Loading...
HomeMy WebLinkAboutPermit B94-0150 - CITY OF TUKWILA - DEMOLITION AND RESTORATIONCity of 7Yikwilci: (206) 431 -3670 Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 DEMOLITION PERMIT Permit No: B94 -0150 Type: B -DEMO Category: RES Address: 3436 S 130 ST Location: Parcel #: 735960 -0230 Wetlands: Water Dist: 125 Units: 001 Contractor License No:RJCIN * *066JJ Status: ISSUED Issued: 05/03/1994 Expires: 10/30/1994 Slopes: Y Sewer Dist: VAL VUE Buildings: 001 TENANT CITY OF TUKWILA Phone: 433 -1800 6200 SOUTHCENTER BL, TUKWILA, WA 98188 OWNER CITY OF TUKWILA Phone: 433 -1800 6200 SOUTHCENTER BL, TUKWILA, WA 98188 CONTRACTOR RJC INC. Phone: 206 639 -2681 25035 119TH PLACE S.E., KENT, WA 98031 CONTACT RICK KRIER Phone: 206 639 -2681 25035 119TH PLACE S.E., KENT, WA 98031 k******************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Description: DEMOLITION AND SITE RESTORATION. Valuation: 10,000.00 Demolition Fee: 30.00 Investigation Fee: .00 Cash Bond: .00 Total Permit Fee: 30.00 Bond. Number: 160913P * * * *, ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Center Authorized Signature Date I hereby 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 for an obtain this buildirg permit. Signature:__ Print Name:_ ��e eX Date: ''� Title: L,Q k'.sed.:0Ac_— 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. ALL PERMITS FOR DEMOLITION PROJECTS REQUIRE CONSTRUCTION, DEMOLITION AND LANDCLEARING WASTE MATERIAL FROM THESE PROJECTS TO BE RECYCLED AT A KING COUNTY LICENSED OR APPROVED FACILITY, OR TAKEN TO REGIONAL DISPOSAL FACILITIES. CITY OF TUKWIL( Department of Cmiimunity Development — Permit Cent'r" 6300 Southcenter Boulevard - #100, Tukwila, WA 98188 (206) 431 -3670 Building Permit Application Tracking PLAN CHECK NUMBER " � 0 -OES(T PROJECT NAME SITE ADDRESS C 0+ UK SUITE NO. INSTRUCTIONS TO STAFF • Contacts with applicants or requests for information should be summarized in writing by staff so that the status of the project may be ascertained at any time. • Plan corrections shall be completed and approved prior to sending to the next department. • Any conditions or requirements for the permit shall be noted in the Sierra system or summarized concisely in the form of a formal letter or memo, which will be attached to the permit. • Please fill out your section of the tracking chart completely. Where information requested is not applicable, so note by using "N /A ", date and initial. DEPARTMENTAL REVIEW "X" in box indicates which departments need to review the project. DEPARTNIEN:� TE: APPROVED LJIRFIIAENT )MMENI BUILDING - initial review FIRE PLANNING PUBLIC WORKS 0 OTHER BUILDING - final review BUILDING OFFICIAL 14- ica-cm 4,/y1,- 4t2-6/q/- 441 -qdi-A. /4, / ROUTED GA,..../4 INIT: 4/?-6 ( CONSULTANT: Date Sent Date Approved - FIRE PROTECTION: Detectors FIRE DEPT. LETTER DATED: INSPECTOR: N/A ZONING: BAR/LAND USE CONDITIONS? ammo REFERENCE FILE NOS.: INIT: MINIMUM SETBACKS: N- S- UTILITY PERMITS REQUIRED? ■ Yes PUBLIC WORKS LETTER DATED: E- W- No IAJD IZ6- 4 St`ptxc TYPE OF CONSTRUCTION: INIT. . CERT. OF OCCUPANCY? DYes %No UBC EDITION (year): 119f REVIEW COMPLETED INI : AMOUNT OWING: 430. CONTACTED -- 1---42-- 119 � (RD.C.,, DATE NOTIFIED j BY. 2nd NOTIFICATION BY: Irt. 3RD NOTIFICATION BY: (init.) 01/08/93 CITY OF TUKWILA BUILDIk PERMIT APPLICATION Department of Community Development - Building Division 6300 Southcenter Boulevard, Tukwila WA 98188 (206) 431 -3670 • PLAN CHECK NUMBER APf'LICATION.:111IU.ST BE LLEfl OU.T COMPLETELY. DESCRIPTION: BUILDING PERMIT: FEE PLAN CHECK FEE :: AMOUNT ' RCPT # oo DATE:: BUILDING SURCHARGE ' OTHER:' TOTAL 00:. SITE ADDRESS SUITE # - -C = .) (1, ) l ='_)61 VALUE OF CONSTRUCTION - $ J01000 .--- I � cL.rn c3 PROJECT NAME/TENANT C4) c. - AUK )t • ASSESSOR ACCOUNT # v1 ��:_ "�� �o •- D -D C) TYPE OF 1\ Building • Addition • Tenant Improvement (commercial) ►1. Demolition (building) WORK: 0 Rack Storage 0 Reroof 0 Remodel (residential) 0 Other DESCRIBE WORK TO BE DONE: ,t -'1 , II' f( 0-6"Th c . s; --/-0...., rd a'( it (- G\- f / O -J -�' /1C - - -, (C&_-_.1 BUILDING USE (office, warehouse, etc.) Oa_ 1-(1C_I ) *1Oin NATURE OF BUSINESS: WILL THERE E A CHANGE IN USE? Ca No 0 Yes If Yes, new building requirements may need to be met. Please explain: 'JCL,, -r-) C.) /1 h r.\ SQUARE FOOTAGE - Building: (C`'(;) , Tenant Space: Area of Construction: WILL THERE BE STORAGE OR USE OF FLAMMABLE, COMBUSTIBLE "No 0 Yes IF YES, EXPLAIN: FIRE PROTECTION FEATURES: 0 Sprinklers 0 Automatic Fire Alarm OR HAZARDOUS MATERIALS IN THE BUILDING? System PROPERTY OWNER (i �_, � r).{L 7i-/c l ,/ l-7 ((i PHONE PHONE jai J J.. -�� 7C1 ZIPI _ 3 �� �� ADDRESS (r) -CC ,L,0 i,L."(. "I1 C cLl ]-[Q,r CONTRACTOR j�,' C (.:4_, (j( r ADDRESS e9 .5-0:3<,--- / (gi _fi-. 1)i Wiz =_ i�E� X.�� ZIP/)3/ WA. ST. CONTRACTOR'S LICENSE # EXP. DATE ��' I. ARCHITECT /1/' Al /V/4 ADDRESS ZIP .1 ;. HEREBY: CERTIFY: THA't�:I HAVE:.READ;AND EXAMINED, Th11S: APPLICATION, AND KNOW THE SAME.:T BE TRUE AND CORRECT, AND 1 AUTHORIZED' TO>APPLY FOR THISPERMIT.< DATE 6i y 6 PHONE/ r7)(() BUILDING OWNER OR AUTHORIZED AGENT SIGNATURiz — -- PRINT NAME ADDRESS CONTACT PERSON / )UG e,i,sr- n - s )/77 c< /() lmYi/((— CITY/ZIP A--/cc-it C/ PHONE 0 (/79: APPLICATION SUBMITTAL In order to ensure th your application is accepted for plan review, please make sure to fill out the application completely and follow the plan syy mittal checklist on the reverse side of this form. Handouts are available at the Building counter which provide more detailed information on application and plan submittal requirements. Application and plans must be complete In order to be accepted for plan review. VALUATION OF CONSTRUCTION Valuation for new construction and additions are calculated by the Department of Community Development prior to application submittal. Contact the Permit Coordinator at 431 -3670 prior to submitting application. In all cases, a valuation amount should be entered by the applicant. This figure will be reviewed and is ' subject to possible revision by the Building Division to comply with current fee schedules. BUILDING OWNER / AUTHORIZED AGENT If the applicant is other than the owner, registered architect/engineer, or contractor licensed by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and obtain the permit will be required as part of this submittal. EXPIRATION OF PLAN REVIEW Applications for which no permit is issued within 180 days following the date of application shall expire by limitations. The building official may extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant as defined in Section 304(d) of the Uniform Building Code (current edition). No application shall be extended more than once. If you have any questions about our process or plan submittal requirements, please contact the Department of Community Development Building Division at 431 -3670. DATE APPLICATION ACCEPTED DATE APPLICATION EXPIRES lo- 13-9(1 0/22/93 COMMERCIAL SUBMITTAL CHECKLIST NEW COMMERCIAL BUILDINGS /ADDITIONS . nCompleted building permit application (one for, each structure - Assessor. Account Number Two sets. (2) of the following: nSpecifications COMMERCIAL TENANT IMPROVEMENTS Completed building permit application one: or each :structure Assessor Account Number: wo (2) sets of construcbon'pians; which include Site plan. Locadon of tenantspaoe xisdng and proposed parking andscape plan (if ;appiicabie, l e , change of,use Overall building plan, Tenantlocabon Use of. adjacent. (common wall). tenant Overall dimensions: of buiidingar square foota Structural calculations stamped by a. d engineer Soils report stamped by a Washington State licensed engineer F---1 Topographical survey Energy calculations stamped by a Washington. State. licensed engineer or architoct: Legal description • - Working drawings, stamped by a Washington State license architect, which include • Site plan • Architectural drawings • Structural drawings • Mechanical drawings •• Elevations •Civil drawings • Landscape plan Completed utility permit application(one forentire project) Six (6) sets of civil drawings NOTE: 'See utility permrt;application and checklist for specific uhli submittal requirements State license Floor plan of proposed tenant space Tenant space plan with use of each room tabeli �xit doors,. egress patterns • New walls,, existing Wali, and walls to be demoiishe •Construction details Cross sections. showing wall construction and meth attachment for floor and ceiling LStructural calculations stamped Washington licensed :engineer;may be °required,fstructur i work'is to be;done 2 sets NOTE 11 anyutrbty work is to lie done, submit, separate :utility permit aPPlicabon'and plans. RACK STORAGE:: Li Completed building permit application:: n Assessor Account Number Two (2) sets of plans, which include: Building floor plan showing: • Entire space where racks will be located • Exit doors :. • . • • Dimensions of all aisles. Tenant space floor plan •showing rack storage layout, aisles and NOTE :: include dimensions of racks (height, width and length) aisles : and exit ways on plan: .. Structural calculations stamped by a Washington State licensed engineer (rack storage 8' and ovor).:' NEW SINGLE - FAMILY DWELLINGS/ADDITIONS Completed building permit application (one for each structure) it REROOF for:each structure) :Narrative.descnbing existing roof, material being; remove material being installed NOTE A certification letter is required prior to final inspection and sign:: off of the permit ANTENNA/SATELLITE DISHES Completed building permit application Assessor Account Number. •Two (2) sets of pians, which include: Site Plan:(showing •building and •location of antenna/satellite''disl Details antenna/satellite•dish and:method of attachmen :Structural calculations stamped by a Washington State engineer may be'required RESIDENTIAL REMODELS Completed building permit application: Assessor Account Number Legal description Assessor Account Number [1 Two sets (2) of working drawings,. which include • Site plan (On plan,: 'show closest hydrant location: • Foundation plan .include accessro;bullding, showing • Floor,plan Width and length of access:) • Roof plan • Building elevations (all. ■views • "Building cross - section .• Structural, framing plans Washington State .Energy Code :Two (2) sets of working drawings;which inciu Site plan Foundation;plan ;Floor plan ;: Roof pian;° Building elevations: (all views Building cross= section Structural, framing plans: . NOTE 11 any utility Work into tie done pro ytde ut111 and,plans must be Nubm/tted " " °' REROOFS •Completed building perrrtft application Assessor Account Numbe • Narrative describing existing root ; l being remove matenai :being installed :NOTE A certification letter Is required prior to final Inspection and sign off of the permit ri Completed utility permit application n Six (6) sets of site plans showing utilities NOTE; Building :site plan. and utility site plan may be combined See utility permit application and checklist for specific submittal requirements Adcitionai topographical and soils inforrrration maybe required jf:unigtie site conditions.;: * **•******* k***** *************k**********k** **** A•***** ***** k*A** k CITY OF 1'UKW]:LA, WA TRANSMIT ********** k********* k***.*** k***k k.* *****k*** * **** *k* *k*k*•k*k*h*** TRANSMIT Number: 940.00502 Amount: 30.00 05/03/94 11:12 Permit No: 894- 0150.. Type: B-DEMO DEMOLITION 1' t T Parcel No 735960- -02.30 %iQ�3 /�4 Site Address: 3436 S 130.:ST Payment Method: CHECK Notation: ROC INC. Irtit: 8L13 * k****•k*•* **** k*****.** *** ** *. * * * ** ***k•k• ***** * *k•kkk k*A* * *hk h•k** *k•kk Account Code 000/322.100 Descr iptiar► BUILDING RB:S Total (This Payment): •Total Fees:. 30.00 Total All Payments: 30.00 Balance: .00 ,Paid 30.00 30..00 GENERA TOTAL CHECK CHANGE 1588A000 30.00 30.00 30.00 0.00 21448 4••■■■■■•• CITY OF TUKWILA Address: 3436 S 130 ST Suite: Tenant: CITY OF TUKWILA Type: 8-DEMO Parcel #: 735960-0230 ******************k********************************************k***A**k**** Permit Conditions: 1. No changes will be made,to01100ahOss,approved by the Tukwila Building Division '11-■ 44, 2. All permits, inspeA ion records, and approVe-d,40jans shall be , maintained ays0046 at job, site prior the ,,,,isart of d any construcnAlr'. ,T0s01 'do'cuments v are ,(114 intOd a va i 1 ab 1 e uAttyf f44,95, IL(.1nSpe4Cti on approVa 1 4W's0-romteds4 3. Remove a taly4ed, loph,,prete,,,4s1fOWefVuhdotiori e at co crete, clpf'ete '04otDos,06asonr.yAwa 1 1 s, gage floors, d ways a 40 meNs grtietures "d0000.1, loose mifc,e11nq materi Vfrom sitch4lot or f)arbe 1 of4ground, prapeig'ap sanit sewer and) watet.;b1;4iinfect ions'', properly fill6 Itw'' i me 4 f otheFwy eki0otect al 1 ;gii.temer4s„, „eel lars, septic tanks,. Permit No: 894-0150 Status: ISSUED Applied: 04/12/1994 Issued: 05/03/1994 we Va 1ll1%4 /V ' p 1 air st rt of or • au sha nqoTherexcavaons. y of penrn1 t . slYteoff iAat 1 opsncL co to be a p entiqt o,r ;N°, • 0 • 4 . race ora perm t or appovaL(1gq f:Ilitatinhall,,1 not be core.i.C.,ro. an mp"040volo.i, any v ittlapt§-11), y of. tpe h ts%c,sr .e 97 oilanv other , anvegsadY t p suming trp„ gt e r.1 ty,odr i o tote t \ iv.).0.c0p4's of thi co.d.e,,,, be4alia ,, • 1 11 ' S'•5 ,r4 • \, N e " '11 r.51: 41%.ltif4ff, , 4%1 •1 +7,, :P .5' gt 41 11 kt,77,0' f INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter °Blvd:, #100, Tukwila, WA 98188 0150 PERMIT NO. (206) 431 -3670 • .:,,, uKYPe �A)i o ns.:. , �FMO .•ddr ,., D , I ?6 Date Celled:. ,,, 6 _ q al Infix tiogg• ' fl- • E'v, f ` a , 0 ' Date Wanted* ,5 44'7> _ qI am p.m. Requester. c 644- - r , Al 04,C W !r �{t°C ite, r't • ir...... �2 I phone No.: 3 3- 0179 Approved per applicable codes. COMMENTS: O Corrections required prior to approval. s $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali to schedule reinspection. [ecetNo.: A. rwaw�arte« OCT 31 '91 09:39 DEVELOPERS INSURANCS036844065 IrIcchico SRO P PERFORMANCE BOND V-1 1�nt5C7 P. 2/5 BOND NO. 160913P KNOW ALL MEN BY THESE PRESENTS: that RJC, INC. as Principal, herein after called Contractor, and INDEMNITY COMPANY OF CALIFORNIA , a California corporation authorized to transact a general surety business in the State of WASHINGTON , as Surety, are held and firmly bound unto CITY OF TUKWILA as Obligee, hereinafter called Owner, in the amount of -EIGHT THOUSAND EIGHT HUNDRED SEVENTY TWO & 40/100 -- ($8,872.40) Dollars ($ ), for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally by these presents. WHEREAS, Contractor has by written agreement dated APRIL 11th , 19 94 , entered into a. contract with Owner for RESIDENTIAL STRUCTURE DEMOLITION & SITE RESTORATION ON CITY -OWNED PARCEL which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform said contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect. Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Owner having performed Owner's obligations thereunder, the Surety may promptly remedy the default, or shall promptly (1) Complete the Contract in accordance with its terms and conditions, or (2) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination by the Surety of the lowest responsible bidder, 'or, if the Owner elects upon determination by Owner and Surety jointly of the lowest responsible bidder, arrange for a contract between such bidder and Owner, and make available as work progresses (even though there should be a default or succession of defaults under the contract or contracts of completion arranged under this paragraph) sufficient funds to pay the cost of Developers Insurance Company • Indemnity Company of California • Insco Insurance Services, Inc. 17780 Filch, Irvine, CA 92744 • Mailing Address: P.O, Box 19725, Irvine, CA 92713 Crn vA.n 1P)) 1� OCT 31 '91 09:40 DEVELOPERS INSURANC5036844065 P.3/5 c completion less the balance of the contract price; but not exceeding, including other costs and damages for which the Surety may be liable hereunder the amount et forth in the first paragraph hereof. The term "balance of the contract price," as used in this paragraph, shall mean the total amount payable by Owner to Contractor . under the Contract and any amendments thereto, less the amount properly paid by Owner to Contractor. Any suit under this bond m»st be instituted hefnrp the expiration of one (1) years from the date on which final payment under the contract falls due. No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein. Signed and Sealed this 11th day of APRIL 1994 RJC..INC. INDEMNITY COMPANY OF CALIFORNIA Principal Surety By: B ORMA•8 Back 1/91 • Attorney -in -Fact Glenn F. Davidson POWER OF ATTORNEY OF I ' EMNITY COMPANY OF CALIFO ( IA AND DEVELOPERS INSURANCE COMPANY P.O. BOX 19725, IRVINE, CA 92713 • (714) 263 -3300 N2 161457 NOTICE; 1. All power and authority herein granted shall In any event terminate on the 31st day of March, 1996. 2. This Power of Attorney is void 11 altered or if any portion is erased. 3. This Power of Attorney is void unless the seal Is readable, the text is In brown Ink, the signatures are In blue Ink and this notice Is In red Ink. 4. This Power of Attorney should not be returned to the Attornoy(s) -In -Fact, but should remain a permanent part of the obligee's records. KNOW ALL MEN BY THESE PRESENTS, that, except as expressly limited, INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY, do each severally, but not jointly, hereby make, constitute and appoint ** *GLENN F. DAVIDSON, ALVIN L. SCHERICH, CYNTHIA L. B. MILLER, J. WILLIAMSON, JOINTLY OR SEVERALLY * ** the true and lawful Attorney(s) -In -Fact, to make, execute, deliver and acknowledge, for and on behalf of each of said corporations as sureties, bonds, undertakings and contracts of suretyship In an amount not exceeding Two Million Five Hundred Thousand Dollars ($2,500,000) In any single undertaking; giving and granting unto said Attorney(s) -In -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done In connection therewith as each of said corporations could do, but reserving to each of said corporations lull power of substitution and revocation; and all of the acts of said Attorney(s) -In -Fact, pursuant to these presents, are hereby ratified and confirmed. The authority and powers conferred by this Power of Attorney do not extend to any of the following bonds, undertakings or contracts of suretyship: Bank depository bonds, mortgage deficiency bonds, mortgage guarantee bonds, guarantees of Installment paper, note guarantee bonds, bonds on financial institutions, lease bonds, insurance company qualifying bonds, self - Insurer's bonds, fidelity bonds or ball bonds. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY, effective as of September 24, 1986: RESOLVED, that the Chairman of the Board, the President and any Vice President of tho corporation be, and that each of them hereby Is, authorized to execute Powers of Attorney, qualifying the attorney(s) named In the Powers of Attorney to execute, on behalf of the corporation, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assis- tant Secretory of the corporation be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and In the future with respect to any bond, undertaking or contract of suretyship to which It Is attached. IN WITNESS WHEREOF, INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY have severally caused these presents to be signed by their respec- tive Presidents and attested by their respective Secretaries this 1st day of April, 1993. INDEMNITY COMPANY OF CALIFORNIA By De je F. Vincent', Jr. Prosldent ATTEST By Walter Crowell Secretary DEVELOPERS INSURANCE COMPANY By ATTEST By Dan', F. Vincent', Jr. President Walter Crowell Secretary STATE OF CALIFORNIA ) SS. COUNTY OF ORANGE ) On April 1, 1993, before me, Tiresa Taafua, personally appeared Dante F. Vlncontl, Jr, and Walter Crowell, personally known to me (or provided to me on the basis of satisfactory evidence) to be the porrlon(a) whose name(e) le /are subscribed to the within Instrument and acknowledged to me that he /she /they executed the same In his /her /their authorized capacity(les), and that by his /her /their slgnaturo(s) on the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the Instrument. WITNESS my hand and official seal. Signature CERTIFICATE OFFICIAL SEAL TIRESATAAFUA NOTARY PUBLIC • CALIFORNIA PRINCIPAL OFFICE IN ORANGE COUNTY ry,> My Commission Exp. Aug. 4, 1995 1P* The undersigned, as Senior Vice President of INDEMNITY COMPANY OF CALIFORNIA, and Senior Vice President of DEVELOPERS INSURANCE COMPANY, does hereby certlly that the foregoing and attached Power of Attorney remains In full force and has not been revoked; and furthermore, that the provisions of the resolutions of the respective Boards of Directors of sald corporations sot forth in the Power of Attorney, are in force as of the date of this Certificate. This Certificate is executed In the City of Irvine, California, this 1 lth day of APRJ 1 , 199 INDEMNITY COMPANY OF CALIFORNIA By ID -310 REV. 4/93 'D■e> L.C. Flebiger Senior Vice Prosldent DEVELOPERS INSURANCE COMPANY By l\. ` ` L.C. Fieblger Senior Vice President Attl/P11 , • 1 1 PRODUCER BELL ANDERSON AGENCY INC P 0 BOX 887 KENT WA 98035-0887 UR A . . C E ISSUE DATE (MWDINYY) 04/11/94 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR .ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER ^ AETNA CASUALTY & SURETY INSURED RJC INC 25035 119TH PL SE KENT WA 98031 COMPANY pck LETTER AMERICAN STATES INS. COMPANY c LETTER COMPANY D LETTER COMPANY E LETTER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POUCY EXPIRATION DATE (MWDD/YY) OMITS A GENERAL UABILITY 081CO24003169 COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR. OWNER'S & CONTRACTOR'S PROT. AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON•OWNED AUTOS GARAGE LIABILITY 02CC5319491 04/08/94 10/08/93 04/08/95 12/06/93 GENERAL AGGREGATE PRODUCTS-COMP/OP AGO. PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MEO. EXPENSE (My one person) COMBINED SINGLE LIMIT s1, 000,000 $1,000,000 s 500,000 s 500,000 s 100,000 $ 5 —J 000 100,000 BODILY INJURY (Per person) BODILY INJURY (Per occident) PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS ........................ ....................... .... ........................................ EACH ACCIDENT DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE 3 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS THE CITY OF TUKWILA IS NAMED AS ADDITIONAL INSURED RE:HOUSE DEMOLITION AT 3436 S 130TH ST. PROJECT #94—BG01 :CERTIFICATE: HOLDER CITY OF TUKWILA 6200 SOUTHCENTER BLVD TUKWILA WA 98188 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Q. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UF,'ONITHE COMPANY, 5S—AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /1 ANN BOSIK site plan issue resolutions .