HomeMy WebLinkAboutPermit D15-0006 - FORSBERG RESIDENCE - TRAILER/SHED DEMOLITIONFORSBERG DEMOLITION
12207 50 AVE S
D15-0006
Citv 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.eov
DEVELOPMENT PERMIT
Parcel No: 0179001770
Address: 12207 50TH AVE S
Project Name: FORSBERG DEMOLITION
Owner:
Name:
FORSBERG SCOTT J
Address:
36329 SE 56TH ST , FALL CITY, WA,
98024
Contact Person:
Name:
JOHN TAMBURELLI
Address:
646 SW 134 ST, BURIEN, WA, 98146
Contractor:
Name:
SCOTTS CONCRETE & CONST INC
Address:
PO BOX 580, FALL CITY, WA, 98024
License No:
SCOTTCC941LK
Permit Number: D15-0006
Issue Date: 1/28/2015
Permit Expires On: 7/27/2015
Phone: (206) 920-2220
Phone: (425) 222-6983
Expiration Date: 7/1/2016
Lender:
Name: SCOTT FORSBERG
Address: PO BOX 580, FALL CITY, WA, 98024
DESCRIPTION OF WORK:
REMOVE EXISTING TRAILER/SHEDS, PUMP EXISTING SEPTIC TANK AND REMOVE SEPTIC TANK TO CONSTRUCT A
SFR UNDER PERMIT D14-317
Project Valuation: $3,800.00 Fees Collected: $573.66
Type of Fire Protection: Sprinklers: NO
Fire Alarm: NO
Type of Construction: VB Occupancy per IBC: R-3
Electrical Service Provided by: TUKWILA FIRE SERVICE Water District: TUKWILA
Sewer District: TUKWILA SEWER SERVICE
Current Codes adopted by the City of Tukwila:
International Building Code Edition:
2012
National Electrical Code:
2014
International Residential Code Edition:
2012
WA Cities Electrical Code:
2014
International Mechanical Code Edition:
2012
WAC 296-4613:
2014
Uniform Plumbing Code Edition:
2012
WA State Energy Code:
2012
International Fuel Gas Code:
2012
Public Works Activities:
Chan nelization/Striping:
Curb Cut/Access/Sidewalk:
Fire Loop Hydrant:
Flood Control Zone:
Hauling/Oversize Load:
Land Altering: Volumes: Cut: 10 Fill: 10
Landscape Irrigation:
Sanitary Side Sewer: Number: 0
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter: No --�j
Permit Center Authorized Signature: Date:
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:
Date r�7
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: 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 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).
6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila
Permit Center.
7: 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.
8: 'PUBLIC WORKS PERMIT CONDITIONS'
The applicant or contractor must notify the Public Works Inspector at (206) 433-0179 upon commencement
and completion of work at least 24 hours in advance. All inspection requests for utility work must also be
made 24 hours in advance.
10: Permit is valid between the weekday hours of 7:00 a.m. and 10:00 p.m. only. Coordinate with the Public
Works Inspector for any work after 5:00 p.m. and weekends.
11: Any material spilled onto any street shall be cleaned up immediately.
12: The Land Altering Permit Fee is based upon an estimated 10 cubic yards of cut and 10 cubic yards of fill. If
the final quantity exceeds this amount, the developer shall be required to recalculate the final quantity and
pay the difference in permit fee prior to the Final Inspection.
13: Any septic tanks in the area shall be pumped empty and removed or filled with sand. A copy of the
documentation from the business that performed the pumping shall be provided to the Public Works
Inspector.
14: Sewer and water utilities shall be plugged at the mains if they are to be abandoned. If they will be used
again in the near future for a new building, they shall be capped at the property line and at the water meter
respectively.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL"
1600 PUBLIC WORKS FINAL
CITY OF TUILA
Community Development Department
• Public Works Department
• Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
bqp://www.TukwilaWA.2ov
Z� e PAO
Building Permit No.
Project No.
Date Application Accepted:
Date Application Expires:
use
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.: 0 1 7900 % %%0
Site Address:ZZ Z-d 7 6-0 0- Q ✓e. SO, Suite Number: Floor:
Tenant Name: /�%��' New Tenant: ❑ ..... Yes ❑ .. No
PROPERTY OWNER
Name O/ D /z
Address: ,Q 0� l A3Ox 60
City: /� t / Stater Zi��42,/
CONTACT PERSON — person receiving all project
communication
Name: o7tf
WI V I /1
Address: /P., ! . .5w 1.3yo-
city: of giC4 State: ilam, •
/ ) Zi
Phon(j dG /'a72,0 „U Fax -
Email
O
GENERAL CONTRACTOR INFORMATION
Company Nam ��� / / o
Address: o �-O e) ri� f7
ing
City: ^ / /► l State:,.) Z• • /�ov
Pho VV 2/O, to Fax: �V �!
Contr Reg Exp Date:
Tukwila Business License No.:
ARCHITECT OF RECORD
Company Name:
Architect Name:
Address: V //T
City: State: Zip:
Phone: Fax:
Email:
ENGINEER OF RECORD
Company Name:
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: Fooe be.c
Address: /00 `�d�
Aw City / C...V GCState;V4 Zi p
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Revised: February 2012
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Page 1 of 4
BUILDING PERMIT INFORMA' N — 206-431-3670
Valuation of Project (contractor's bid price): $ 3, DO0. wa4- Existing Building Valuation: S
Describe the scope of work (please provide detailed information):
ze
'
-3
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
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
I" Floor
2'd Floor
P Floor
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 dwe 7in, ovidethe following:
Lot Area (sq ft)Floor area of principal dwelling: Floor area of accessory dwelling:
*Provide documion that s s that the principal owner lives in one the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Stan d: Compact: Handicap:
Will there be a change in use? ❑....... .......No If "yes", explain:
❑ ....... Sprinklers ❑ .......Auto is Fire A%=dmat,
El ....... None ❑....... Other (specify)
Will there be storage or use of flammable ombustible or hrials in the building? ❑ .......Yes ❑ . No
If `yes', attach list of materials d storage locations 8-112" x II " paper including quantities and Material Safety Data Sheets.
SEPTIC SYSTEM
❑ .......On -site Septi /Syster
Department.
— For on -site septic system, provide 2 copies
septic design approved by King County Health
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PUBLIC WORKS PERMIT INY RATION = 206-433-0179
Scope of Work (please provide detailed information):
n _ _ r I e/ . L — _I.
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
Tukwila ❑ ... Water District # 125 ❑... Highline ❑... Renton
❑ .. Water Availability Provided
Seger District
. Tukwila ❑ ...Valley View El ... Renton ❑... Seattle
❑ .. Sewer Use Certificate ❑ ...Sewer Availability Provided
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.
Su itted with Aimlication mark boxes which a I :
. Civil Plans (Maximum Paper Size — 22" x 34")
❑ .. Technical Information Report (Storm Drainage) ❑ ... Geotechnical Report ❑ .. Traffic Impact Analysis
❑ .. Bond ❑... Insurance ❑... Easement(s) [:1 ... Maintenance Agreement(s) El.. Hold Harmless — (SAO)
El.. Hold Harmless — (ROW)
Proposed Activities (mark boxes that apply):
❑ .. Right-of-way Use - Nonprofit for less than 72 hours ❑ ... Right-of-way Use - Profit for less than 72 hours
❑ .. Right-of-way Use - No Disturbance El ... Right-of-way Use — Potential Disturbance
❑ .. Construction/Excavation/Fill - Right-of-way ❑
Non Right-of-way ❑
�. Total Cut ! b cubic yards
Total Fill / 0 cubic yards
❑ .. S 'tary Side Sewer
�. Ca r Remove Utilities
El. rontage Improvements
❑ .. Traffic Control
❑ .. Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑... Work in Flood Zone
El ... Storm Drainage
yam... Abandon Septic Tank
El ... Curb Cut
❑... Pavement Cut
❑... Looped Fire Line
❑ ...
Grease Interceptor
El ...
Channelization
El ...
Trench Excavation
El ...
Utility Undergrounding
❑ .. Permanent Water Meter Size (1) WO # (2) " WO # (3) WO #
❑ .. Temporary Water Meter Size (1) WO # (2) " WO # (3) WO #
❑ .. Water Only Meter Size ........... WO # ❑ .. Deduct Water Meter Size "
❑ .. Sewer Main Extension............ Public ❑ Private ❑
❑ .. Water Main Extension............ Public ❑ Private ❑
FINANCE INFORMATION
Fire Line Size at Property Line Number f Public Fire
❑ .. Water ❑ .. Sewer ❑ .. age Tr tmer
Monthly Service Billing to:
Name:
Mailing Address:
Water Meter RefundBilline:
Mailing
Telephone:
city
Day Telephone:
State Zip
City
State Zip
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PERMIT APPLICATION NOTE,
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 PWUW BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
Signature:
Print N
3
Date:
Day Telephon�iZ7O'Z,Z2-0
City
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a
BULLETIN A2
TYPE C PERMIT FEE ESTIMATE
PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION
PW may dust estimated fees
S or7Ca-P
PROJECT NAME / 2-07 6_4*- aye , S�r PERMIT #
If you do not provide contractor bids or an engineer's estimate with your permit
application, Public Works will review the cost estimates for reasonableness and may adjust
estimates.
1. APPLICATION BASE FEE 250 (1)
2. Enter total construction cost for each improvement category:
Mobilization
Erosion prevention �
Watq /Sewer `urface Water SUO
Road/Parking/Access
A. Total Improvements
3. Calculate improvement -based fees:
B. 2.5% of first $100,000 of A.
0
C. 2.0% of amount over $100,000, but less than $200,000 of A. ,
D. 1.5% of amount over $200,000 of A. _
4. TOTAL PLAN REVIEW FEE (B+C+D) A (4)
5. Enter total excavation volume /0 cubic yards
Enter total fill volume Zo cubic yards
Use the following table to estimate the grading plan review fee. Use the
greater of the excavation and fill volumes.
QUANTITY IN CUBIC
YARDS
RATE
Up to 50 CY
Free
51 — 100
$23.50
101 — 1,000
$37.00
1,001 — 10,000
$49.25
10,001 — 100,000
$49.25 for 1 10,000,
PLUS $24.50 for each additional 10,000 or fraction thereof.
100,001 — 200,000
$269.75 for 1 100,000,
PLUS $13.25 for each additional 10,000 or fraction thereof.
200,001 or more
$402.25 for 1 200,000,
PLUS $7.25 for each additional 10,000 or fraction thereof.
GRADING Plan Review Fees
$ (5)
TOTAL PLAN REVIEW FEE DUE WITH PERMIT APPLICATION Zoo `
(1+4+5) $
The Plan Review and Approval fees cover TWO reviews: 1) the first review associated with the submission of the
application/plan and 2) a follow-up review associated with a correction letter. Each additional review, which is
attributable to the Applicant's action or inaction shall be charged 25% of the Total Plan Review Fee.
RECEIVED
CITY OF TUKWILA
Approved 09.25.02 opp'0 0JAN 0.7 2015
Last Revised 01/01/14 1
"HERMIT CENTER
r,
BULLETIN A2
TYPE C PERMIT FEE ESTIMATE
PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION
PW ma ad ust estimated fees
6c,
6. Permit Issuance/Inspection Fee (B+C+D) $ c� (6)
7. Pavement Mitigation Fee $ (7)
The pavement mitigation fee compensates the City for the reduced life span due to removal of
roadway surfaces. The fee is based on the total square feet of impacted pavement per lane and
on the condition of the existing pavement. Use the following table and Bulletin 1B to estimate
the pavement mitigation fee.
Approx.
Remaining Years
Pavement Overlay and
Repair Rate
(per SF of lane width)
20-15 (100%)
$10.00
15-10 (75%)
$7.50
10-7 (50%)
$5.00
7-5 (33%)
$3.30
5-2 (25%)
$2.50
2-1 (10 %)
$1.00
0-1
$0.00
8. GRADING Permit Issuance/Inspection Fee $ 3 '� (8)
Grading Permit Fees are calculated using the following table. Use
the greater of the excavation and fill volumes from Item 5.
QUANTITY IN CUBIC
RATE
YARDS
50 or less
$23.50
51 —100
$37.00
101 — 1,000
$37.00 for 1S` 100 CY
plus $17.50 for each additional 100 or
fraction thereof.
1,001 — 10,000
$194.50 for 151 1000 CY
plus $14.50 for each additional 1,000 or
fraction thereof.
10,001 — 100,000
$325.00 for the ls` 10,000 CY
plus $66.00 for each additional 10,000 or
fraction thereof
100,001 or more
$919.00 for 1"' 100,000 CY
plus $36.50 for each additional 10,000 or
fraction thereof.
9. Technology Fee (5 % of 6+8)
Approved 09.25.02
Last Revised 01/01/14
l8
$
2
r
(9)
Y
r
2
i'
1
BULLETIN A2
TYPE C PERMIT FEE ESTIMATE
PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION
PW may adjust estimated fees
10. TOTAL OTHER PERMITS
A. Water Meter — Deduct ($25)
B. Flood Control Zone ($52.50 — includes Technology Fee)
C. Water Meter — Permanent*
D. Water Meter — Water only*
E. Water Meter — Temporary*
* Refer to the Water Meter Fees in Bulletin AI
Total A through E
11. ADDITIONAL FEES
A.
Allentown Water (Ordinance 1777)
B.
Allentown Sewer (Ordinance 1777)
C.
Ryan Hill Water (Ordinance 1777)
D.
Allentown/Foster Pt Water (Ord 2177)
E.
Allentown/Foster Pt Sewer (Ord 2177)
F.
Special Connection (TMC Title 14)
G.
Duwamish
H.
Transportation Mitigation
I.
Other Fees
DUE WHEN PERMIT IS ISSUED
Total A through I $
0.00 (9)
0.00 (1.0)
6,3
(6+7+8+9+10+11) $ 45 � 0.00
ESTIMATED TOTAL PERMIT ISSUANCE AND INSPECTION FEE
This fee includes two inspection visits per required inspection. Additional inspections (visits)
attributable to the Permittee's action or inaction shall be charged $60.00 per inspection.
WATER METER FEE
Permanent and Water Only Meters
Size
(inches)
Installation
Cascade Water Alliance
RCFC ,=
01.01.2014 -12.3 .2015
Total Fee
0.75
$62
$600,5
$6630
1
$1125
41,012.50
$16,137.50
1.5
$2425
$30,025
$32,450
2
$2825
$48,040
$50,865
3
$4425
-$96,080
$100,505
4
$7825
$136, 25
$157.,950
6
$12525Z
$300,236
$312,775
Approved 09.25.02
Last Revised 01/01/14
Temporary Meter \
0.75" $300
2.593 $l,soo
3
Clear Form
DESCRIPTIONS• QUANTITY
PermitTRAK $4,233.61
D14-0317 Address: 12207 50TH AVE S Apn: 0179001770 $3,917.93
DEVELOPMENT $3,050.60
PERMIT FEE
R000.322.100.00.00
0.00
$3,046.10
WASHINGTON STATE SURCHARGE
B640.237.114
0.00
$4.50
MECHANICAL $189.00
PERMIT FEE COMBOSFR
R000.322.100.00.00
0.00
$189.00
PLUMBING $252.00
PERMIT FEE COMBOSFR
R000.322.100.00.00
0.00
$252.00
PUBLIC WORKS $245.50
PERMIT ISSUANCE/INSPECTION FEE
R000.342.400.00.00
0.00
$92.50
CONSTRUCTION PLAN REVIEW
R000.345.830.00.00
0.00
$92.50
GRADING PLAN REVIEW
R000.345.830.00.00
0.00
$23.50
GRADING PERMIT ISSUANCE
R000.342.400.00.00
0.00
$37.00
TECHNOLOGY FEE $180.83
TECHNOLOGY FEE
R000.322.900.04.00
0.00
$180.83
D15-0006 Address: 12207 SOTH AVE S Apn: 0179001770 $315.68
PUBLIC WORKS $313.50
BASE APPLICATION FEE
R000.322.100.00.00
0.00
$250.00
PERMIT ISSUANCE/INSPECTION FEE
R000.342.400.00.00
0.00
$20.00
CONSTRUCTION PLAN REVIEW
R000.345.830.00.00
0.00
$20.00
GRADING PERMIT ISSUANCE
R000.342.400.00.00
0.00
$23.50
TECHNOLOGY FEE $2.18
TECHNOLOGY FEE R000.322.900.04.00 0.00 $2.18
TOTALPAID '
Date Paid: Wednesday, January 28, 2015
Paid By: SCOTTS CONCRETE & CONSTRUCTION
Pay Method: CHECK 6089
Printed: Wednesday, January 28, 2015 3:34 PM 1 of 1
RWSYS7EMS
DE SCRIPTIONS
PermitTRAK
ACCOUNTQUANTITY
PAID
$257.98
D15-0006 Address: 12207 50TH AVE S Apn: 0179001770 ',
$257.98 '
DEVELOPMENT
$250.52
PERMIT FEE
R000.322.100.00.00
0.00
$149.10
PLAN CHECK FEE
R000.345.830.00.00
0.00
$96.92
WASHINGTON STATE SURCHARGE
6640.237.114
0.00
$4.50
TECHNOLOGY FEE
$7.46
TECHNOLOGY FEE
TOTAL R3985
R000.322.900.04.00
0.00
$7.46
$257.98
Date Paid: Wednesday, January 07, 2015
Paid By: SCOTT'S CONCRETE
Pay Method: CHECK 5989
Printed: Wednesday, January 07, 2015 9:48 AM 1 of 1
SYSTEMS
[M
INSPECTION RECORD
Retain a copy with permit �j�— bD�,�
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: f
Type of Inspection: d
Ff
%�UAo
, A I�
Address:
27A-7
o re; '". VC �)
Date Called:
T
Special Instructions:
f r',qkf 14k&5f � n fRG �•cl�i frs
Date Wanted: _ a.m.
7�- -� /,S p.m.
Requester:.
to r aa' / fL,(tr
Phone No: v
2-60-3rz
Inspector: 1l � Dates-�
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
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66
CITY OF TUKWILA
of Public Works Department
0 206-433-0179
DEVELOPMENT BULLETIN C6
SEPTIC TANK ABANDONMENT
Septic tank removal or abandonment shall meet King County Board of Health
Code 13.04.054, and Policy and Procedure P88-01. You must provide
the City evidence that King County requirements have been met within thirty (30)
days.
Abandonment general procedure as follows:
1. Pump the tank dry, bleach, and pump again. The tank may be removed
or abandoned in place by punching holes in it and filling it with sand or
gravel; and
2. Provide a receipt from a King County approved pumper documenting
septage removal; and
3. Remove or destroy lid; and
4. Fill the septic tank with compacted sand or gravel; and
5. Report the removal or abandonment to the King County Health officer.
This Bulletin should not be used as a substitute for codes and regulations. Your project will be
reviewed for specific compliance to codes and regulations.
References
P88-01
UPC
Approved 2002
PERMIT COORD COPY
PLAN REVIEW/ROUTING SLIP
PERMIT NUMBER: D15-0006 DATE: 01/07/15
PROJECT NAME: FORSBERG DEMOLITION
SITE ADDRESS: 12207 50 AVE S
X Original Plan Submittal Revision # before Permit Issued
Response to Correction Letter #
DEPARTMENTS:
A��- AW (,
Building Division
orks
PRELIMINARY REVIEW:
Not Applicable ❑
(no approval/review required)
Revision # after Permit Issued
--1�7 "
-11 1'9� IT CPL
Fire Prevention M Planning Division
Structural ❑ Permit Coordinator 0
DATE: 01/08/15
Structural Review Required ❑
REEVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS: DUE DATE: 02/05/15
Approved ❑ Approved with Conditions
Corrections Required ❑ Denied ❑
(corrections entered in Reviews) (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
SCOTTS CONCRETE & CONST INC
Page 1 of 2
DepartmentA^ Washington: State
LaborCh i Industries
SCOTTS CONCRETE & CONST INC
Owner or tradesperson
FORSBERG, SCOTT
Principals
FORSBERG, SCOTT, PRESIDENT
Doing business as
SCOTTS CONCRETE & CONST INC
WA UBI No.
602 599 791
License
PO Box 580
FALL CITY, WA98024
425-222-6983
KING County
Business type
Corporation
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor Active.
........................
Meets current requirements.
License specialties
GENERAL
License no.
SCOTTCC941 LK
Effective — expiration
06/12/2006— 07/01 /2016
Bond
I-- ..........
CBIC $12,000.00
Bond account no.
SF0379
Received by L&I Effective date
06/12/2006 06/11 /2006
Expiration date
Until Canceled
Insurance
..............
Nevada Capital Ins Co $1,000,000.00
Policy no.
NCIC-0005784
Received by L&I Effective date
07/21 /2014 07/20/2014
Expiration date
07/20/2015
Insurance history
Savings
No savings accounts during the previous 6 year period.
https:Hsecure.Ini.wa.gov/verify/Detail.aspx?UBI=60259979I&LIC=SCOTTCC941LK&SAW= 01/28/2015