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Home My WebLink AboutPermit EL12-0807 - US HEALTH WORKSThis record contains information which is exempt from public disclosure pursuant to the Washington State Public Records Act, Chapter 42.56 RCW as identified on the Digital Records Exemption Log shown below. EL12 -0807 US Health Works 200 Andover Park East RECORDS DIGITAL D- ) EXEMPTION LOG THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION F,age # Code Exemption � � �� Brief Explsnatoty Description, Statute /Rule The Privacy Act of 1974 evinces Congress' intent that Personal Information — social security numbers are a private concern. As such, individuals' social security numbers are Social Security Numbers redacted to protect those individuals' privacy pursuant 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. to 5 U.S.C. sec. 552(a), and are also exempt from 552(a); RCW 552(a); RCW disclosure under section 42.56.070(1) of the 42.56.070(1) 42.56.070(1) Washington State Public Records Act, which exempts under the PRA records or information exempt or prohibited from disclosure under any other statute. Redactions contain Credit card numbers, debit card Personal Information — numbers, electronic check numbers, credit expiration 10 DR2 Financial Information — dates, or bank or other financial account numbers, RCW RCW 42.56.230(4 5) which are exempt from disclosure pursuant to RCW 42.56.230(5) 42.56.230(5), except when disclosure is expressly required by or governed by other law. US HEALTH WORKS 200 ANDOVER PK E EL1 2-0807 City offukwila • 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.gov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Project Name: US HEALTH WORKS ELECTRICAL PERMIT Permit Number: EL12 -0807 Issue Date: 08/27/2012 Permit Expires On: 02/23/2013 Owner: Name: ANDOVER PLAZA LLC Address: 1501 N 200TH ST , SHORELINE WA 98133 Contact Person: Name: DAVE BOOTH Address: 21307 67 AV W , LYNNWOOD WA , 98036 Contractor: Name: ELECTRIC ELECTRIC INC Address: 21307 67 AV W , LYNNWOOD WA 98036 Contractor License No: ELECTEI258MH Phone: 425 - 771 -3293 Phone: 425 - 771 -3293 Expiration Date: 07/31/2014 DESCRIPTION OF WORK: REMOVE AND REINSTALL (4) RECEPTACLES AT NEW RECEPTION DESK WALL. REMOVE AND REINSTALL (3) RECEPTACLES AT NEW BACK RECEPTION WALL. Value of Electrical: NRES: $1,500.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical service provided by: PUGET SOUND RGY Permit Center Authorized Signature: Fees Collected: $115.50 ational Electrical Code Edition: 2008 .Date: ? — L I hereby certify that I have read and examined this rmit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whethe 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 t performance of work. I authorized to sign and obtain this electrical permit. Signature: Date: 8 Z 7- / Z Print Name: cD,41,4 D e/8007-71 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. doc: EL -4/10 EL12 -0807 Printed: 08 -27 -2012 PERMIT CONDITIONS Permit No. EL 12 -0807 * *ELECTRICAL ** 1: A copy of the electrical work permit shall be posted or otherwise made readily accessible to the Electrical Inspector at each work site. 2: Approved plans shall be maintained at the construction site and shall be readily available to the Electrical Inspector. 3: All electrical work shall be in accordance with NFPA 70 - NEC, and requirements for electrical installations, Chapter 296 -46B WAC. 4: When any portion of the electrical installation is to be hidden from view by permanent placement of parts of the building, such equipment shall not be concealed until it has been inspected and approved by the Electrical Inspector. 5: The issuance of an electrical work permit shall not be construed to be a permit for, or an approval of, any violation of the provisions of the electrical code or other ordinances of the jurisdiction. Permits or related documentation that presumes to grant this authority are therefore not valid. 6: Any change in the scope of work described by the electrical work permit shall require additional work permits. Where approved plans have been issued, revisions to the plans and additional review may be required. doc: EL -4/10 EL12 -0807 Printed: 08 -27 -2012 CITY OF TUKWILA Community Development Department Permit Center 6301) Southcenter Blvd., Suite 100 Tukwila, W4 98188 h ttp :11w\a w. T u kw i I a W A. go v Electrical Permit No. O oZ - aq O 3-- Project No. Date Application Accepted: Date Application Expires: (For office use o1110 ELECTRICAL 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 Address: 200 Andover Park East US Health Works Tenant Name: PROPERTY OWNER Name: Dave Booth Name: Andover Plaza City: Lynnwood State: WA Zip: 98036 Address: 200 Andover Park East City: Lynnwood State: WA City: Tukwila State: WA Zip: CONTACT PERSON — person receiving all project, communication Name: Dave Booth Address: 21307 67th Ave W City: Lynnwood State: WA Zip: 98036 Phone: (425) 771 -3293 Fax: (425) 771 -3805 City: Lynnwood State: WA Tukwila Business License No.: BUS- 0993063 Zip: 98036 Phone: (425) 771 -3293 Fax: (425) 771 -3805 Email: eei200 @aol.com King Co Assessor's Tax No.: Suite Number: 8 Floor: 1 New Tenant: ❑ Yes m..No ELECTRICAL CONTRACTOR INFORMATION Company Name: Electric Electric, Inc. Address: 21307 67th Ave W City: Lynnwood State: WA Zip: 98036 Phone: (425) 771 -3293 Fax: (425) 771 -3805 Contr Reg No.: ELECTE1258MH Exp Date: 07/31/2014 Tukwila Business License No.: BUS- 0993063 Valuation of Project (contractor's bid price): $ 1,500 Scope of Work (please provide detailed information): Remove and reinstall 4 receptacles at new reception desk wall. Remove and reinstall 3 receptacles at new back reception wall. Will service be altered? ❑ Yes 0 No Adding more than 50 amps? ❑ Yes No Type of Use: Reception counter remodel, relocate 5 existing devices Type of work: ❑ New ❑ Addition ❑ Service Change ® Remodel ❑ Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service ❑ Tenant Improvement Property Served by: ❑ Puget Sound Energy ❑ Seattle City Light \ Applications\rornti- Application, On Line \_01 I Applications \Eleo k, I Pet nit Application Revised 8-9 -I Ldocs Revised: August 2011 bh Page 1 of 2 RESIDENTIAL NEW RESIDENTIAL SERVICE ❑ New single family dwellings $152.85 (including an attached garage) ❑ Garages, pools, spas and outbuildings $81.90 ea ❑ Low voltage systems (alarm, furnace thermostat) $59.85 ea RESIDENTIAL REMODEL AND SERVICE CHANCES ❑ Service change or alteration $81.90 (no added /altered circuits) ❑ Service change with added /altered circuits $81.90 number of added circuits $11.55 ea ❑ Circuits added /altered without service change $54.60 (up to 5 circuits) ❑ Circuits added /altered without service change $54.60 (6 or more circuits) $7.65 ea ❑ Meter /mast repair $68.25 ❑ Low voltage systems ............................ $59.85 (alarm, furnace thermostat) MULTI- FAMILY AND COMMERCIAL Fees are based on the valuation of the electrical contract. MISCELLANEOUS FEES ❑ Temporary service (residential) $63.00 ❑ Temporary service (generator) $78.75 ❑ Manufactured /mobile home service $84.00 (excluding garage or outbuilding) ❑ Carnivals $78.75 Number of concessions $10.50 ea -PERMIT APPLICATION NOTES 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 extension of time for an additional period not to exceed 90 days. The extension shall be requested in writing and justifiable cause demonstrated. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR'ELECTRICAL CONTRACTOR: Signature: Print Name: David C. Booth Date: 08/24/2012 Day Telephone: (425) 771 -3293 Mailing Address: 21307 67th Ave W Lynnwood WA 98036 City H:\ Applications \Forms- Applications On Line \2011 Applications \Electrical Permit Application Revised K -9 -I I.docx Revised: August 21111 bh Stale Zip Page 2 of 2 • City of Tukwila • 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.gov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: US HEALTH WORKS RECEIPT Permit Number: EL12 -0807 Status: APPROVED Applied Date: 08/27/2012 Issue Date: Receipt No.: R12 -02449 Payment Amount: $115.50 Initials: TLS Payment Date: 08/27/2012 08:19 AM User ID: 1670 Balance: $0.00 Payee: ELECTRIC ELECTRIC INC TRANSACTION LIST: Type Method Descriptio Amount Payment Check 21598 115.50 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 115.50 Total: $115.50 doc: Receipt -06 Printed: 08 -27 -2012 INSPECTION RECORD f�, Retain a copy with permit &t 1 06 INSPECTION NO. PERMIT NO.( CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -367 Permit Inspection Request Line (206) 431 -2451 Project: us 14. J(' Type of Inspection: Address: Zoo k-P1 Special Instructions: Date Called: Date Wanted: . Requester: p.m. Phone No: ® Approved per applicable codes. El Corrections required prior to approval. COMMENTS: n Inspector: Date: 41 n REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. f INSPECTION NO. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING D 6300 Southcenter Blvd., #100, Tukwila. WA 98188 t Permit Inspection Request Line (206) 431 -2451 tlo8 7 PERMIT NO. IVISION (206) 431 -367 Project: v/ 0004, tAlo �� Type of Inspection: `..� -7v0c Address: �0 , J t6oxfo / c Date Called: F Special Instructions: Date Wanted:. it a.n' . p.m. Requester: Phone No: JApproved per applicable codes. EJ Corrections required prior to approval. COMMENTS: /1- ' tnlAtit/ czkia� Inspector: / %6446A Date: REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Contractors or Tradespeople Prill Friendly Page • Electrical Contractor A business licensed by Lal to contract electrical work within the scope of its specialty. Electrical Contractors must maintain a surety bond or assignment of savings account. They also must have a designated Electrical Administrator or Master Electrician who is a member of the firm or a full -time supervisory employee. Business and Licensing Information Name Phone Address Suite /Apt. City State Zip County Business Type Parent Company ELECTRIC ELECTRIC INC 4257713293 21307 67Th Ave W Lynnwood WA 98036 Snohomish Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 600349839 Active ELECTEI258MH Electrical Contractor 7/8/1975 7/31/2014 General Unused Master Electrician INFORMATION License VERHESJ963D5 Name VERHEY, STEPHEN J Status Active Business Owner Information Name Role Effective Date Expiration Date VERHEY, STEPHEN J 01/01/1980 VERHEY, STEPHEN J Agent 01/01/1980 Bond Information No records found for the previous 6 year period Assignment of Savings Information Page 1 of 1 Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date 1 8/7/1989 Until Released Bond $4,000.00 8/7/1989 Insurance Information No records found for the previous 6 year period Summons /Complaint Information Summons and Complaints are not filed with the department for this contractor type Warrant Information Warrants are not filed with the department for this contractor type https: // fortress .wa.gov /lni/bbip /Print.aspx 08/27/2012