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Home My WebLink AboutPermit PG13-078 - MCMICKEN COURT BUILDING - ALTERATIONMCMICKEN COURT 4220 S 164 ST PG13-078 City AI'ukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Inspection Request Line: 206-431-2451 Web site: httn://www.TukwilaWA.gov PLUMBING/GAS PIPING PERMIT Parcel No.: 5379800670 Address: 4220 S 164 ST TUKW Project Name: MCMICKEN COURT BUILDING Permit Number: Issue Date: Permit Expires On: PG 13-078 05/30/2013 11/26/2013 Owner: Name: BAUMEISTER LLC Address: 4632 NE 89TH ST , SEATTLE WA 98115 Contact Person: Name: Address: Email: IAN HAMAD 4632 NE 89 ST , SEATTLE WA 98115 IAN.HAMAD@GMAIL.COM Contractor: Name: B & L PLUMBING SERVICE Address: 15423 50 PL W , EDMONDS WA 98026-4414 Contractor License No: BLPLUS*097P2 Phone: 206-331-1524 Phone: 425 745-4162 Expiration Date: 02/03/2015 DESCRIPTION OF WORK: ROUGH -IN PLUMBING WASTE, WATER, AND VENTS FOR NEW MIXED USE BUILDING Value of Plumbing/Gas Piping: Fees Collected: Electrical Service Provided by: $20,000.00 $1,145.81 Permit Center Authorized Signature: I hereby certify that I have read an governing this work will be compli ex• dwith p\k Uniform Plumbing Code Edition: 2009 International Fuel Gas Code Edition: 2009 Date: ocf 30 ( 1 ed this permit and know the same to be true and correct. All provisions of law and ordinances whether specified herein or not. The granting of this permit does not p e 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 plumbing/gas piping permit and agree to the conditions on the back of this permit. Signature: Print Name: 1'V.7(`(.d1<-' L eco,, cr Date: C 3° - (7 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. .a....• ICU, A!In Dr! 14_n7A D.inro.l• AR_zn_')n1z PERMIT CONDITIONS Permit No. PG 13-078 1: ***PLUMBING AND GAS PIPING*** 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: All new plumbing fixtures installed in new construction and all remodeling involving replacement of plumbing fixtures and fittings 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 and Conservation Standards in accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code Section 402 of Washington State Amendments. 13: 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. rine- 1 IDCAHn Pr 13-07R Printed: 05-30-2013 CITY OF TUKWI Community Developmei.. _Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http:/Iwww.TukwilaWA.gov 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 Site Address: If 21-0 S• C 0 —t Tenant Name: King Co Assessor's Tax No.: 63 7 ?foo 7�1 Suite Number: PROPERTY OWNER Name: kAA..Cc. J Address: 4,6.3 L /1/6 t f r City: c 1>; State: um ta. Zip: CONT, communication Name: yc KCt. tAA-C. (1 Address: 11.6 City: re State: Zip: ;6,(ts` Phone: 6 ,6 2if Fax: qtr 7 4 Email: / 414 G1Cf IAA(( •j +.k CO t Nl Floor: New Tenant: ❑ Yes ..No -PLUMBING CONTRACTOR INFORMATION Company Name: -r L f /` b , k( I3-6 Address: / it 3 rc L City: (lc eba 6107,ip. Phone: 5 , 4 J/)x. Contr Reg No.: i7 Exp Date: \th' Tukwila Business License No.: /},t fon iit A\ r• Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): Pr, ,r—vt S Building Use (per Intl Building Code): V— A Occupancy (per Int'I Building Code): ktz Utility Purveyor: Water: EL In L) c kJ (Ni 1-1.\Applications \Forms -Applications On Line \201.1 Applications\Plumbing Permit Application Revised 8-9-11 docx Revised. August 2011 hh Sewer: V4 ( 1,-e` ite C),,1 �\ Page 1 of 2 Indicate type of plumbing fixtures and/ Fixture Type Qty Bathtub or combination bath/shower 1$ Dishwasher, domestic with independent drain g Shower, single head trap I Sinks It Rain water system — per drain (inside building) Grease interceptor for commercial kitchen (>750 gallon capacity) Each additional medical gas inlets/outlets greater than 5 t Atmospheric -type vacuum breakers not included in lawn sprinkler backflow protections (1-5) s piping outlets being installed and the quant''"e1ow: Fixture Type Qty Bidet J, '7 Drinking fountain or water cooler (per head) Lavatory li Urinal It 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 t Atmospheric -type vacuum breakers not included in lawn sprinkler backflow protections over 5 Fixture Type J Qty Clothes washer, domestic J, '7 Food -waste grinder, commercial Wash fountain Water closet It 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 t Gas piping outlets Fixture Type Qty Dental unit, cuspidor Floor drain 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 t 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). 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY T414 LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR Z D GENT: / r c -(s. 1.14...A., C/(1 Signature: Print Name: Mailing Address: H.\Applications\Forms-Applications On Line\2011 Applications\Plumbing Permit Application Revised 8-9-11.docx Revised: August 2011 bh Day Telephone: City Date: xS (7'-1e ( 3 State 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 RECEIPT Parcel No.: 5379800670 Permit Number: PG 13-078 Address: 4220 S 164 ST TUKW Status: PENDING Suite No: Applied Date: 05/17/2013 Applicant: MCMICKEN COURT BUILDING Issue Date: Receipt No.: R13-01664 Payment Amount: 81,145.81 Initials: WER Payment Date: 05/17/2013 01:34 PM User ID: 1655 Balance: $0.00 Payee: BAUMEISTER LLC (PHONE) TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd MC Authorization No. 003202 ACCOUNT ITEM LIST: Description 1,145.81 Account Code Current Pmts PLAN CHECK - NONRES PLUMBING - NONRES 000.345.830 229.16 000.322.103.00.00 916.65 Total: $1,145.81 d..1-• Dennin,_r1C. Printed: 05-17-2013 INSPECTION NO. INSPECTION RECORD Retain a copy with permit 613-070 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 431-2451 Pro'ect: Type o>_LUspec lon: Addr ss Date Called: Special Instructions: Date Wa ted: r�-f / L../Ire 6.;;-:: Requester: j/ Phone No: r. E1Approved per applicable codes. t� Corrections required prior to approval. COMMENTS: ‘6--f Ntspe or: LAN-- 7 Date— a - Li I C'A ,_YA n EINSPECTION FEE RE UIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. 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 P‘ -I -o78 Proje t 1 e 'ti1,' t -((E. N ea„ �--i Type f Inspe tion: �� cocl� - i r'I �M� Address: LI2 2 5 (C,t4 SI Date Called: Special Instructions: Date Wanted: I— Z—u- I >\a.n3 p:m. Requester: Phone No: 9o( -33I -I5 - Approved per applicable codes. L- J Corrections required prior to approval. COMMENTS: mot OC� Ins ctor: Date: EINSPECTION FEE REQUIRED. Prior to next inspection. fee must be aid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 431-2451 INSPECTION RECORD Retain a copy with permit PERMIT NO.- Project: Typ of Inspection; Address: 1i 22b S ! 0U s -r- Date C Iled: C. it Special Instructions: Date Wanted: V al. Requester: IA it / Phone -NO: ` ‘IZIApproved per applicable codes. Corrections required prior to approval. COMMENTS: (0 0 ctor: Date:, 1 1 EINSPECTION FEE R QUIRED. Prigiro next inspection. fee must be aid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 p (206) 431-3670 Permit Inspection Request Line (206) 431-2451 3 -078 Project:, Type of Inspection: Cd Q-1 0.xp(Al l l� in q Re Al \ +dm ✓T Address: -( '2 2Cj S 1611 s i Date Called: .. Special Instructions: Date Wanted:. 1—I e'en.5--3 Pm. Requester: Phone No: 40(o-331— lszy, ® Approved per applicable codes./ D Corrections required prior to approval. COMMENTS: �� NIA1✓ AJ' %n✓ - 6 oaTsvvef.Jeik - ��i7Je or%' i lrispec>tor: 'tnn.wr•. Date:. S -3C- t3: n REINSPECTION FEE)REQUIRED. Prior to next inspection, fee must,be. paid at 6300 Southc nter Blvd.. Suite 100. Call to schedule reinspection.: and Tong REVISIONS I`!,o rhanaes shall he made to the scope '._..• without prior approval of - .:'f.wila Building Division. ..::mons will require a new plan submittal 1 L.: i may include additional plan review fees. 1 SEi =,RATE PERMIT QU1RED FOR: e Mecharik 0 Orglectrical 0 Plumbing Riot Piping of Tukwila Et. a_P`!N G DIVISION, 1 o'rG30' Loading Zone II Gas Meter —r sear excrranger //Electric Meters 5' wide landscaped type 11 W Heating Duct (typ.) Fresh Air Intake for Gas Fumaces 1110111111111111111111111111111111111111 Main Stack - Vent Vent, 4" duct from bathroom fan to exterior (typ.) r� uct from range hood to exterior Dryer Vent to Exterior Hose bib FDC J Main Sted— Sprinkler Control Room rJ Nti 5 Standard Parking Stalls 9'x19' UP To Public Sewer O!' irRview approas su . of construction of any adopt 01 pproved Field By ciaa 44" wide walk way 6 Standard Parking Stalls 9'x19' P 3 - to out and ortissions. mfl2s does not author': Ws or ordinance. Receipt COW Ofd ITU!la BUILDING DIVISItORI Bride enclosure matching color of building REVIEWED FOR CODE COMPLIANCE APPROVED HAY 2 1 2013 City of Tukwila BUILDING DIVISION } Garbage and Recycling Dumpsters enclosure RECEIVED CITU OF TUK'NIL4j IviAY 1 7 2013 PERMIT CENTER k4\"c 179 4" duct from bathroom fan to exterior (typ.) 74-- 2'4— F5� v Vent 17 brain lines (typ.) ain Stack -4 31' 11 elk 7" duct from range hood to exterior (tYP •) \V 31' 178 e'4 C.- 1 Vent 1, Vent 14'10 176 7 I Maintain 7' distance from point o1 ,Lbearing to beginning of hole l through floor joist Il 0 i 10 0 1510 1510 5 1510 9'4 14'10 CO 7 176 2nd & 3rd Floor North REVIEWED FR CODE COMPLIANCE APPROVED MAY 21 2013 City of Tukwila BUILDING DIVISION RECEIVED CITY OF TUKWILA MAY 1 7 2013 PERMIT CENTER 6/2/2014 City of Tukwila Department of Community Development IAN HAMAD 4632 NE 89 ST SEATTLE, WA 98115 RE: Permit No. PG13-078 MCMICKEN COURT BUILDING 4220 S 164 ST 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 7/27/2014. 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 7/27/2014, 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, J�enni r Marshall Technician Fi . No PG13-078 6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665 October 28, 2013 Ian Hamad 4632 NE 89 Street Seattle, WA 98115 City of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director RE: Request for Extension Development Permit No. D12-384 Plumbing/Gas Piping Permit No. PG13-078 Dear Mr. Hamad, This letter is in response to your written request for an extension to Permit Numbers D12-384 and PG 13- 078 for McMicken Court Building project. The Building Official has reviewed your letter and considered your request to extend the above referenced permits. It has been determined that the City of Tukwila Building Division will be extending your permits an additional 180 days from their date of expiration. Consequently the updated expiration dates are as follows: D12-334: March 21, 2014 PG13-078: May 26, 2014 If you should have any questions, please contact our office at (206) 431-3670. Sincerely, File: Permit No. D12-384 & PG13-078 W.\Permit Center\Extension Letters\Permits\2013\PG13-078 Permit Extension.docx 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665 lan Hamad 4632 NE 89th Street Seattle WA 98115 10/25/2013 ;DECEIVED OCT 2 2 2013 (;OIJfmum 1 Y t)hVELOPMEN r City of Tukwila Department of Community Development 6300 Southcenter Boulevard, #100 Tukwila, WA 98188 RE: Permit No. PG13-078 - I herewith request an extension for my permit. Because I broke my collarbone playing soccer I could not work on the building, which caused the delay in the project. Best regards lan Hamad l \ f7 res l 3 ag. &A-1/01 ose)if\A 0/208 10-01-2013 IAN HAMAD 4632 NE 89 ST SEATTLE WA 98115 City of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director RE: Permit No. PG13-078 MCMICKEN COURT BUILDING 4220 S 164 ST TUKW Dear Permit Holder: 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 11/27/2013. Based on the above, you are hereby advised to: 1) Call the City of Tukwila Inspection Request Line at 206-431-2451 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 11/27/2013, 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, Bill Rambo Permit Technician File: Permit File No. PG13-078 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665 • Pi PLAN EVIEW/ROUTING SLIP ACTIVITY NUMBER: PG13-078 DATE: 05-17-13 PROJECT NAME: McMICKEN COURT BUILDING SITE ADDRESS: 4220 S 164 ST X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: , s H3 4.AWC tidng Division 44, -H3 kVic Works Fire Prevention Structural Planning Division Permit Coordinator 1 DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete DUE DATE: 05-21-13 Not Applicable Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg 0 Fire 0 Ping ❑ PW 0 Staff Initials: TUES/THURS ROUTING: Please Route ryl, Structural Review Required ❑ No further Review Required ❑ REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved Notation: Approved with Conditions 'Yr DUE DATE: 06-18-13 Not Approved (attach comments) ❑ REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg 0 Fire 0 Ping ❑ PW 0 Staff Initials: Documents/routing slip.doc 2-28-02 La King County Department of Natural Resources and Parks Wastewater Treatment Division v - Non -Residential Sewer Use Certification • To be completed for all new sewer connections, reconnections or change of use of existing connections. • This form does not apply to repairs or replacements of existing sewer connections within five years of disconnect. Please Print or Type y2 Lo S. '1 Property Street Address jTALLi(C. L) City State ZIP Z4 ( t LLC Owner's Name Subdivision Name Lot # Subdiv. # Block # Building Name (if applicable) For King County IP Only Account # No. of RCEs Monthly Rate Property Tax ID # 7 A20 " 0'c '70 Party to be Billed (if different from owner) City or Sewer District V i /LY Date of Connection Side Sewer Permit # qg ( 2 ) 1331— IJ2M Please report any demolitions of pre-existing building on this property. Owner's Phone Number (with Area Code) Credit for a demolition may be given under some circumstances. Demolition of pre-existing building? ❑ Yes 1R -No ( ) Was building on Sanitary Sewer? ❑ Yes 0 No Property Contact Phone Number (with Area Code) Was Sewer connected before 2/1/90? 0 Yes 0 No Sewer disconnect date: Type of building demolished? Owner's Mailing Address 96 NC d5 dl. .r&/Yet (AA c'el.1r A. Fixture Units Fixture Units x Number of Fixtures = Total Fixture Units Kind of Fixture Fixture Units No. of Fixtures Total Fixture Units Public Private Public Private Bathtub and Shower 4 4 Shower, per head 2 2 Dishwasher 2 2 Drinking fountain (each head) 1 .5 Hose bibb (interior) 2.5 2.5 Clotheswasher or laundry tub 4 2 lt Sink, bar or lavatory 2 1 2 Z Sink, Clinic flushing 8 8 Sink, kitchen 3 2 Sink, other (service) 3 1.5 Sink, wash fountain, circle spray 4 3 Urinal, flush valve, 1 GPF 5 2 Urinal, flush valve, >1 GPF 6 2 Urinal, waterless 0 0 Water closet, tank or valve, 1.6 GPF 6 3 7 Water closet, tank or valve, >1.6 GPF 8 4 Total Fixture Units I S� Residential Customer Equivalent (RCE) 20 fixture units equal 1.0 RCE Total No. of Fixture Units = �� 20 RCE Request to apply demolition credit to multiple buildings? 0 Yes 0 No B. Other Wastewater Flow (in addition to Fixture Units identified in Section A) Type of Facility/Process: Estimated Wastewater Discharge: Gallons/days Residential Customer Equivalents (RCE): 187 gallons per day equals 1.0 RCE Total Discharge (gal/day) = 187 C. Total Residential Customer Equivalents: (add A & B) A B -4c RCE CITY OF TUKWILA MAY 1 7 2013 RCE PERMIT CENTER Pursuant to King County Code 28.84, all sewer customers who establish a new service which uses metropolitan sewage facilities shall be subject to a capacity charge. The amount of the charge is established annually by the King County Council at a rate per month per residential customer or residential customer equivalent for a period of fifteen years. The purpose of the charge is to recover costs of providing sewage treatment capacity for new sewer customers. All future billings can be prepaid at a discounted amount. All future billings can be prepaid at a discounted amount. Questions regarding the capacity charge or this form should be referred to King County's Wastewater Treatment Division at 206-684-1740. I certify that the information given is correct. I and tand that the capacity charge levied will be based on this information and any deviation will require resubmission of corrected or determinati of a revised capacity charge. Signature of Owner/Representative - Date i7 — t3 Print Name of Owner/Representative 1058 (Rev. 9/07) T . i rt:>( White — Kino County Yellow — Local Sewer Aoencv Pink — Sewer Customer •�a2s�ma. f3 Contractors or Tradespeople Peter Friendly Page • Page 1 of 2 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 B E L PLUMBING SERVICE UBI No. 601311502 Phone 4257454162 Status Active Address 15423 50Th Pl W License No. BLPLUS'097P2 Suite/Apt. License Type Construction Contractor City Edmonds Effective Date 10/22/1991 State WA Expiration Date 2/3/2015 Zip 980264414 Suspend Date County Snohomish Specialty 1 Plumbing Business Type Individual Specialty 2 Unused Parent Company Business Owner Information Name Role Effective Date Expiration Date CAUSER, CHRIS L Owner 10/22/1991 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 9 American Contractors Indem CO 100144428 11/02/2010 Until Cancelled $6,000.00 02/03/2011 7 OLD REPUBLIC INS CO YLI268237 10/21/2009 Until Cancelled 07/06/2010 08/30/2010 $6,000.00 10/16/2009 6 DEVELOPERS SURETY & INDEM CO 797578C 10/21/2008 Until Cancelled 09/02/2010 08/30/2010 $6,000.0010/21/2008 04/02/2008 5 COLONIAL AM CAS & SURETY OF MD LPM4047070 10/21/2001 Until Cancelled 10/21/2008 $6,000.00 11 /26/2001 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 12 OHIO SECURITY INS CO BKS53726931 03/10/2011 03/10/2014 $1,000,000.00 03/07/2013 11 0010 CAS INS BH053726931 03/10/2009 03/10/2011 $1,000,000.00 02/26/2010 10 0010 CAS INS BH053726931 03/11/2008 03/11/2009 $1,000,000.00 04/02/2008 9 LANDMARK AMERICAN INS CO LBA025050 10/27/2007 10/27/2008 04/17/2008 $500,000.00 10/13/2007 8 LANDMARK AMERICAN INS CO LBA001091 10/27/2006 10/27/2007 $500,000.00 10/27/2006 Summons/Complaint Information Cause County Complaint Judgment Status Payment Paid By 10-2-10779-7SEA PACIFIC PLUMBING SUPPLY COMPANY LLC KING Date: 03/22/2010 Amount: $2,370.54 Bond(s): 797578C, YLI268237 Date: Amount: $0.00 Open Date: 08/30/2010 Amount: $915.09 Bond httns //fortress.wa_vov/lni/bbin/Print.asnx 05/30/2013