HomeMy WebLinkAboutPermit PG13-0155 - GUO OPTOMETRY - ALTERATIONGUO OPTOMETRY
381 STRANDER BL
PG13-0155
Parcel No:
Address:
Project Name:
11)
City of Tukwila
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
PLUMBING/GAS PIPING PERMIT
2623049064
381 STRANDER BLVD
GUO OPTOMETRY
Permit Number:
Issue Date:
Permit Expires On:
PG 13-0155
11/27/2013
5/26/2014
Owner:
Name:
Address:
Contact Person:
Name:
REGENCY CENTERS LP
PO BOX 790830 , SAN ANTONIO, WA,
78279
DARIAN CHARBONEAU
Address: 3 LAKE BELLEVUE DR, SUITE 201,
BELLEVUE, WA, 98005
Contractor:
Name: WILLIAMS MECHANICAL INC
Address: 3903 SMITH AV , EVERETT, WA, 98201
-4549
License No: WILLIMI088PA
Lender:
Name:
Address:
Phone: (425) 454-3621
Phone: (425) 303-0828
Expiration Date: 10/1/2015
DESCRIPTION OF WORK:
DEMO (3) SINKS, ROUGH -IN TWO EXAM SINKS AND ONE FUNNEL FLOOR DRAIN
Valuation of Work: $7,000.00
Water District: TUKWILA
Sewer District: TUKWILA SEWER SERVICE
Fees Collected: $156.88
Current Codes adopted by the City of Tukwila:
Internations Building Code Edition:
International Residential Code Edition:
International Mechanical Code Edition:
Uniform Plumbing Code Edition:
Permit Center Authorized Signature:
2012
2012
2012
2012
International Fuel Gas Code:
WA Cities Electrical Code:.
WA State Energy Code:
2012
2012
2012
Date: 1/..03
I hearby 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�an e -e to tcon
itionsattachedt this permit.
Signature:
Print Name:
Date:
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: ***PLUMBING/GAS PIPING PERMIT CONDITIONS***
2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the
Tukwila Building Division.
3: All permits, inspection records and applicable plans shall be maintained at the job and available to the
plumbing inspector.
4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and
the Fuel Gas Code.
5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved.
6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and
Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of
the holder of the permit to make sure that the work will stand the test prescribed before giving
notification that the work is ready for inspection.
7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall
unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes
installed outside the conditioned space shall be insulated to minimum R-3.
8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing
shall be protected by steel nail plates not less than 18 guage.
9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No
plumbing piping shall be directly embedded in concrete or masonry.
10: All pipes penetrating floor/ceiling assemblies and fire -resistance rated walls or partitions shall be
protected in accordance with the requirements of the building code.
11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin
layers to twelve inches above the top of the piping with clean earth, which shall not contain stones,
boulders, cinderfill, frozen earth, or construction debris.
12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for,
or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any
other ordinance of the jurisdiction.
13: The applicant agrees that he or she will hire a licensed plumber to perform the work outlined in this
permit.
14: All new plumbing fixtures installed in new construction and all remodeling involving replacement of
plumbing fixtures in all residential, hotel, motel, school, industrial, commercial use or other occupancies
that use significant quantities of water shall comply with Washington States Water Efficiency ad
Conservation Standards in accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code Section
402 of Washington State Amendments
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
8004 GROUNDWORK
•
1900 PLUMBING ANAL
8005 ROUGH -IN PLUMBING
•
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
Project No.
Date Application Accepted:
1,1( 5-15
Date Application Expires:.1 S -t Li
(For office use only)
PLUMBING / GAS PIPING 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.: 262304906403
Site Address: 381 Strander Blvd
Tenant Name:
GUO Optometry
Suite Number: 381 Floor: Ground
PROPERTY OWNER
Name: Chris Daniell
Address: 5335 SW Meadows Road Suite 295
City: lake Oswego State: OR Zip: 97035
CONTACT PERSON — person receiving all project
communication
Name: Darian Charboneau
Address: 3 Lake Bellevue Drive Suite 201
City: Bellevue State: WA Zip: 98005
Phone: (425) 454-3621 Fax: (425) 454-6918
Email: darian@woodmanconstruction.com
New Tenant: m Yes ❑..No
PLUMBING CONTRACTOR INFORMATION;
Company Name: Williams Mechanical
Address: 3909 Smith Ave
City: Everett State: WA Zip: 98201
Phone: (425) 303-0828 Fax: (425) 339-9244
Contr Reg No.: Exp Date:
Tukwila Business License No.: V- la 34-7 (
Valuation of Project (contractor's bid price): $ _ 7,000
Scope of Work (please provide detailed information):
Demo 3 sinks, rough -in two exam sinks and one funnel floor drain
Building Use (per Int'l Building Code).
Occupancy (per Int'l Building Code):
Utility Purveyor: Water. Sewer
H:Wpphcations'Forms-Applications On Line \2011 Applications\Plumbing Permit Application Revised 8-9-1 l.docx
Revised: August 2011
bh
Page 1 of 2
Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below:
Fixture Type
Qty
Bathtub or combination
bath/shower
Dishwasher, domestic with
independent drain
1
Shower, single head trap
Sinks
2
Rain water system — per
drain (inside building)
Grease interceptor for
commercial kitchen (>750
gallon capacity)
Each additional medical
gas inlets/outlets greater
than 5
Atmospheric -type vacuum
breakers not included in
lawn sprinkler backflow
protections (1-5)
Fixture Type
Qty
Bidet
Drinking fountain or water
cooler (per head)
1
Lavatory
Urinal
Water heater and/or vent
Repair or alteration of
water piping and/or water
treatment equipment
Backflow protective device
other than atmospheric -
type vacuum breakers 2
inch (51 mm) diameter or
smaller
Atmospheric -type vacuum
breakers not included in
lawn sprinkler backflow
protections over 5
Fixture Type
Qty
Clothes washer,
domestic
Food -waste grinder,
commercial
1
Wash fountain
Water closet
Industrial waste
treatment interceptor,
including trap and vent,
except for kitchen type
grease interceptors
Repair or alteration of
drainage or vent piping
Backflow protective
device other than
atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Gas piping outlets
Fixture Type
Qty
Dental unit, cuspidor
Floor drain
1
Receptor, indirect waste
Building sewer and each
trailer park sewer
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity
Medical gas piping
system serving 1-5
inlets/outlets for a specific
gas
Each lawn sprinkler
system on any one meter
including backflow
protection devices
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 180 days. The extension shall be requested in writing
and justifiable cause demonstrated. Section 103.4.3 International Plumbing 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 OWN THORIZED AGENT:
Signature: /��
Print Name: Charlie Dean
Date: 11/14/2013
Day Telephone: (425) 303-0828
Mailing Address: 3903 Smith Ave Everett WA 98201
H:\Applications\Fomu-Applications On Lme\2011 Apphcations\Plumbing Pemut Apphcatton Revised 8-9-1 I.docx
Revised: August 2011
bh
City State Zip
Page 2 of 2
Cash Register Receipt
City of Tukwila
DESCRIPTIONS
PermitTRAK
I ACCOUNT
I QUANTITY I PAID
$156.88
PG13-0155 Address: 381 STRANDER BLVD
Apn: 2623049064
$156.88
PLUMBING
$156.88
PERMIT ISSUANCE BASE FEE
R000.322.100.00.00
$32.50
PERMIT FEE
R000.322.100.00.00
$93.00
PLAN CHECK FEE
TOTAL FEES PAID BY RECEIPT: R115
R000.322.103.00.00
$31.38
$156.88
Date Paid: Friday, November 15, 2013
Paid By: BRADLEY WILLIAMS WILLIAMS MECH
Pay Method: CREDIT CARD 07535G
Printed: Friday, November 15, 2013 2:35 PM 1 of 1
ISYSTEMS
INSPECTION NO.
—INSPECTION RECORD
Retain a copy with permit
P6 3-ots5
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:
G ut OP Me, ey
Typ of Inspection: ,.-.-.
r 4146tk.1sFINA l
Addres :R ����
Date Called:
Special Instructions:
Date Wanted:
r a m.
Requester:
Phone No:
' Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
� j1 I4 -
Inspect r:60•
Date:
(- 7-/y.
R INSPECTION FEE RE IRED. Prior to next inspection, fee must be
paidjat 6300 Southcenter lvd., Suite 100. Call to schedule reinspection.
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
P613 -0 is
PERMIT NO.
CITY OF TUKWILA. BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 431-2451
Proj ct: ,
(�uO oPFt'1M
Type of Inspectio
C ircU
0
Ad a s:
, ( r ;J�
Date Called:
N�..o u Vii-
J, ../'
�
Special Instructions:
2 S r . _k,' A "
,A J r _w - . `1:
A�
Date Wanted:` Z,
�� .
a.m.
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
Inspecltor:
n REINSPECTION FEE RE
paid at 6300 Southcentel
Date:.
IRED._Prior to next inspection, fee must be
Blvd., Suite 100. Call to schedule reinspection.
StFARATE PERMIT
REQUIRED FOR:
14 Mechanical
Electri
Plumbin
Mas Pip
City of Tu
BU!LF)!NG DI
PROJECT. LOCATION
Strander Boulevard
PROJECT INFORMATION
SCOPE Of WORK
REMOVE CO DUSTING WAILS. APD
PARNRON WALLS 6 SINKS WITH NEW
ACOUSIICALCEUIG
PROPERTY OWNER
RE (SRC T CENTERS LP
ZONING PISMRIC1
110
SITE AREA
26041050,
PARCEL NUMBER
167301-9064
ADOPTED BUILDING CODE
7012 SC
PREVIOUSUSE
RESTAURANT
P005001DU6E
RE 1.41. I CLINIC (OPTOMETRY)
OCCUPANCY CLASSTOC1P0N
(0000080
BUILDING CONSTRUCTION TYPE
1.14
BUILDING YEAR BUST
1990
GROSS BALDING R00R AREA
31 60051
TI FLOOR AREA
1030 SF
OCCUPANT LOAD
111'0),100)
PLUMBING (IXTURE REOUIRED
111 ISPRONDED)
FRE SPRIN.IER 575TEN.
YES
LEGAL DESCRIPTION
LOT 1 Or 0411 pF TMVRA SHORT RAI NO MOSS RE CORDNG N0 9208261819 3810 SNORT
RAI DV POR Or1Y41MOF NEIN- 8EGSW000 Of NE 1411 N 011021 E 129357E1 TOS
MGN OF STRANDER SOS 3115861533E hes R TO ROB 11. S 014477 W 83 FT TAP 04 TANGENT
CURVE CONCAVE 10 NE RAD 01 13041 1H SEE/ ALG SD LT/RVE RIAU ARC OF 34-7791 ARC
1E40010347E07 n 115861133E 23211r115 501342100 FT 1313861533 E901 165
01.14.27... 52 E11.0N 861513 0 133 01 05 5 01.467714 1501110 N 861533 W49213, NIS
4$.20.37W11351R 84501x41W3110Ri11 580I533 W 12OFT11501.44211746011 THN
8815.33 A, 6901 TO w L/407 SALO SW 1:411504710:40041 83 R TO SW CORNER°. NE l4
TN 5 81406+3 E 1309.18 R TO W MGN 03 ANDOVER PARA WEST IH N 01-0325 E 128691 R 155
MGN Or SIRANDER &VO 05 N 861503 W &4111 R T0008 - ANA LOT 20F CITY 0r NAWILA
LOT 1N 101 NO 88644 RECORONG N0 530,240241- LESS r0RTI5N FOR RAV TO CITY OA
TUXvtILA
ABBREVIATIONS
8LA'G
CLR
CON/
CS
3&
DS
U
E0
53453
RC
EX
NOR
HDV40
NCR
BOOTS
COVER UNE
CLEAR
(0111 ./000
CASEMENT MASCO
DOUBLE
D O'M15POIIT
• qN
00381
10UAL
EXSENG
300 ENG
0D9.1) WKS*
!FADER
HARDWOOD
HANGER
HORIZ
MATt
435
MN
DE
50
5f
351
SID
0
V 3AS
003009000
MAXW4011
NaNUFACTURER
MNR4'UM
OVER
ON CENTER
511013E DETECTOR
SAFETY GLASS
SOLAR( FEET
SODER
SILOS WINDOW
TYPICAL
UTAE SS NOTED OTHERWISE
VENT TO OUTSDE
WITH
CONTRACTOR TO VERIFY ALL OF EXISTING
CONDITIONS PRIOR TO CONSTRUCTION REPORT TO
ARCHITECT FOR ANY DISCREPENCIES FOUND.
MINIMUM NAILING SHALL COMPLY WITH TABLE 2304.9 1 OF THE 2012 IBC.
METAL SRO BRACING (I MAX FP 0 C.
EXIST SERUCIURE -.
METAL TRACK
3 YR 30 GA ME AT STUDS 0200C
REVISIONS
No changes shall be made to the scope
of work without prior approval of
Tukwila Building Division.
NOTE: Revisions will require a new plan submittal
and may include additional plan review fees
METAL ANGLE
` -- 3059034005 CEILING PANEL
0 3B' . 4 EXPANSION
ANCHOR BOLTS ®8' 0.C.
- 4E 143 TRACT(
OTYP. WALL DETAILS
SCALE: 1'
a
1X
0
f-0
0 E11101 M. 100
)4ARC1 EXIST. HT. OF AIR )EFUSEIS)
•X
a
a
0
X�
n
I
SO
X
X
V
X
-J
1543'
- DIST. 10 DOOR M CLOSER:
/ CLOSER TO BE ADJUSTED RANK S SECS.
58014803500000019503030011512 DEGREE
REVIEWED FOR
CODE COMPLIANC
APPROVED
NOV 2 0 2013
City of u wila
BUILDING VISIO
1. INSTALL OCCUPANCY SENSER AT RESTROOM 6
EXAM 60045.
2 INSTALL AUTOMATIC TIME SWITCH AT DISPLAY
WAMNG AREA.
15133.1 Occupancy sensors: Occupancy serurs
shall be nspae4 dalm7a11y Wring off Se Wm
In an area 1)e nitre than 30 Brutes after 84 ane Ins
tam 490141 Laa tutees 1nWP1ed by um9r0y
Amon Sal haw a.aMpaeed, manta a.ml
capable of Maip m ION *nen Om span b otu Ned.
152301110147813 Tine Switches: Aalome7c Mr.
5443054 55441 haw 4 minimum) Ery dad and be
caps* of bets /el b 7 erns day types per.en4
_Land Incorporate a1 mesa* 6d44y%NANO halve.
MANS tuna oft a1 bads fora bad 24 haus and men
sures 9011*5* ad0dled op4ntl*u. AMmab
0174 OAWNas NA1 Ando have pagan badwp
capa0Dtles.MYrA IAevern Bre 104 a Ro9ran a4 W e
sed -99 for a11mM101040*. 593.9. kteo led.
350 SWAY SWITCH)DPOUBLE)
)E) FIRE SPRINKLER HEAD
O
0
(E)AR DIFFUSER
6' RECESS LIGHT
I n 0 1 TRACKLKM
RWRESCENT LIGHT
24s48 ACOUSTICAL CEILING TILE
OREFLECTED:CEILING PLAN
SCALE: 1/4' =
OTFS.
LATERAL 9PAd1G CLUSTER- (4) 11 CA CALV SO2 --ANNEALED MED STEEL WIRES SECURED TO 4hN RUNNER
WITHIN 2' OF CROSS '0 AVD SPLAYED 90 0E(RTS FROM EACH OTHER AT 45 DEGREES M.X. ABOVE NORLIONTAL
30051555 5.7000 12'-0' OC MAX 0.N3 6'-0' MAX FROM EACH WALL WIRES SHOULD BE TAUT 191THOUI
CAUSIN. (RUNG 10 UR.
SUSPENSION WIRE 11 GA CALV. SCR -ANNEALED 111.1) STEEL WIRE ENCASED IN I' DNI. CONDUIT (FOR UPLIFT
RLS IIIAN'1). SEL -11.41. 111 RE 10 MAIN RUNNER W. .NN 2' 31 CROSS T. CONDUIT TO OCCUR AF EVERY LATERAL
BRACING :LISTER AND SI/SPEA50N WIRES ID OCCUR Al i -0' 0.C. MAX EACH WAY.
3 TURNS MN
WITHIN 3' TPF
00` 11
TOFAS)71 90i N \
WAL ANGLE AT
(2) AC0A:ENT
SIDES. -'O/DE
MIN 2' 7417:
OVAL. 4401E
MAN RUNNER.
HEA'.0 03111
CROSS 'r
NEW SHOWING 1ATERAL BRACING
CLUSTER AND SUSPENSION WIRE
2' MAY.
(0
N0)0 /2
NOTE 11
RUNNER FINDS AT
OPPOSITE WALLS
TO 810AT FREE
ON POSMETE0R
ANGLE. PR0V13E
3/4' CLEARANCE
BETWEEN ENDS OF
(RIO d WALL
OCEILING BRACING DIAGRAM
SCALE NO
N0 9 CA. LATERAL SUPPORT WIRE WITHIN 3'
OF EACH GINNER OF 00401 TEXTURE SPLAY
VISES AS SHOWN AND FASTEN 13 BFAL1 OR
PURUN. ITN. OF 3 YARE TURNS.EACN.
CONNECTION P0541
NO 9 CA LATERAL SUPPORT 'JURE AT
CENTER ENDS 0' EA FIXTURE. FIXTURE
SUPPORT WIRE SUPPLI0 BY CEI:INO
CO00.4LTOR•
MAX. EYP.
45.
RECESSED FLUORESCENT
FIXTURE
CROSS TIE
MAIN STR11011.1RAL
RUNNER 4-C' O.C.
OLIGHTING FIXTURE BRACING DIAGRAM
SCALE NO
(EXIT;
- 5 WATTS UNMATED EXITSIGNM
EMERGENCY BACA UP POWER
DISPLAY
—.WAITING
EX.AAI 1:•�
"•�'m` DROP/ 1101.1)
-• .. ...7d'
7.17.
r.�. 34.34
RI Ell ['ERICA. PANEL
12001/1213)
ALL NEW DOORS ARE 1334' SC W000 WITH IEVER.TYPE
HANDLES MOUNTED BETWEEN 3P y1040 HIGH.
OFLOOR PLAN
SCALE: 1/4-= 1'.0'
SYMBOL
REMOVED WALL
EXIST. WALL
NEW WALL
RECEIVED
CITY OF TUKWILA
NOV 1 5 2013
PERMIT CENTER
Gl3--0155
NA4aR CATE OESOWTIC010FRENSAKS
1.1-2.3 MOAT SU
SWEr
SITE PLAN
FLOOR PLAN
DETAILS
Jell MASER
aEENIAMER
Al
PERMIT COORD COPY
PLAN REVIEW/ROUTING SLIP
ACTIVITY NUMBER: PG13-0155
PROJECT NAME: GUO OPTOMETRY
SITE ADDRESS: 381 STRANDER BL
X Original Plan Submittal
Response to Correction Letter #
DATE: 11-15-13
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS:
Building sio 1
Pubic or s
Fire Prevention
Structural
Planning Division
n Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 11-19-13
Complete
Comments:
Incomplete
Not Applicable
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg 0 Fire 0 Ping 0 PW 0 Staff Initials:
TUES/THURS ROUTING:
Please Route ❑ Structural Review Required n No further Review RequiredIX
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 12-17-13
Approved ❑ Approved with Conditions Not Approved (attach comments)
Notation:
REVIEWER'S INITIALS: DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg 0 Fire 0 Ping 0 PW 0 Staff Initials:
Documents/routing slip.doc
2-28-02
Contractors or Tradespeople Prifer Friendly Page
•
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 WILLIAMS MECHANICAL INC UBI No. 601413863
Phone 4253030828 Status Active
Address 3903 Smith Ave License No. WILLIMI088PA
Suite/Apt. License Type Construction Contractor
City Everett Effective Date 10/1/1992
State WA Expiration Date 10/1/2015
Zip 982014549 Suspend Date
County Snohomish Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
tenses
License
Name
Type
Specialty 1
Specialty
2
Effective
Date
Expiration
Date
Status
WILLIPH136Q4PLUMBING
WILLIAMS
a
HTG INC
Construction
Contractor
Boiler/Steam
Fit/Prot Piping
Plumbing
11/24/1987
11/19/1992
Archived
Business Owner Information
Name
Role
Effective Date
Expiration Date
WILLIAMS, DEBORAH KAY
Agent
09/27/2011
Bond Amount
WILLIAMS, BRADLEY PATRICK
President
01/01/1980
1977877
WILLIAMS, DEBORAH KAY
Secretary
01/01/1980
WILLIAMS, DEBORAH KAY
Treasurer
09/27/2011
INS CO OF THE WEST
ZUCCARINI, MICHAELJ
Agent
01/01/1980
01/01/1980
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
4
THE HANOVER INS.
1977877
10/01/2010
Until Cancelled
$12,000.0009/15/2010
10/07/2013
3
INS CO OF THE WEST
2271807
10/01/2007
Until Cancelled
10/23/2010
$12,000.00
10/01/2007
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
19
Federated
Mutual Ins Co
9059851
09/30/2013
09/30/2014
$1,000,000.00
10/07/2013
18
Federated
Mutual Ins Co
5326871
09/30/2013
09/30/2014
$1,000,000.0009/29/2013
17
CHARTER OAK
FIRE
INSURANCE
COM
4TC00427P552C0F09
09/30/2010
09/30/2014
$1,000,000.0008/30/2013
16
CONTINENTAL
WESTERN
INSURANCE
CWP2643064
09/30/2007
09/30/2010
$1,000,000.0009/23/2009
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
httnc • //fnrtrecc _ wa _ crnv/l n i /hhin/Pri nt. asnx
11/27/2013
Contractors or Tradespeople Prir r Friendly Page
Infractions/Citations Information
Infraction / Citation
Date
RCW Code
Type
Status
Violation Amount
PSAMD00708
3/2/2011
18.106.020
PLUMBER INFRACTION
Satisfied
$250.00
Page 2 of 2
https://fortress.wa.gov/lni/bbip/Print.aspx 11/27/2013