The URL can be used to link to this page

Home My WebLink AboutPermit D12-194 - US HEALTH WORKS - RECEPTION AREAUS HEALTH WORKS 200 ANDOVER PK E sunE 8 D12 -194 City okukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -43 1 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.TukwilaWA.gov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Project Name: US HEALTH WORKS DEVELOPMENT PERMIT Permit Number: D12 -194 Issue Date: 07/10/2012 Permit Expires On: 01/06/2013 Owner: Name: ANDOVER PLAZA LLC Address: 1501 N 200TH ST , SHORELINE WA 98133 Contact Person: Name: GERALD M UTLEY Address: 719 116 SW , EVERETT WA 98204 Contractor: Name: ARM & HAMMER CONSTRUCTION Address: 10718 10 DR SE , EVERETT WA 98208 Contractor License No: ARMHAHC902OZ Lender: Name: Address: Phone: 425 381 -9153 Phone: 425 - 381 -9153 Expiration Date: 09/09/2012 DESCRIPTION OF WORK: MODIFY EXISTING RECEPTION DESK AND BUILD NEW WALL BEHIND RECEPTION DESK Value of Construction: $2,600.00 Fees Collected: $243.92 Type of Fire Protection: SPRINKLERS /AFA International Building Code Edition: 2009 Type of Construction: Occupancy per IBC: 0008 Electrical Service Provided by: PUGET SOUND ENERGY * *continued on next page ** doc: IBC -7/10 D12 -194 Printed: 07 -10 -2012 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N • • Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: Hauling: N Start Time: End Time: Land Altering: Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: Moving Oversize Load: Start Time: End Time: Sanitary Side Sewer: Sewer Main Extension: Private: Public: Storm Drainage: Street Use: Profit: N Non - Profit: N Water Main Extension: Private: Public: Water Meter: N Permit Center Authorized Signature: Lx Date: l` t O/ t L I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the performance of work. I am authorized to sign and obtain this development permit and agree to the conditions attached to this permit. Signatur Print Name: co/a•c_ i- i-z_s..)/ Date: / `/0 --�oi� 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. PERMIT CONDITIONS: 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center (206/431- 3670). 4: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 5: Partition walls that are tied to the ceiling and all partitions greater than 6 feet in height shall be laterally braced to the building structure. 6: All construction shall be done in conformance with the approved plans and the requirements of the International Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code. doc: IBC -7/10 D12 -194 Printed: 07 -10 -2012 7: All plumbing and gas piping work shall bespected and approved under a separate per /issued by the City of Tukwila Building Department (206- 431- 3670). 8: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building Department (206- 431 - 3670). 9: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. 10: ** *FIRE DEPARTMENT CONDITIONS * ** 11: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the following concerns: 12: Maintain sprinkler coverage per N.F.P.A. 13. Addition/relocation of walls, closets or partitions may require relocating and /or adding sprinkler heads. (IFC 901.4) 13: All new sprinkler systems and all modifications to existing sprinkler systems shall have fire department review and approval of drawings prior to installation or modification. New sprinkler systems and all modifications to sprinkler systems involving more than 50 heads shall have the written approval of Factory Mutual or any fire protection engineer licensed by the State of Washington and approved by the Fire Marshal prior to submittal to the Tukwila Fire Prevention Bureau. No sprinkler work shall commence without approved drawings. (City Ordinance No. 2327). 14: Maintain fire alarm system audible /visual notification. Addition/relocation of walls or partitions may require relocation and /or addition of audible /visual notification devices. (City Ordinance #2328) 15: All new fire alarm systems or modifications to existing systems shall have the written approval of The Tukwila Fire Prevention Bureau. No work shall commence until a fire department permit has been obtained. (City Ordinance #2328) (IFC 104.2) 16: An electrical permit from the City of Tukwila Building Department Permit Center (206- 431 -3670) is required for this project. 17: Contact The Tukwila Fire Prevention Bureau to witness all required inspections and tests. (City Ordinances #2327 and #2328) 18: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of such condition or violation. 19: These plans were reviewed by Inspector 511. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575 -4407. 20: The maximum flame spread class of finish materials used on interior walls and ceilings shall not exceed that set forth in Table No. 803.5 of the International Building Code. doc: IBC -7/10 D12 -194 Printed: 07 -10 -2012 CITY OF TUKW.4101 Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http: / /www.TukwilaWA.gov Building No. I2 Project No. Date Application Accepted: Date Application Expires: (For office use only) CONSTRUCTION PERMIT APPLICATION Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** SITE LOCATION Site Address: at -tom Tenant Name: (/S a/I,A- King Co Assessor's Tax No.: C1.2-2- � h ` Suite Number: Floor: 360 New Tenant: ❑ Yes c4. No PROPERTY OWNER Name: .- L_. .ii / i ..r. Address: q //6 6-r �.a I (� City: � 2L State: (�� Zip: 6y 6 Name: Email: /-.ri1L , .LSD 26)? %lhp,,` U—. (If Address: Aso/ ip T sr City:, 1■622 -1 State:fa Zip: 73 CONTACT PERSON — person receiving all project communication Name: .- L_. .ii / i ..r. Address: q //6 6-r �.a I (� City: � 2L State: (�� Zip: 6y 6 Phone: w -7.3 91,9�Fax: j— [t Email: /-.ri1L , .LSD 26)? %lhp,,` GENERAL CONTRACTOR INFORMATION Company Name: /". / ,i /1"./YYR ar.it 42/171/02:4— 416 Address:17/?. — // 6 S City: /-1/149.2t State: j�l/ Zip: q�nn9 �1'� lam/ Phone: Y,� c _ / -9�53 Fax: Contr Reg No.: 4#1001#902 Date: ,�„ t /g Tukwila Business License No.: ��(1�Oq q pin 5 H:Wpplications\Forms- Applications On Line\2012 Applications\Permit Application Revised - 2- 7- 12.docx Revised: February 2012 bh ARCHITECT OF RECORD Name: Address: Company Name: Architect Name: Address: City: State: Zip: Phone: Fax: Email: ENGINEER OF RECORD Name: Address: Company Name: Engineer Name: Address: City: State: Zip: Phone: Fax: Email: LENDER/BOND ISSUED (required for projects $5,000 or greater per RCW 19.27.095) Name: Address: City: State: Zip: Page 1 of 4 BUILDING PERMIT INFORMATION — 206 - 431 -3670 Valuation of Project (contractor's bid price): $ I Existing Building Valuation: $ Describe the scope of work (please provide detailed information): Will there be new rack storage? El ....Yes V..No If yes, a separate permit and plan submittal will be required. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 421 Sprinklers 54. Automatic Fire Alarm ❑ None ❑ Other (specify) ata there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No If `yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11 " paper including quantities and Material Safety to Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:Wpplications'Forms- Applications On Line\2012 Applications\permit Application Revised - 2- 7- 12,docx Revised: February 2012 bh Page 2 of 4 Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC lat Floor 0/ rd Floor 3rd Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 421 Sprinklers 54. Automatic Fire Alarm ❑ None ❑ Other (specify) ata there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No If `yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11 " paper including quantities and Material Safety to Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:Wpplications'Forms- Applications On Line\2012 Applications\permit Application Revised - 2- 7- 12,docx Revised: February 2012 bh Page 2 of 4 PUBLIC WORKS PERMIT INFOTION — 206 - 433 -0179 Scope of Work (please provide detailed information): Call before you Dig: 811 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Water District ❑ .. Tukwila ❑ ...Water District #125 ❑ .. Water Availability Provided Sewer District ❑ .. Tukwila ❑ .. Sewer Use Certificate ❑ ...Valley View ❑ ...Sewer Availability Provided 0... Highline 0... Renton ❑ ... Renton ❑... Seattle Septic System: ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. Submitted with Application (mark boxes which apply): ❑ .. Civil Plans (Maximum Paper Size — 22" x 34 ") ❑ .. Technical Information Report (Storm Drainage) ❑ .. Bond ❑...Insurance 0... Easement(s) Proposed Activities (mark boxes that apply): ❑ .. Right -of -way Use - Nonprofit for less than 72 hours ❑ .. Right -of -way Use - No Disturbance ❑ .. Construction/Excavation /Fill - Right -of -way ❑ Non Right -of -way ❑ ❑ .. Total Cut ❑ .. Total Fill cubic yards cubic yards ❑ ... Geotechnical Report 0... Maintenance Agreement(s) ❑ .. Traffic Impact Analysis ❑ .. Hold Harmless — (SAO) ❑ .. Hold Harmless — (ROW) 0... Right-of-way Use - Profit for less than 72 hours 0... Right-of-way Use — Potential Disturbance ❑... Work in Flood Zone El... Storm Drainage ❑ .. Sanitary Side Sewer 0... Abandon Septic Tank 0... Grease Interceptor ❑ .. Cap or Remove Utilities 0... Curb Cut ❑ ... Channelization ❑ .. Frontage Improvements 0... Pavement Cut U... Trench Excavation ❑ .. Traffic Control 0... Looped Fire Line 0... Utility Undergrounding ❑ .. Backflow Prevention - Fire Protection " Irrigation " Domestic Water ❑ .. Permanent Water Meter Size (1) " WO # (2) " WO # (3) " WO # ❑ .. Temporary Water Meter Size (1) " WO # (2) " WO # (3) " WO # ❑ .. Water Only Meter Size 71 WO # ❑ .. Deduct Water Meter Size " ❑ .. Sewer Main Extension Public ❑ Private ❑ ❑ .. Water Main Extension Public ❑ Private ❑ FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) ❑ .. Water ❑ .. Sewer ❑ .. Sewage Treatment Monthly Service Billing to: Name: Day Telephone: Mailing Address: City State Zip Water Meter Refund/Billing: Name: Mailing Address: Day Telephone: City State Zip H:\Applications\Forms- Applications On Line\2012 Applications\Permit Application Revised - 2- 7- 12.docx Revised: February 2012 bh Page 3 of 4 PERMIT APPLICATION NOTES —0 • 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 grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). 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 ! E ; s • AUTHOO r ED Signat Print Name: Mailing Address: ?L' ' 7(6 s T 510/- H:\Applications\Forms- Applications On Line\2012 Applications\Permit Application Revised - 2- 7- 12.docx Revised: February 2012 bh Date: Day Telephone: City a/A 9:6491Y State Zip Page 4 of 4 • �J��►rLA wq�, City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -43 1 -3670 Fax: 206 -431 -3665 Web site: http: / /www.TukwilaWA.wov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: US HEALTH WORKS RECEIPT Permit Number: D12 -194 Status: APPROVED Applied Date: 06/07/2012 Issue Date: Receipt No.: R12 -02081 Initials: User ID: Payee: WER 1655 Payment Amount: $149.60 Payment Date: 07/10/2012 11:07 AM Balance: $0.00 GERALD UTLEY TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 092119 ACCOUNT ITEM LIST: Description 149.60 Account Code Current Pmts BUILDING - NONRES STATE BUILDING SURCHARGE 000.322.100 145.10 640.237.114 4.50 Total: $149.60 doc: Receiot -06 Printed: 07 -10 -2012 I J��LA wqs City of Tukwila ( Z Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206-431-3665 Web site: http: / /www.TukwilaWA.Eov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: US HEALTH WORKS RECEIPT Permit Number: D12 -194 Status: PENDING Applied Date: 06/07/2012 Issue Date: Receipt No.: R12 -01810 Initials: User ID: JEM 1165 Payment Amount: $94.32 Payment Date: 06/07/2012 12:15 PM Balance: $149.60 Payee: GERALD M UTLEY TRANSACTION LIST: Type Method Descriptio Amount Payment Check 1809 94.32 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts PLAN CHECK - NONRES 000.345.830 94.32 Total: $94.32 doc: Receiot -06 Printed: 06 -07 -2012 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188- (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: 21 S 14 f A t_ ; '- (001t.<- Type of Inspection: rr�s L..- Address: 1C70 It NI Jc3-x1E 2 P'- L Date Called: ., Special Instructions: C.)(30 —01 . Date Wanted:. Io - a -17 m. p.m.. Requester: Phone No: Li ZS -1Si- q IS 'Approved per applicable codes. COMMENTS: \I •E c.\de /1--IN L ElCorrections required prior to approval. 3 ■ Date: REINSPECTION FEE REQUIRE Prior to fiext inspection, fee must Tie pai.d�at 6300 Southcenter Blvd:. uite 100. Call to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit Lb12 -A 9 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 lZ- (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 i_ Project: ZJ S t 4 E A1.- K ioR L Type of Inspection: t2_ i°t, ,_.,A.) G Address: Date Called: Special Instructions: Date Wanted:. airlm. Requester: Phone No: 6.12 —'-5 49 l -Gts 3 pproved per applicable codes. El Corrections required prior to approval. COMMENTS: In's.pec tor r PECTION FEE REQUIRED. Prior to�'iext inspection. fee must be at16300 Southcenter Blvd... Suite 100. Call to schedule reinspection. n REII paid Date: €.52 ) INSPECTION NUMBER INSPECTION RECORD Retain a copy with permit l) is - i la- - S PERMIT NUMBERS CITY OF TUKWILA FIRE DEPARTMENT 444 Andover Park East, Tukwila, Wa. 98188 206 - 575 -4407 Project: LIS /J(/'i-Wdr4S Type of Inspection: S -V,N L e S' Address: D - p L Suite #: tr Contact Person: Hood & Duct: S pecial Instructions: Phone No.: ji."/ vJ Approved per applicable codes. Corrections required prior to ap COMMENTS: Sprinklers: e S' Fire Alarm: tss Hood & Duct: S P . V 1.4J A-_ — alc-- Pre -Fire: Permits: Occupancy Type: -- �1 , t� o F4- IA.m.? a._ a w12- Needs Shift Inspection: 5' Sprinklers: e S' Fire Alarm: tss Hood & Duct: NO Monitor: Pre -Fire: Permits: Occupancy Type: -- Inspector/el & c7)-- -- Date: ej -h e/h Z Hrs.: $100.00 REINSPECTION FEE REQUIRED. You will receive an invoice from the City of Tukwila Finance Department. Call to schedule a reinspection. Billing Address Attn: Company Name: Address: City: State:, Zip: Word /Inspection Record Form.Doc 6/11/10 T.F.D. Form F.P. 113 SEPARATE PER m IT REQUIRED FOR: ec an:ca Electrical Plumbing OtSas Piping City of'lkwila BtJl I i 5! DiVISION avo?I tosvaismita s 'I yr 2 Cam a sort 3 Laura. } FILE CIPY Permit No. . 1'12 - IRl--1 g t Plan review approval is stthject to 811'01S and o -ya raval of constructionitaslents,does not a the lolation of any adopted code i *oninanoe. E Feld • •. oonatietis ackmo swoon= 'ow °ate ', aqm -y3' r . ASS` gib k h al a YMn i i i i i 77341 WOO y.a.l.e • 1 it4 City Of BUILDING ha SION LSVV i3 Vd mothvV OVA+ BAKER BLVD. t 1 REVIE FOR CODE COLIANCE APPRWED JUN 2 V012 9 City of �.a=.. DIN z .5 7ss 8 Alt a CITY TUK° ' A JUN 0 7 2012 PERMIT CENTER ila ISION . w. N. stuff J I iZVl4 . •41 .141.14 4I*34Se0 awns 5It ,S5'11Ol REVISIONS No ch ►aes shall be made to the scope ('S ' ,VAV 9) £SV3' )I 1Vd WiiOQNV of work without prior approval of Tukwila Building Division. NOTE': Revisions will require a new plan submittal and may include additional plan review fees. Kos-La fd.aorers ,,90,5d.10 N gai aRr_ I Da— I 1'1 Ex ELEC. PANEL LEADE L ill 1 VCt WALL BELOW COUNTER CURTAIN CEILING 1 Izz vct Replace carpet with VCT New full height wall GENIE ON MULLI Replace carpet with VCT Modify front desk - straight across with ADA height counter on North end. 54' HIGH WALL (Covenant) CABINETS 21819 49th Ave. S.E. • Bothell, WA 98021 • (425) 481-4799 4 • e?...44.171- 4t-)6) .S. REVIEWED FOR CODE COMPLIANCE APPROVED JIIN 2 2 2012 City of Tukwila BUILDING DIVISION [Covenant CABINETS 21819 49th Ave. S.E. • Bothell, WA 98021 • (425) 481-4799 16— Irl Lt t1424 2- (.t.)1)44Q 6 / 2- N I •■■■■■■•••1“... JUN 0 7 2012' PERMIT CENTER REVItyvtD FOR CODE COMPLIANCE APPROVED JUN 2 2 2012 1 City of Tukwila ' UILDING DIVISION Covenant CABINETS 12156E1-7 Truoli- 21819 49th Ave. S.E. • Bothell, WA 98021 • (425) 4814799 •-• sz, Os. Lvinieh)75 vs% I I 1.1 I 1 1 I I I 1! I I 1 —n REVIEWED FOR CODE COMPLIANCE APPROVED JUN 2 2 2012 City of Tukwila BUILDING DIVISION'; cITY O 'Tt tlA JUN 07 2012 PERMIT CENSER PERMIT COORD C0M PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D12 -194 PROJECT NAME: US HEALTH WORKS SITE ADDRESS: 200 ANDOVER PK E, STE 8 DATE: 06/07/12 X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # after Permit Issued DEPARTMENTS: bL AOC 14/3-0__. PV we 014 14•11 buildin g Division Fire Prevention AFCNIA-di 11j, Public Works I� Structural Planning Division • MI Permit Coordinator ❑ DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete DUE DATE: 06/12/12 Incomplete ❑ Not Applicable n Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES /THURS ROUTING: Please Route lt Structural Review Required n No further Review Required n REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: DUE DATE: 07/10/12 Approved ❑ Approved with Conditions Jf Not Approved (attach comments) n Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents /routing slip.doc 02/29/12 Contractors or Tradespeople Prr tter Friendly Page I General /Specialty Contractor A business registered as a construction contractor with L &I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name ARM & HAMMER CONSTRUCTION UBI No. 601532321 Phone 4253819153 Status Active Address 10718 10Th Dr Se License No. ARMHAHC9020Z Suite /Apt. License Type Construction Contractor City Everett Effective Date 9/9/2010 State WA Expiration Date 9/9/2012 Zip 98208 Suspend Date County Snohomish Specialty 1 General Business Type Individual Specialty 2 Unused Parent Company Other Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status RAMEXI'991 BU RAM EXTERIORS INC Construction Contractor Siding Carpentry/ Framing 1/31/2001 1 / 1 /2002 Archived PJINTI'011BD P J INTERPRIZE INC Construction Contractor General Unused 1/4/1999 12/31/2003 Archived PJINT**065D1 P J INTERPRIZE Construction Contractor Siding Carpentry/Framing 3/21/1994 3/15/1999 Archived Business Owner Information Name Role Effective Date Expiration Date UTLEY, GERALD MATTHEW Owner 09/09/2010 Bond Amount Bond Information Page 1 of 2 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 2 Western Surety Co 61128005 09/07/2011 Until Cancelled $12,000.00 09/02 /2011 1 American Contractors Indem CO 100138220 09/07/2010 09/07/2011 11/19/2011 $12,000.0009/09 /2010 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 3 Nevada Capital Ins Co 77NPP4014879 09/07/2011 09/07/2012 $1,000,000.00 09/14/2011 2 Nevada Capital Ins Co 77NPP4014879 09/01/2011 09/01/2012 $1,000,000.00 09/02/2011 1 Nevada Capital Ins Co NCIC000926 09/07/2010 09/07/2011 5300,000.00 09/09/2010 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period Infractions /Citations Information Infraction / Citation I Date I RCW Code J Type I Status I Violation Amount https: // fortress .wa.gov /lni /bbip /Print.aspx 07/10/2012