HomeMy WebLinkAboutPermit D13-0369 - SUMMIT HOMES - TENANT IMPROVEMENTSUMMIT HOMES
16000 CHRISTENSEN RD
STE 303
EXPIRED 07/15/2014
D13-0369
Parcel No:
Address:
116
City of Tukwila
1
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Inspection Request Line: 206-438-9350
Web site: http://www.TukwilaWA.gov
DEVELOPMENT PERMIT
2523049077 Permit Number: 013-0369
16000 CHRISTENSEN RD 303 Issue Date: 1/16/2014
Permit Expires On: 7/15/2014
Project Name: SUMMIT HOMES
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Contractor:
Name:
Address:
License No:
Lender:
Name:
Address:
BRCP RIVERVIEW PLAZA LLC
248 HOMER AVE , PALO ALTO, WA,
94301
TARA STROYAN
1326 5 AVE, STE 400 , SEATTLE, WA,
98101
RAYMOND -NORTHWEST LLC
520 W WALNUT AVE , ORANGE, CA,
92868
Phone: (206) 587-7120
Phone: (714) 771-7670
RAYMOL*877C0 Expiration Date: 2/19/2015
SELF -FINANCED BY OWNER
DESCRIPTION OF WORK:
INTERIOR TENANT IMPROVEMENT TO EXPAND EXISTING SUITE. WORK TO INCLUDE CONSTRUCTION OF NEW
PARTITIONS, DOORS, AND FINISHES.
Project Valuation: $40,000.00
Type of Fire Protection: Sprinklers: YES
Fire Alarm: YES
Fees Collected: $1,373.84
Type of Construction: IIB Occupancy per IBC: B
Electrical Service Provided by: TUKWILA FIRE SERVICE Water District: TUKWILA
Sewer District: TUKWILA SEWER SERVICE
Current Codes adopted by the City of Tukwila:
Internations Building Code Edition:
International Residential Code Edition:
International Mechanical Code Edition:
Uniform Plumbing Code Edition:
2012
2012
2012
2012
International Fuel Gas Code:
WA Cities Electrical Code:
WA State Energy Code:
2012
2012
2012
Public Works Activities:
Channelization/Striping:
Curb Cut/Access/Sidewalk:
Fire Loop Hydrant:
Flood Control Zone:
Hauling/Oversize Load:
Land Altering:
Landscape Irrigation:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter:
Volumes: Cut: 0 Fill: 0
Number: 0
No
Permit Center Authorized Signature
I hearby certify that I have read and
Date:
ot[Nilq
ined this permit and know the same to be true and correct. All
provisions of law and ordinances govixnifig 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. ,
Signature: Date: /` `C./l `/
Print Name:
This permit shall become null and void if the work is not commenced within 180 days for 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 PERMIT CONDITIONS***
2: Work shall be installed in accordance with the approved construction documents, and any changes made
during construction that are not in accordance with the approved construction documents shall be
resubmitted for approval.
3: All permits, inspection record card and approved construction documents shall be kept at the site of work
and shall be open to inspection by the Building Inspector until final inspection approval is granted.
4: New suspended ceiling grid and light fixture installations shall meet the seismic design requirements for
nonstructural components. ASCE 7, Chapter 13.
5: Partition walls shall not be tied to a suspended ceiling grid. All partitions greater than 6 feet in height
shall be laterially braced to the building structure. Such bracing shall be independent of any ceiling splay
bracing.
6: All construction shall be done in conformance with the Washington State Building Code and the
Washington State Energy Code.
7: There shall be no occupancy of a building until final inspection has been completed and approved by
Tukwila building inspector. No exception.
8: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap
the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks,
wells, and other excavations. Final inspection approval will be determined by the building inspector
based on satisfactory completion of this requirement.
9: Every occupied space other than enclosed parking garages and buildings used for repair of automobiles
shall be ventilated in accordance with the applicable provisions of the International Mechanical Code.
• 1
10: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the
City of Tukwila Building Department (206-431-3670).
11: All electrical work shall be inspected,and approved under a separate permit issued by the City of Tukwila
Permit Center.
12: 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.
13: All mechanical work shall be inspected and approved under a separate permit issued by the City of
Tukwila Permit Center (206/431-3670).
14: ***FIRE DEPARTMENT PERMIT CONDITIONS***
15: Portable fire extinguishers, not housed in cabinets, shall be installed on the hangers or brackets supplied.
Hangers or brackets shall be securely anchored to the mounting surface in accordance with the
manufacturer's installation instructions. Portable fire extinguishers having a gross weight not exceeding
40 pounds (18 kg) shall be installed so that its top is not more than 5 feet (1524 mm) above the floor.
Hand-held portable fire extinguishers having a gross weight exceeding 40 pounds (18 kg) shall be installed
so that its top is not more than 3.5 feet (1067 mm) above the floor. The clearance between the floor and
the bottom of the installed hand-held extinguishers shall not be Tess than 4 inches (102 mm). (IFC 906.7
and IFC 906.9)
16: Extinguishers shall be located in conspicuous locations where they will be readily accessible and
immediately available for use. These locations shall be along normal paths of travel, unless the fire code
official determines that the hazard posed indicates the need for placement away from normal paths of
travel. (IFC 906.5)
17: Fire extinguishers require monthly and yearly inspections. They must have a tag or label securely
attached that indicates the month and year that the inspection was performed and shall identify the
company or person performing the service. Every six years stored pressure extinguishers shall be emptied
and subjected to the applicable recharge procedures. If the required monthly and yearly inspections of
the fire extinguisher(s) are not accomplished or the inspection tag is not completed, a reputable fire
extinguisher service company will be required to conduct these required surveys. (NFPA 10, 4-3, 4-4)
18: Egress doors shall be readily openable from the egress side without the use of a key or special knowledge
or effort. (IFC 1008.1.8.3 subsection 2.2)
19: Dead bolts are not allowed on auxiliary exit doors unless the dead bolt is automatically retracted when
the door handle is engaged from inside the tenant space. (IFC Chapter 10)
20: Exit hardware and marking shall meet the requirements of the International Fire Code. (IFC Chapter 10)
21: Door handles, pulls, latches, locks and other operating devices on doors required to be accessible by
Chapter 11 of the International Building Code shall not require tight grasping, tight pinching or twisting of
the wrist to operate. (IFC 1008.1.8.1)
22: Aisles leading to required exits shall be provided from all portions of the building and the required width
of the aisles shall be unobstructed. (IFC 1013.4)
23: 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).
24: Sprinklers shall be installed under fixed obstructions over 4 feet (1.2 m) wide such as ducts, decks, open
grate flooring, cutting tables, shelves and overhead doors. (NFPA 13-8.6.5.3.3)
25: 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)
26: All electrical work and equipment shall conform strictly to the standards of the National Electrical Code.
(NFPA 70)
•
27: 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.
28: In order to provide you with the fastest police and fire protection under emergency conditions, please
post your suite, room or apartment number in a conspicuous place near the main entry door. (IFC 505.1)
29: These plans were reviewed by Inspector 511. If you have any questions, please call Tukwila Fire
Prevention Bureau at (206)575-4407.
30: Any overlooked hazardous condition and/or violation of the adopted Fire or Building Codes does not
imply approval of such condition or violation.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
1400 FIRE FINAL
0409 FRAMING
0606 GLAZING
0406 SUSPENDED CEILING
CITY OF TUKWILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd-, Suite 100
Tukwila, WA 98188'
http://www.TukwilaWA.gov
Building Permit No. I? 071J I
Project No:
Date Application Accepted: I2-� (till
Date Application Expires:t/�{ t 0
(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.
King Co, Assessor's Tax No.: 2S2W4°I O%
Site Address: 'TOO CAI �\ w
C5ti"�t `' v Suite Number: Floor:
Tenant Name: 2$lAJYlfAA-- New Tenant: ....Yes ..No
PROPERTY OWNER
Company Name:
Name: ¶a.x-& vV
Name: (hi fDro'
City: ,/�
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Address: c...0-Th� J
Address: NO
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Phone:nry„(3� -1( l�ax: e _'r'
State: ! t )tel
Zip: n l��
CONTACT PERSON — person receiving all project
communication
Company Name:
Name: ¶a.x-& vV
Address:' cin .e...., 10. 10. 4fX)
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City: ,/�
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Address: c...0-Th� J
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Phone: 1 1S16/ 111: `OCO' 11(2 -
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Email:
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Zip:
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Email: .1-f.0,,c. jAn
Fax:
City:
GENERAL CONTRACTOR INFORMATION
Company Name:
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Address:' cin .e...., 10. 10. 4fX)
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City: ,/�
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Address:
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Phone: 1 1S16/ 111: `OCO' 11(2 -
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Email:
Email: kelc ,^�,t . ,n A 'nl/%7S hat
City:
State:
Address:
Zip:
Phone:
Fax:
City:
Contr Reg No.:
Zip:
Exp Date:
Tukwila Business License No.:
Email:
F1:\Applicntionidrorms-Applications On Line \2011 Applicat ions\Per nit Application Revised - 8-9-1 Ldoc>
Revised: August 2011
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.ARCHITECT OF RECORD
:::::
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Address:' cin .e...., 10. 10. 4fX)
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City: ,/�
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State:,'` Zip: j�
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Phone: 1 1S16/ 111: `OCO' 11(2 -
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Email:
Email: kelc ,^�,t . ,n A 'nl/%7S hat
ENGINEER OF RECORD
Name: gte_el raja,,
j �-QX '
Company Name:
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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: gte_el raja,,
j �-QX '
Address:
City: State: Zip:
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•
BUILDING PERMIT INFORMATION — 206-431-3670
Valuation of Project (contractor's bid price): $
)00
Existing Building Valuation: $
Describe the scope of work (please provide detailed information):
r b�x�► r , gJrr �v (19 --Afteurit
cdcuiAL. U oNt-k AA)
\-10Yis ci-00(5 t UJ\k-.
Will there be new rack storage? ❑ Yes [ 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:
Will there be a change in use? ❑ Yes
Compact: a• -•3411. --
No if "yes", explain:
Handicap:
FIRE PROTECTION/HAZARDOUS MATERIALS:
7.. Sprinklers Automatic Fire Alarm ❑ None ❑ Other (specify)
Will 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 ata 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.
II: u\pplicaiioniTurnrs :4pplic:nions On I.we1-011 iuns\Peunil Rer lxd - 8-0-11 dor.:
Revised: August 2011
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Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
I Floor
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�B
IV
��
rd Floor
/) 1
49
1115
1f27
3rd Floor
1Si
(/ /
r1 )CJ -1 �
l `
400
V
r
-M� i J
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:
Will there be a change in use? ❑ Yes
Compact: a• -•3411. --
No if "yes", explain:
Handicap:
FIRE PROTECTION/HAZARDOUS MATERIALS:
7.. Sprinklers Automatic Fire Alarm ❑ None ❑ Other (specify)
Will 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 ata 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.
II: u\pplicaiioniTurnrs :4pplic:nions On I.we1-011 iuns\Peunil Rer lxd - 8-0-11 dor.:
Revised: August 2011
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•
•
PUBLIC WORKS PERMIT INFORMATION — 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 0 ... Water District #125
❑ ...Water Availability Provided
Sewer District
❑ ...Tukwila
❑ ...Sewer Use Certificate
0 .. Highline
❑... Valley View 0 .. Renton
❑...Sewer Availability Provided
❑ .. 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")
0 ...Technical Information Report (Storm Drainage) ❑ .. Geotechnical Report
0 ...Bond 0 .. Insurance 0 .. Easement(s) 0 .. Maintenance Agreement(s)
Proposed Activities (mark boxes that apply):
❑ ...Right-of-way Use - Nonprofit for Tess than 72 hours
❑ ...Right-of-way Use - No Disturbance
❑ ...Construction/Excavation/Fill - Right-of-way 0
Non Right-of-way 0
❑ ...Total Cut
❑ ...Total Fill
cubic yards
cubic yards
❑ ...Sanitary Side Sewer
❑ ...Cap or Remove Utilities
❑ ...Frontage Improvements
❑ ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑.
❑.
❑.
❑.
❑...Traffic Impact Analysis
❑ ... Hold Harmless — (SAO)
❑ ... Hold Harmless — (ROW)
❑ .. Right-of-way Use - Profit for less than 72 hours
❑ .. Right-of-way Use — Potential Disturbance
❑ .. Work in Flood Zone
❑ .. Storm Drainage
. Abandon Septic Tank
. Curb Cut
. Pavement Cut
. Looped Fire Line
❑ ...Permanent Water Meter Size...
❑ ...Temporary Water Meter Size ..
❑ ...Water Only Meter Size
❑ ...Sewer Main Extension Public 0
❑ ...Water Main Extension Public 0
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
WO#
WO #
WO # ❑ ...Deduct Water Meter Size
Private 0
Private ❑
FINANCE INFORMATION
Fire Line Size at Property Line
0 ... Water 0 ...Sewer
Monthly Service Billing to:
Name:
Number of Public Fire Hydrant(s)
❑ ...Sewage Treatment
Mailing Address:
Day Telephone:
Water Meter Refund/Billing,;
Name:
Mailing Address:
City
State
Zip
Day Telephone:
City
State
Zip
1 I:'+Applicaiions\Fornu-Applications On Line12011 Applications iPerna' Application Revised - 8-9-1 Ldocc
Revised: Anaust 2011
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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 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 0
Signature:
RIZED AGE
��
Print Name: a
1:2 -LP C7114 mei,*L 4534,yre410
Mailing Address:
Date: 0--1 .QqLD
Day Telephone: ate. 5 0 I.1 L L -D
MP1- GIST 1
State Zip
11::\pplicalions ro ns -Applications On Lina,_UI 1 Applications Permit Applicai ion Re, iced - 0-9-11 does
Revised: Auewt 2011
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Paee 4 of
Cash Register Receipt
City of Tukwila
DESCRIPTIONS
PermitTRAK'
ACCOUNT
QUANTITY
PAID
834.40
D13-0369 Address: 16000 CHRISTENSEN
RD 303
Apn: 2523049077
$834.40
DEVELOPMENT
$834.40
PERMIT FEE
WASHINGTON STATE SURCHARGE
TOTAL FEES PAID BY RECEIPT: R769
R000.322.100.00.00
8640.237.114
$829.90
$4.50
$834.40
Date Paid: Thursday, January 16, 2014
Paid By: MICHAEL BURELL
Pay Method: CREDIT CARD 016031
Printed: Thursday, January 16, 2014 9:31 AM 1 of 1
IRWSYSTEMS
Cash Register Receipt
City of Tukwila
DESCRIPTIONS
ACCOUNT
QUANTITY PAID
$539.44
D13-0369 Address: 16000 CHRISTENSEN RD 303 Apn: 2523049077
$539.44
DEVELOPMENT
$539.44
PLAN CHECK FEE
TOTAL FEES PAID BY RECEIPT: R300
R000.345.830.00.00
$539.44
$539.44
Date Paid: Tuesday, December 10, 2013
Paid By: BURGESS DESIGN, INC.
Pay Method: CHECK 012653
Printed: Tuesday, December 10, 2013 10:04 AM 1 of 1
CRWSYSTEMS
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: �r
U 1T1 I -I-kQiIiii ,
Type of ns ection:
t 4 vV l 3
Ades
:
6Pbd c 14 IS 74Ni an
Date Called:
Special Instructions:
Date Wante :l
Ks
Requester: r 1
E
Phone No:(A1 6
El.!.kpproved per applicable codes.
ECorrections required prior to approval.
COMMENTS:
F1.PC-1Q'Nrt1 J tJ6w .v1/4P41\ )
ti
n
Date:
1- ZZ_ILI.
pINSPECTION FEE REQ IRED. Prior next inspection, fee must be
pid/at 6300 Southcenter B d., Suite 10 . Call to schedule reinspection.
6/2/2014
City of Tukwila
Department of Community Development
TARA STROYAN
1326 5 AVE, STE 400
SEATTLE, WA 98101
RE: Permit No. D13-0369
SUMMIT HOMES
16000 CHRISTENSEN RD, STE 303
Dear Permit Holder:
Jim Haggerton, Mayor
Jack Pace, Director
In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building
Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National Electric
Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and become null
and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of such permit, or if
the building or work authorized by such permit is suspended or abandoned at any time after the work has begun for a period of 180
days. Your permit will expire on 7/15/2014.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206-438-9350 to schedule for the next or final inspection. Each
inspection creates a new 180 day period, provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven(7) days before it is due to expire. Address
your extension request to the Building Official and state your reason(s) for the need to extend your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your
extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and/or receive an extension prior to 7/15/2014, your permit will become null and void
and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
Marshall
echnician
File 13-0369
6300 Southcenter Boulevard Suite 1400 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
PERMIT COORD COPY M
PLAN REVIEW/ROUTING SLIP
ACTIVITY NUMBER: D13-0369 DATE: 12/10/13
PROJECT NAME: SUMMIT HOMES
SITE ADDRESS: 16000 CHRISTENSEN RD, STE 303
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # after Permit Issued
DEPARTMENTS:
fa -
Building Division ❑
0,\ IZ /F-1\i'13Public Wor s ❑
ktoc 1)--i(p-(3
ire Prevention
Structural ❑
1t.(Jk IZttZ�l3
Planning tvision ❑
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 12/12/13
Complete 5
Incomplete
Not Applicable
Comments:
Permit. Center`UseOnly
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete:
Bldg ❑ Fire 0 Ping 0 PW 0 Staff Initials:
TUES/THURS ROUTING:
Please Route
Structural Review Required n No further Review Required ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 01/09/14
Approved ❑ Approved with Conditionsr. Not Approved (attach comments) ❑
Notation:
REVIEWER'S INITIALS:
DATE:
Pernit'Center Use Oriltb
CORRECTION LETTER MAILED:
Departments issued corrections:
Bldg 0 Fire 0 Ping 0 PW 0 Staff initials:
RAYMOND -NORTHWEST LLC
0 Washington State Department of
Labor & Industries
Page 1 of 2
RAYMOND -NORTHWEST LLC
Owner or tradesperson
WINSOR, TRAVIS WAYNE
Principals
WINSOR, TRAVIS WAYNE
MICHAEL POTTER
Doing business as
RAYMOND -NORTHWEST LLC
WA UBI No.
603 273 515
520 W WALNUT AVE
ORANGE, CA92868
714-771-7670
Business type
Limited Liability Company
Governing persons
MICHAELPOTTER
License
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor
License specialties
GENERAL
License no.
RAYMOL*877C0
Effective — expiration
02/19/2013 — 02/19/2015
Bond
Liberty Mutual Ins Co
Bond account no.
24034355
Active.
Meets current requirements.
$12,000.00
Received by L&I Effective date
02/19/2013 02/12/2013
Insurance
First Specialty Ins Corp $2,000,000.00
Policy no.
IRG200016701
Received by L&I Effective date
08/08/2013 07/31/2013
Expiration date
07/31/2014
Savings
No savings accounts during the previous 6 year period.
t/t(D' 0°M( -I131
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603273515&LIC=RAYMOL*877CO&SAW= 01/16/2014