work and the buildings may now be demolished. All work was done in accordance with all federal, state, and local regulations. If you have any questions, please call me at your convenience. Sincerely, - LONG SERVICES CORPORATION Don Yamamoto Division Manager DY:dy "YOUR PARTNER IN SAFETY, QUALITY AND SERVICE" June 10, 1998 City of Tukwila John W. Rants, Mayor Department of Community Development Steve Lancaster, Director Evan Casey CSM Lodging LLC 2575 University Avenue, #150 St. Paul, MN 55114 Dear Mr. Casey: SUBJECT: CORRECTION LETTER #1. Development Permit Application Number MI98 -0093 CSM Hotel 16038 West Valley Hy This letter is to inform you of corrections that must be addressed before your application for development permit can be approved. All correction requests from each department must be addressed at the same time and reflected on your drawings. I have enclosed review comments from the Public Works Division. At this time the Building Division, Fire Department and Planning Department have no comments regarding your application for permit. The City requires that two (2) complete sets of revised plans be resubmitted with the appropriate revision block. In order to better expedite your resubmittal a Revision Sheet must accompany every resubmittal. I have enclosed one for your convenience. Corrections /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 City of Tukwila Permit Center at (206) 431- 3671. Sincerely, Brenda Holt /431-111--- Permit Technician Enclosures File: MI98 -0093 6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 ! (206) 4113670 • FiiiC 6206)411,160 PUBLIC WORKS DEPARTMENT COMMENTS DATE: June 3, 1998 PROJECT: CSM HOTEL DEMO PERMIT NO: MI98 -0093 PLAN REVIEWER: Contact Joanna Spencer at (206) 433 -0179, if you have any questions regarding the following comments. 1. Show location of sanitary sewer, storm drainage lines and water service lines including size of water meters. Sewer and water utilities shall be capped at the mains if they are to be abandoned. If they will be used again in the near future for a new building, they shall be capped at the pro- perty line and at the water meter respectively. Please show capping locations on plan If you need any assistance, please contact City Minkler Shops, Mr Dave Grege @ (206) 433 -1863 regarding water lines and water meter info and Mr John Howat @ (206) 433 -1864 regarding sanitary side sewer lines. _ r- Detach And. Display Ccrtitic,u.. DEPARTMENT OF LABOR AND INDUSTRIES REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL s,:' ^REGIST.,'. #.'•. ,; EXP DATE ..•'; CC0.1 NUPREI *148PU•06/23/1999 ;EFFECTIVE ;DATE " • '10/3.1/.1986:: NUPRECON•INC • 14540 NE 91ST REDMOND WA 98052 F625- 052-010 (8/97) �_r►n.asss� .awaw_srww w �+t.r._wa �e.,e.� �.�: Detach And Display Certificate REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL . REGIST. # EXP. DATE CCO1 NUPREI *148PU 06/23/1999 EFFECTIVE.. DATE 10/31/1986 NUPRECON: INC 14540 NE :91ST, REDMOND: WA'.-; 98052 Please Remove And Sign Identification Card Before Placing In Billfold Signature Issued by DEPARTMENT OF LABOR AND INDUSTRIES F625-052-000 (8/97)