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HomeMy WebLinkAboutPermit D98-0388 - NW COMPUTER SUPPORT - EXPANSIOND98 -0388 965 Industry Dr. NW Computer Support City of Tukwila ( Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 Parcel No: 252304 -9034 Address: 965 INDUSTRY DR Suite No: Location: Category: AOFF Type: DEVPERM Zoning: Const Type: Gas /Elec.: Units: 001 Setbacks: North: Water: TUKWILA Wetlands: Contractor License No: PAULSBRO44JJ NW COMPUTER SUPPORT 965 INDUSTRY DR, TUKWILA WA 98188 PACIFIC GULF PROPERTIES 631 STRANDER BLVD, TUKWILA WA 98188 PAUL STEPHENS BLDG & PLUMBING 22401 100 AV SE, KENT WA 98031 CONTACT PAUL STEPHENS 22401 100 AV SE, KENT WA 98031 ********************************* * * * * * * * * * * * **** * * * * * * *'k * * *•k ** *fit *** k ** * * ** * ** k* Ic * * ** Permit Description: REMOVE 2 DOORWAYS FOR EXPANSION, REMOVE 12 LF NON- STRUCTURAL WALL. ************************************** k************** * * * * * * * * * * * * * * * * * ** * * * * ** * * * *** Construction Valuation: $ 1,200.00 PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: Curb Cut /Access /Sidewalk /CSS: N Fire Loop Hydrant: N No: Size(in): .00 Flood Control Zone: N Hauling: N Start Time: Land Altering: N Cut: Landscape Irrigation: N Moving Oversized Load: N Start Time: ,End Time: Sanitary Side Sewer: N No: Sewer Main Extension: N. Private: Storm Drainage: N Street Use: N Water Main Extension: N Private: Public: * k***************************************************** * * * * * * * * * * * * * * * * * *'k * * ** * * * * ** TOTAL DEVELOPMENT PERMIT FEES: $ 78.50 ********** k* * * * * * * * * * * * * * * * * *k * * * * * * ***•. , k * * * * * * *,4 ** *ink * ** OCCUPANT OWNER CONTRACTOR Permit Center Authorized Signature: I hereby certify that I have read and ex rifled 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 provision of any other state or local laws regulating construction or the perforn.nc of work. I am authorized to sign for and obtain this development •erm't. Signature: WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES, APPLICANT IS PROCEEDING AT THEIR OWN RISK. Print Name :_Pa Cr DEVELOPMENT PERMIT Permit No: Status: Issued: Expires: (206) 431 -3670 098 -0388 ISSUED 11/25/1998 05/24/1999 Occupancy: OFFICE UBC: 1997 Fire Protection: AUTO FIRE ALARM .0 South: .0 East: .0 West: .0 Sewer: TUKWILA Slopes: Y Streams: Phone:.(206)575 -0765 Phone: 206 -650 -4475 Phone: 206- 650 -4475 End Time: Fill: Public: * * * * * * * * * * * * * * * * * * ** Date: // Date: N--t-/--,r 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. Address: 965 INDUSTRY DR Suite: Tenant: Type: DEVPERM Parcel #: 252304-9034 CITY OF TUKWILA Permit No: D98 -0388 Status: ISSUED A p p l i e d : 11/12/1993 Issued: 11/251/993 •k•k*•k*`k•k**-k *•k•k* *•k•A A A A•k•k•k k *•k•k•k•k•k k *• k• k*• k****• k4* A•• k• k• k• k• k• k* •k* **k** **** *'k *** * *•k•k *•k'•k* Permit Conditions: 1. No changes will be made to the plans unless; approved by the Architect or Engineer and t he �tu.kw:;1 „la Bui1ding_Division. 2 ., E 1 ectr i cal permits .. ha,11.4b ;eo.bt�a:.heo -i,p r o u•gh the Washington State''Division of L:abcir 'v`a nd Indus ~ tr�ie. aar'd at`1.1 electrical y'fA ti��y. Work w i l l be insp'ec.t"ed by ,th:at. agency C24�3'- 66110 Al i p ermits, ,ths�bat.t on 'r�,ecate c s, ; , a nd apprlov fi shat 1_ be .avai1ab1e at ►e i.o b� s1tre {pr,', or` :e the 4t rof rY:}(y .con s Uct•i on { XThese do um are to be 'h ta i nett andf?a;va i l - able until, inal 5 spection 4pE5`rova "l''is granted. ''''N. ' . A11 cons riic,tion �,. e, t� r ,t-ci • ba acne,' ��f�rz��cc�riformanc :e ; ..witli'�ap, e P�`u�r•�, .p 1 ans .0,0' reou remen.ts of the i f orm Building Cod ; (1 9 Edit 10 , as amen ameed,` Uniform ; Mecha Code . t {1.997 �Eci i t 1 and Wa`s�h i n`gt�on State Ener�gv ( Edition) . . 5. Validity 04 ermit'. The iss°ivance`of a permit or . ,approval'0. plans'; specification .and c ii t ompo t -i :cans shall not;'n :,con - strsued to be a ''perm.ieT or. or. an approval of t. any 'U:ioi.atai..on of ocnv of ns, ` sio,at the bin Id ` tcode or of any . other ordinance off.-.,the ur,i,sdi . t .i eorl.,. NO.•- permit preium1ng g ive' .au thrrity ,:!to „...vi e ,' canc el. the .pr.ovis1ons of " : y th�i c r code).. sha11,.be valid. ' 6 ..._ ? . ,,, Project Name/Tenant: AM/ Gomel) TE2 si)7'2 re-r Value of Construction: 4Zed• Site Address: City State/Zip: 96..5 /`ia ?/ lr - iV L) s7t -f' ,2n TLfk14'f - /04 Tax Parcel Number: a 5 3.0 4 / - 90.3 - O Property Owner: MG /pt' 6 l[ f ? Pants dnv-- Phone: R66 - 675 .5 Fax #: �a (f .-- .s 75 0 7z / St eet Address: City State /Zip: &.3 / 5772/140E72_ 13iV D #C04i/ //.4 L Wier Contractor: PR ST ' .l_s Phone: aid (ft'- c J f Street Address: City State /Zip: L 7'7 1 c2/ Both if vex f' • f/r.., t . r...ri . q ' c7) 1 Fax #: 25 8S9 -S 92 Architect: Phone: Street Address: City State /Zip: Fax #: Engineer: Phone: Street Address: City State /Zip: Fax #: Contact Person: 1rz ,,,,% -S'66 .1, t ., p Phone: 006 6..fa -. 9Y7.S Street Addr s: City State /Zip: 22 /a271, ,1(. .r'.&- /r - Lt-t< < >/ Fax #: aft- is -59. Description of work to be done: D /2- LF /(1D� f sue- -ef gz'fr -L P.GN1,9- ,; doO iL1 y s p-,,,_ E J /W.15/O / Ja° Av✓fL-1.-. Existing use: ❑ Retail ❑ Restaurant ❑ Multi- family 51-Warehouse [73 Hospital ❑ Church ❑ Manufacturing ❑ Motel /Hotel PKI Office ❑ School /College /University ❑ Other Proposed use: ❑ Retail 171 Restaurant 71 Multi-family Warehouse 71 Hospital E3 Church ❑ Manufacturing ❑ Motel /Hotel Office ❑ School /College /University ❑ Other Will there be a change of use? ❑ yes -no If yes, extent of change: (Attach additional sheet if necessary) Will there be rack storage? ❑ yes 21. no Existing fire protection features: El sprinklers Plautomatic fire alarm ❑ none ❑ other (specify) Building Square Feet: 12 g 0 t5 existing Area of Construction: (sq. ft.) .P..-e CO Will there be storage of flammable /combustible hazardous material in the building? ❑ yes Qno Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating quantities & Material Safety Data Sheets Commercial / Multi- Family Tenant Improvement / Alteration Permit Application CITY OF TU''gILA Permit Center 6300 Southcenter Blvd., Suite 100, Tukwila, WA 98188 (206) 431 -3670 ❑ Channelization /Striping ❑ Curb cut/Access /Sidewalk ❑ Flood Control Zone ❑ Hauling ❑ Fire Loop /Hydrant (main to vault) #: Size(s): ❑ Land Altering 0 Cut cubic yds. 0 Fill cubic yds. ❑ Landscape Irrigation ❑ Sanitary Side Sewer #: ❑ Sewer Main Extension 0 Private 0 Public ❑ Storm Drainage ❑ Street Use ❑ Water Main Extension 0 Private 0 Public ❑ Water Meter /Exempt It: Size(s): 0 Deduct 0 Water Only ❑ Water Meter /Permanent # Size(s): ❑ Water Meter Temp it Size(s): Est. quantity: gal Schedule' ❑ Miscellaneous 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 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 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once. Date application accepted: /f -/L - , Date application expires: Appl/catlorytaken by: (initials) PLEASE SIGN BACK OF APPLICATION FORM CTPERMIT.DOC 1 /29/97 Application and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or facsimile. APPLICANT REQUEST FOR PUBLIC WORKS SITE/CIVIL PLAN REVIEW OF THE,POLLOWING:.. (Additional reviews may be determined by the Public Works Department) BUILDING OWNER OR AUTHORRI,EDAGENT: Signature iaPj� . e/z Date: ,I_ D g 'Irf - Print na e l " )/1(Gw riCL 6E cc.I G(L_ P'°- E. s7 S-- 0765 ax _ 5- 7S- -d ?`z-/ Address� 3 S�� e� b (/p #� City /State /Zip '"' �^/�/� 9 / ALL COMMERCIAUMULTI-FINILY TENANT IMPROVEMENT /ALAIR ATION PERMIT APPLICATIONS niqW. r BE SUBMITTED WITH THE FOLL'17WING: ➢ ALL DRAWINGS TOTE STAMPED BY WASHINGTON STATE LICENSED ARCHITECT, "S"RUCTUR1L ENGINEER OR CIVIL ENGINEER D ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN • BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED N/A SUBMITTED ❑ � fCF Complete Legal Description ❑ ❑ Metro: Non - Residential Sewer Use Certification if there is a change in the amount of plumbing fixtures (Form H -13). Business Declaration required (Form H -10). Four (4) sets of working drawings (five(5) sets for structural work), which include : ❑ cn, Site Plan (including existing fire hydrant location(s) 1. North arrow and scale 2. Property lines, dimensions, setbacks, names of adjacent roads, any proposed or existing easements 3. Parking Analysis of existing and proposed capacity; proposed stalls with dimensions 4. Location of driveways, parking, loading & service areas 5. Recycle collection location and area calculations (change of use only) 6. Location and screening of outdoor storage (change of use only) 7. Limits of clearing /grading with existing and proposed topography at 2' intervals extending 5' beyond property's boundaries 8. Identify location of sensitive area slopes 20% or greater, wetlands, watercourses and their buffers (change of use only) 9. Identify location and size of existing trees that are located in sensitive areas and buffer (TMC 18.45.040), of those, identify by size and species which are to be removed and saved 10. Landscape plan with irrigation and existing trees to be saved by size and species (exterior changes or change of use only) 11. Location and gross floor area of existing structure with dimensions and setback 12. Lowest finished floor elevation (if in flood control zone) 13. See Public Works Checklist for detailed civil /site plan information required for Public Works Review (Form H- 9). ❑ 71-- Floor plan: show location of tenant space with proposed use of each room labeled ❑ ❑ Overall building floor plan with adjacent tenant use; identify tenant space use and location of storage of any hazardous materials; dimensions of proposed tenant space. ❑ 17I. Vicinity Map showing location of site ❑ ❑ Rack Storage: If adding new racks or altering existing rack storage, provide a floor plan identifying rack layout and all exit doors. Show dimensions of aisles, include dimensions of height, length, and width of rack. Structural calculations are required for rack storage eight feet and over. ❑ ❑ Indicate proposed construction of tenant space or addition and walls being demolished ❑ ❑ Construction details ❑ ❑ Sprinkler details - details of sprinkler hangers, specifically penetrations in structure, i.e., roof; size of water supply to sprinkler vault with documentation from contractor stating supply line will meet or exceed sprinkler system design criteria as identified by the Fire Department. ❑ ❑ Washington State Non - Residential Energy Code Data shall be noted on the construction drawings. ❑ ❑ SEPA Checklist - if intensification of use (check with Planning Department for thresholds). ❑ ❑ Attach plans, reports or other documentation required to comply with Sensitive Area Ordinance or other land use or SEPA decisions. ❑ ❑ Food service establishments require two (2) sets of stamped approved plans by the Seattle -King County Department of Public Health prior to submitting for building permit application. The Department of Public Health is located at 201 Smith Tower, Seattle, WA or call (206) 296 -4787. (Form H -5) ❑ csa.- Copy of Washington State Department of Labor and Industries Valid Contractor's License. If no contractor has been selected at time of application a copy of this license will be required before the permit is issued OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ". 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT. CTPERMIT.DOC 1/29/97 Account Code Description 000/322.100 BUILDING - NONRES 000/386,904 ^STATE BUILDING SURCHARGE • : • CITY OFJUKNILA NA � � � �� � '.lRMNSMIT` *A***+****^*****+*aA TRANSMIT—Number: R9700873 Amount: ' 49.35 11/25/98 13:30 ▪ .aymont Method: 3332 Notation: PAUL STEPHES BL Initc TKF Permit No: D98-0388 Typo: DEVPERM DEVELOPMENT PERMIT Parcel No: 252304-9834 ` Site Address: 965 INDUSTRY DR Total Fees: 78.50 This Payment 49.35 Total ALL Pmts: 78.50 Balance: `�.0O �A.**+*a*+****+A***i.*o*++**a^**+k**********A.*+*+***+�***aa++***** t! AmOunt 44-85 ` � R159 i2�01 9719 TOTAL � ''4935 • • il+ . CJTYOF TUKNILA, WA � . � ��' TRANSMIT **++*++*11***+k*�****++****A*+a*4+0+A*A**^A.*a TRANSMIT Number: R97O0866 Amount: 29,15 11/12/98 12:48 Payment Method: CHECK Notation: PAUL.STEpHENS Initx.'HLH `.. ---�-------'---------�--_-'-----'----_-^--'--------~�,—�.--`-'/~^- ! Permit No: D98-O388 Type: 0EVPEnN DEVELOPMENT PERMIT' parcel No 2523O4-9O34 Site Address: 965 INDUSTRY DR ' � 'Total gees:- : H ' 78.5 v This Payment 29.15 Total ALL Pmts: ' . ,29.15 `'' Balance: ' : '49.35,',' *A*+*A* Account `Code Descr�iptimn. . .. mount 000/345.830 PLAN CHECK - NONRES, ` � 29.15 -�-----_.---.--^=.._----~~---_��.-_~.~� Project: Type of 1 ectio ddre�s:.. __ Date called: Special instructions: Date wanted: I 1 — 1 5 _ 9 9 � p.m. Requester: t C.L 1 t c ..'c1 \ Phon No.• IL 4 '2 .. INSPECTION NO. �:+t'r,!Yx';1.'°�".,3, S�S�J!.`���;` ?`3Q }ski � :��,�,,..[�.. :w.1v;.+x�F'Yf+�.. ^ ;rfd ° .' w �` �� i � F', .!- �.?` INSPECTION RECORD ? - G"a8 Retain a copy with permit . I PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 COMMENTS: 70 proved per applicable codes. Corrections required prior to approval: Ins /f �1� Date: $2.00000 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: Proj: Type o • s• - n : • Ad. (T . I' ,; _( _ it Water led( �� Special instructions: = - --J Date Tantedi cif} Cil. '"" , R stet : S,_f-e.u,- kp proved per applicable codes. Corrections required prior to approval. COMMENTS: -ems. • ItZ C . r.i o+IPs * 4 ^'n..Ffogiwq. INSPECTION RECORD l Retain a copy with perm► -O PERMIT NO. INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WP 98188 (206) 431 -3670 42.00/ EINSPECTION FEE REQUIRED. Prior to inspection, fee must be pai• at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: 0 9 D — NtVJ NDtJ 5— LTtUt2AL WALLS L NONE) SEPARATE D FOPERMIT REQ MECHANICAL ELECTRICAL 0 Ey.N15TING wALS L1EMO N oN si WALLS Q PLUMBING GAS PIPING CITY OF TUKWILA BUILDING DI l By Date qp Permit No. ( IP FILE ��PY.. understand that the Plan Check approvals are subject errors and omissions and approval o 3 s ob I to e pions does not author tae the violation of any 1 adopted code or ordinance. Rac knowledge �; tractor's copy of approved plans Oi= i ti`tcvd� D AP ROV N ►f 20 199 vqs -o3ss RECEIVED CITY OF TUKWIU4 NOV 121998 AERMIT CENTER BUILDINGS 19 -31 PACIFIC GULF BUSINESS PARK TUKWILA • • i •a 11.J •• 1101214111 EXHIBIT B SITE PLAN `-*- -- ���""t'l;l"�. ; f'MRII�DL�tx j • 1,t LANCE VED • CITY OF TUKWILA 0V I 2 1998 PERMIT OENTER • X LANDLORD X ' d361a0 1IWdad 8661 Z t NON vi� o n a a0a iO JptSI' )N Q+11 fin I 8661 o z tON 001110 MY) V FLOOR PLAN — BUILDING 31 CD ( • NMI EXHIBIT A _ - O �I 0 O CO i 1 f0 SO r -.'–u" -- - -- -- — I� -- _ _ _ t 4., o ,�,, 0 == ..=== _____ N 41 • 0 0 r. '11 .,n iri ;�il - -- - -- V il p =4 CO Nrn 0 0 ' -n O N X LANDLORD TENANT, INGRESS Se 20' WIDE i 20' WldE NON—EXCLUSIVE ' EGRESS ACCESS EASEMENT EASEMENT S01 ?8 "W 577 17 LEGAL DESCRIPTION PARCEL 2 SITUATED IN. THE SOUTHEAST QUARTER OF SECTION 26 AND THE SOUTHWEST QUARTER SECTION 25, TOWNSHIP 23 NORTH, RANGE 4 EAST, WILLAMETTE MERIDIAN, . CITY OF TUKWILA, KING COUNTY, WASHINGTON, AND BEING DESCRIBED AS FOLLOWS: . BEGINNING AT A POINT. WHICH IS NORTH 8806'42' WEST, A DISTANCE OF 105.84 FEET AND SOUTH 0147'28" WEST, A DISTANCE OF 90.66 FROM THE EAST QUARTER CORNER OF SAID. SECTION' 26 AND THE WEST QUARTER CORNER pF SAID SECTION 25 AND RUNNING THENCE SOUTH 8812'32" EAST, A DISTANCE OF X33.00 FEET 'TO THE ' CENTERLINE OF A PRIVATE ROAD, ALSO KNOWN AS INDUSTRY DRIVE; THENCE SOUTH' 01 47'28'; WEST;' • ON -*SAID CENTERLINE A7 DISTANCE OF 5 577.17.. FEET:.TO, . THE - BEGINNING OF A TANGENT 250.00 FOOT RADIUS CURVE LEFT; THENCE ON SAID CURVE, THROUGH A• ANGLE OF 1749'33" " (THE ' :LONG• CHORD 'OF - WHICH' BEARS .SOUTH 0707'19' EAST, A DISTANCE OF 77.47 FEETI'AN ARC DISTANCE OF 77.78 FEET • TO THE ENO THEREOF AND THE BEGINNING OF A TANGENT 250.00 FOOT RADIUS CURVE RIGHT; THENCE ON SAID CURVE THROUGH "A CENTRAL ANGLE OF 1749'33" • (THE LONG CHORD OF WHICH BEARS SOUTH 07'07'19" EAST, A DISTANCE OF 77.47 FEET) AN ARC DISTANCE OF 77.78 FEET TO THE END THEREOF; 'THENCE SOUTH 01 ° 47'28" WEST,•A DISTANCE OF•430.00 FEET TO A POINT ON THE NORTH RIGHT -OF- . WAY UNE OF MINKLER BLVD., SAID POINT BEING 45.00 FEET FROM CENTERLINE WHEN MEASURED AT 'RIGHT ANGLES; THENCE LEAVING SAID PRIVATE ROAD CENTERLINE AND RUNNING NORTH 88'12'32" WEST, ON SAID NORTH RIGHT -OF -WAY LINE A 'DISTANCE OF 257.00 FEET TO A POINT; THENCE LEAVING SAID NORTH RIGHT -OF -WAY LINE AND RUNNING NORTH 0147'27' EAST, A DISTANCE OF 1160.23 'FEET TO THE POINT OF BEGINNING, CONTAINING 6.485 ACRES MORE OR LESS.., BASIS OF BEARING BEING THE CENTERLINE OF STRANDER BLVD. PER SURVEY NO. 8704029002. L E G E N D FOUND MONUMENT AS NOTED C AL!'ULATED POINT -NOT SET YELLOW PLASTIC CAP �• - UGH POLE - STORM DP AIN INLL T SIGN POST - MANHOLE ripr .4rrDg U I i i15 WIDE; 'SETBACK RECEIVED CITY OF TUKWILA N OV 1 2199 8 PERMIT CENTER 13L (s J q -3 \PR•ROUTE.000 6/98 ROO COCA COpti PLAN REVIE /ROUTING BLIP ACTIVITY NUMBER: D98 -0388 DATE: 11 PROJECT NAME: NW COMPUTER SUPPORT XX Original Plan Submittal Response to Incomplete Letter Response to Correction Letter # Revision # After Permit Is Issued DEPARTMENTS: Division [ Fire Prevention ublic C�Vorks�� Struct TUES/THURS ROUTING: Routed by Staff n (if routed by staff, make copy to master file and enter into Sierra) Approved E Approved with Conditions Planning Division ❑ a� Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues, Thurs) DUE DATE: 11 -17 -98 Complete ❑ Incomplete ❑ Not Applicable ❑ Comments: Please Route ❑ No further Review Required ❑ REVIEWERS INITIALS: DATE: APPROVALS OR CORRECTIONS: (ten days) DUE DATE: 12 -15 -98 Not Approved (attach comments) ❑ REVIEWERS INITIALS: DATE: CORRECTION DETERMINATION: DUE DATE: Approved ❑ Approved with Conditions ❑ Not Approved (attach comments), REVIEWERS INITIALS: DATE: REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST. # EXP. DATE CCO1 PAULSBRO44JJ 04/01/1999 EFFECTIVE DATE , 04/11/1996 PAUL STEPHENS BLDG & RMDLNG 22401 100TH AVE SE KENT WA 98031 Signature Issued by DEPARTMENT OF LABOR AND INDUSTRIES