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Home My WebLink AboutPermit M14-0226 - FORHAN RESIDENCE - RENOVATION FOR RESIDENTIAL AIRCRAFT NOISE REMEDY IMPROVEMENTFORHAN RESIDENCE 12012 44 AVE S M14-0226 Parcel No: Address: 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 MECHANICAL PERMIT 3347401060 Permit Number: 12012 44TH AVE S Issue Date: Permit Expires On: Project Name: FORHAN RESIDENCE M 14-0226 12/23/2014 6/21/2015 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: FORHAN PAUL E+MONIKA D 12012 44TH AVE S , TUKWILA, WA, 98178 SHARYN PARKER Phone: (206) 296-7437 7277 PERIMETER RD S, SEATTLE, WA, 98108 REGENCY NW CONSTRUCTION INC PO BOX 6429 , BELLEVUE, WA, 98008 REGENNC041JS Phone: (425) 883-1301 Expiration Date: 3/2/2016 DESCRIPTION OF WORK: MECHANICAL RENOVATION OF SINGLE FAMILY HOME REQUIRED FOR PARTICIPATION IN FAA (RANRIP) RESIDENTIAL AIRCRAFT NOISE REMEDY IMPROVEMENTS PROGRAM TO REDUCE NOISE INFILTRATION. THIS WORK MAY INCLUDE STAND ALONE BLENDING UNIT VENTILATION SYSTEM WITH ASSOCIATED DUCTING AND/OR VOLUME DAMPER INSTALLATION TO EXISTING FURNACES WITH EXISTING DUCTING. Valuation of Work: $2,013.00 Type of Work: REPLACEMENT Fuel type: ELECT Fees Collected: $233.88 Electrical Service Provided by: SEATTLE CITY LIGHT Water District: TUKWILA Sewer District: TUKWILA SEWER SERVICE Current Codes adopted by the City of Tukwila: International Building Code Edition: International Residential Code Edition: International Mechanical Code Edition: Uniform Plumbing Code Edition: International Fuel Gas Code: 2012 2012 2012 2012 2012 National Electrical Code: WA Cities Electrical Code: WAC 296-46B: WA State Energy Code: 2014 2014 2014 2012 Permit Center Authorized Signature: (,) Date: la- ) 1' r LI 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 and agree to the conditions attached to this permit. Signature: Print Name: Gct 'e o Y/ 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. Date: /��3/5/ PERMIT CONDITIONS: 1: 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. 2: 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. 3: All construction shall be done in conformance with the Washington State Building Code and the Washington State Energy Code. 4: 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. 5: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy can be obtained at City Hall in the office of the City Clerk. 6: 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). 7: Preparation before concrete placement: Water shall be removed from place of deposit before concrete is placed unless a tremie is to be used or unless otherwise permitted by the building official. All debris and ice shall be removed from spaces to be occupied by concrete. 8: 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. 9: ***MECHANICAL PERMIT CONDITIONS*** 10: All mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center (206/431-3670). 11: 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. 12: Manufacturers installation instructions shall be available on the job site at the time of inspection. PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 1800 MECHANICAL FINAL 0701 ROUGH -IN MECHANICAL CITY OF TUKWJ A Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Mechanical Permit No. Project No. Date Application Accepted: Date Application Expires: to (For office use only) MECHANICAL 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: Tenant Name: 12012 44th Ave. S. PROPERTY OWNER Name: Address: City: State: Zip: CONTACT PERSON — person receiving all project communication Name: Sharyn Parker Address: 7277 Perimeter Road South City: Seattle State: WA Zip: 98106 Phone: (206) 296-7437 Fax: (206) 269-7315 Email: Sharyn.Parker@kingcounty.gov King Co Assessor's Tax No.: 3347401060 Suite Number: Floor: New Tenant: ❑ Yes ..No MECHANICAL CONTRACTOR INFORMATION Company Name: not yet awarded Address: City: State: Zip: Phone: Fax: Contr Reg No.: Exp Date: Tukwila Business License No.: Valuation of project (contractor's bid price): $ 2,013 Describe the scope of work in detail: Mechanical renovation of single-family home required for participation in FAA (RANRIP) Residential Aircraft Noise Remedy Improvements Program to reduce noise infiltration. This work may include: stand-alone blending unit ventilation system with associated ducting and / or volume damper installation to existing furnace with existing ducting. Use: Residential: New ❑ Replacement ❑ Commercial: New ❑ Replacement ❑ Fuel Type: Electric ❑ Gas ❑ Other: H:Wpplications\Forms-Applications On Line \2011 Applications\Mechanical Permit Application Revised 8-9-1I.docx Revised: August 2011 bh Page 1 of 2 Indicate type of mechanical work being installed and the quantity below: Unit Type Qty Furnace <100k btu Furnace >100k btu Floor furnace Suspended/wall/floor mounted heater Appliance vent Repair or addition to heat/refrig/cooling system Air handling unit <10,000 cfm Unit Type Qty Air handling unit >10,000 cfm Evaporator cooler Ventilation fan connected to single duct Ventilation system 1 Hood and duct Incinerator — domestic Incinerator — comm/industrial Unit Type Qty Fire damper Diffuser Thermostat Wood/gas stove Emergency generator Other mechanical equipment Boiler/Compressor Qty 0-3 hp/100,000 btu 3-15 hp/500,000 btu 15-30 hp/1,000,000 btu 30-50 hp/1,750,000 btu 50+ hp/1,750,000 btu 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 additional periods not to exceed 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building 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 THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR Signature: RI D AGENT: Date: Print Name: Ti •thy Fenlasot\ . Day Telephone: (206) 624-2777 Mailing Address: 4000 Delridge Way SW, Suite 200 Seattle WA 98106 City State Zip H:\Applications\Forms-Applications On Line\2011 Applications\Mechanical Permit Application Revised 8-9-11.docx Revised: August 2011 bh Page 2 of 2 Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $13,932.30 D14-0378 Address: 11664 44 AVE S Apn: 3347400690 $857.74 DEVELOPMENT $832.64 PERMIT FEE R000.322.100.00.00 0.00 $501.90 PLAN CHECK FEE R000.345.830.00.00 0.00 $326.24 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $25.10 TECHNOLOGY FEE R000.322.900.04.00 0.00 $25.10 D14-0379 Address: 4925 S 125TH ST Apn: 0179002840 $957.70 DEVELOPMENT ' $929.66 PERMIT FEE R000.322.100.00.00 0.00 $560.70 PLAN CHECK FEE R000.345.830.00.00 0.00 $364.46 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $28.04, TECHNOLOGY FEE R000.322.900.04.00 0.00 $28.04 D14-0380 Address: 12239 46TH AVE S Apn: 0179000830 $924.38 DEVELOPMENT $897.32 PERMIT FEE R000.322.100.00.00 0.00 $541.10 PLAN CHECK FEE R000.345.830.00.00 0.00 $351.72 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $27.06 TECHNOLOGY FEE R000.322.900.04.00 0.00 $27.06 D14-0381 Address: 12020 42ND AVE S Apn: 3347400290 $1,389.32 DEVELOPMENT $1,348.59 PERMIT FEE R000.322.100.00.00 0.00 $814.60 PLAN CHECK FEE R000.345.830.00.00 0.00 $529.49 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $40.73 TECHNOLOGY FEE R000.322.900.04.00 0.00 $40.73 D14-0382 Address: 12012 44TH AVE S Apn:'3347401060$791.10 DEVELOPMENT $767.96 PERMIT FEE R000.322.100.00.00 0.00 $462.70 PLAN CHECK FEE R000.345.830.00.00 0.00 $300.76 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 Date Paid: Thursday, December 18, 2014 Paid By: PAMELA K KUEHL, KING COUNTY IN Pay Method: CREDIT CARD 015718 Printed: Thursday, December 18, 2014 12:17 PM 1 of 5 CRWSYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS PermitTRAK I ACCOUNT QUANTITY I PAID $13,932.30 D14-0382 Address: 12012 44TH AVE S Apn: 3347401060 $791.10 TECHNOLOGY FEE $23.14 TECHNOLOGY FEE R000.322.900.04.00 0.00 $23.14 D14-0383 Address: 11836 44TH AVE S Apn: 3347401015 $991.02 DEVELOPMENT $962.00 PERMIT FEE R000.322.100.00.00 0.00 $580.30 PLAN CHECK FEE R000.345.830.00.00 0.00 $377.20 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $29.02 TECHNOLOGY FEE R000.322.900.04.00 0.00 $29.02 D14-0384 Address: 13007 57TH AVE S Apn: 2137000020 $857.74 DEVELOPMENT $832.64 PERMIT FEE R000.322.100.00.00 0.00 $501.90 PLAN CHECK FEE R000.345.830.00.00 0.00 $326.24 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $25.10 TECHNOLOGY FEE R000.322.900.04.00 0.00 $25.10 D14-0385 Address: 12404 50TH PL'S Apn: 0179002265 $1,311.30 DEVELOPMENT $1,272.86 PERMIT FEE R000.322.100.00.00 0.00 $768.70 PLAN CHECK FEE R000.345.830.00.00 0.00 $499.66 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $38.44 TECHNOLOGY FEE R000.322.900.04.00 0.00 $38.44 D14-0386 Address: 11608 40TH AVE S Apn: 7340600140 $1,545.38 DEVELOPMENT $1,500.06 PERMIT FEE R000.322.100.00.00 0.00 $906.40 PLAN CHECK FEE R000.345.830.00.00 0.00 $589.16 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $45.32 TECHNOLOGY FEE R000.322.900.04.00 0.00 $45.32 Date Paid: Thursday, December 18, 2014 Paid By: PAMELA K KUEHL, KING COUNTY IN Pay Method: CREDIT CARD 015718 Printed: Thursday, December 18, 2014 12:17 PM 2 of 5 SYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $13,932.30;. D14-0387 Address: 1223146 AVE S Apn: 0179000840 $724.46 DEVELOPMENT $703.28 PERMIT FEE R000.322.100.00.00 0.00 $423.50 PLAN CHECK FEE R000.345.830.00.00 0.00 $275.28 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $21.18 TECHNOLOGY FEE R000.322.900.04.00 0.00 $21.18 D14-0388 Address: 4702 S 122 ST ' Apn: 3347401430 $1,129.22 DEVELOPMENT $1,096.14 PERMIT FEE R000.322.100.00.00 0.00 $661.60 PLAN CHECK FEE R000.345.830.00.00 0.00 $430.04 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $33.08 TECHNOLOGY FEE R000.322.900.04.00 0.00 $33.08 M14-0222 Address: 11664 44 AVE 5 Apn: 3347400690 $221.32 MECHANICAL $212.81 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $137.75 PLAN CHECK FEE R000.322.102.00.00 0.00 $42.56 TECHNOLOGY FEE $8.51 TECHNOLOGY FEE R000.322.900.04.00 0.00 $8.51 M14-0223 Address: 12239 46 AVE S Apn: 0179000830 $233.88 MECHANICAL $224.88 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $147.40 PLAN CHECK FEE R000.322.102.00.00 0.00 $44.98 TECHNOLOGY FEE $9.00 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.00 M14-0224 Address: 4925 S 125TH ST Apn: 0179002840 ' $246.42 MECHANICAL $236.94 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $157.05 PLAN CHECK FEE R000.322.102.00.00 0.00 $47.39 Date Paid: Thursday, December 18, 2014 Paid By: PAMELA K KUEHL, KING COUNTY IN Pay Method: CREDIT CARD 015718 Printed: Thursday, December 18, 2014 12:17 PM 3 of 5 WSYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $13,932.30 M14-0224 Address: 4925 S 125TH ST Apn: 0179002840 $246.42 TECHNOLOGY FEE $9.48 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.48 M14-0225 Address: 12020 42ND AVE S Apn: 3347400290 $221.32 MECHANICAL $212.81 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $137.75 PLAN CHECK FEE R000.322.102.00.00 0.00 $42.56 TECHNOLOGY FEE $8.51 TECHNOLOGY FEE R000.322.900.04.00 0.00 $8.51 M14-0226 Address: 12012 44TH AVE S Apn: 3347401060 $233.88 MECHANICAL $224.88 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $147.40 PLAN CHECK FEE R000.322.102.00.00 0.00 $44.98 TECHNOLOGY FEE $9.00 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.00 M14-0227 Address: 11836 44TH AVE S Apn: 3347401015 $233.88 MECHANICAL $224.88 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $147.40 PLAN CHECK FEE R000.322.102.00.00 0.00 $44.98 TECHNOLOGY FEE $9.00 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.00 M14-0228 Address: 12404 50TH PL S Apn: 0179002265 $126.76 MECHANICAL $121.88 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $65.00 PLAN CHECK FEE R000.322.102.00.00 0.00 $24.38 TECHNOLOGY FEE $4.88 TECHNOLOGY FEE R000.322.900.04.00 0.00 $4.88 Date Paid: Thursday, December 18, 2014 Paid By: PAMELA K KUEHL, KING COUNTY IN Pay Method: CREDIT CARD 015718 Printed: Thursday, December 18, 2014 12:17 PM 4 of 5 CR SYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $13,932.30 M14-0229 Address: 13007 57TH AVE S Apn: 2137000020 $221.32 MECHANICAL $212.81 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $137.75 PLAN CHECK FEE R000.322.102.00.00 0.00 $42.56 TECHNOLOGY FEE $8.51 TECHNOLOGY FEE R000.322.900.04.00 0.00 $8.51 M14-0230 Address: 11608 40TH AVE S Apn: 7340600140 $258.96 MECHANICAL $249.00 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $166.70 PLAN CHECK FEE R000.322.102.00.00 0.00 $49.80 TECHNOLOGY FEE $9.96 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.96 M14-0231 Address: 1223146 AVE S Apn: 0179000840 $233.88 MECHANICAL $224.88 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $147.40 PLAN CHECK FEE R000.322.102.00.00 0.00 $44.98 TECHNOLOGY FEE $9.00 TECHNOLOGY FEE R000.322.900.04.00 0.00 $9.00 M14-0232 Address: 4702 S 122 ST Apn: 3347401430 $221.32 MECHANICAL $212.81 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $137.75 PLAN CHECK FEE R000.322.102.00.00 0.00 $42.56 TECHNOLOGY FEE $8.51 TECHNOLOGY FEE R000.322.900.04.00 0.00 TOTAL FEES PAID BY RECEIPT: R3797 $8.51 $13,932.30 Date Paid: Thursday, December 18, 2014 Paid By: PAMELA K KUEHL, KING COUNTY IN Pay Method: CREDIT CARD 015718 Printed: Thursday, December 18, 2014 12:17 PM 5 of 5 CIIIIWYSTEMS IN INSPECTION RECORD Retain a copy with permit PECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 r (206) 431-3670 Permit Inspection Request Line (206) 438-9350 mut- ozz4 Project: , Foy kg til 0-Q-S. Type of inspiction.e. NecAel 1--(c.,ct 1 11$zi: z tilii, 4 if e_ co . Date Called: Special Instructions: 0,41..41 Date Wanted: ..._ - a.m. Requester: t.8? ;V. iteCieKCI Phone No: ?,X) G — 7(3 134Approved per applicable codes. COM ENTS: Corrections required prior to approval. 46 r( Inspector: Dat-3 (5— REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Eitvd.. Suite 100. Call to schedule reinspection INSPECTION RECORD Retain a copy with permit IN PECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd,, #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 hug- on& Project: , . , 1e7 eh a tt PA ( offttc-e. Type of Inspection: e /ger.* Fr fmAt 'Address: MO I 2.- ilit4i Aife-50 , Date Called: Special Instructions: A-4A Date Wanted: 7,—/I-0- a.m. p.m. Requester: Phone No: Approved per applicable codes. ECorrections required prior to approval. COMMENTS: Ajo a cc. 6, cis joir3bc:thr ralt g6lf v• rkS)ediciLt( Inspector: Date: 2- "( REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be I-- paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection PERMIT COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: M14-0226 DATE: 12/17/14 PROJECT NAME: FORHAN RESIDENCE SITE ADDRESS: 12012 44 AVE S X Original Plan Submittal Response to Correction Letter # Revision # before Permit Issued Revision # after Permit Issued DEPARTMENTS: \)---V8-42/1 Building Division 111 Fire Prevention Public Works Structural Planning Division Permit Coordinator IN PRELIMINARY REVIEW: Not Applicable (no approval/review required) DATE: 12/23/14 Structural Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved Corrections Required (corrections entered in Reviews) DUE DATE: 01/20/14 Approved with Conditions ir Denied (ie: Zoning Issues) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: 12/18/2013 REGENCY NW CONSTRUCTIC NC Page 1 of 2 )Labor Wshington State Department of & Industries REGENCY NW CONSTRUCTION INC Owner or tradesperson FOOTE, BRIAN LEE Principals FOOTE, BRIAN LEE, PRESIDENT Doing business as REGENCY NW CONSTRUCTION INC WA UBI No. 601 696 917 PO BOX 6429 BELLEVUE, WA 98008 425-883-1301 KING County Business type Corporation License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor License specialties GENERAL License no. REGENNC041J5 Effective — expiration 04/25/1996— 03/02/2016 Bond TRAVELERS CAS & SURETY CO Bond account no. 103713311 Received by L&I 02/19/2002 Insurance Navigators Ins Co Policy no. sf13cg101922700 Received by L&I 02/11/2014 Insurance history Savings Active. Meets current requirements. $12,000.00 Effective date 02/20/2002 Expiration date Until Canceled $1,000,000.00 Effective date 02/20/2013 Expiration date 02/20/2015 No savings accounts during the previous 6 year period. •r (1TtTlT /n1 /(1/rl1 fln T it-, TlT/1Tl. Tl.T!'1(1 A 1 Tf n ('1 A TT1— 1'l/n'111/11 A