HomeMy WebLinkAboutPermit D04-373 - BURNS RESIDENCE - RESIDENCE DEMOLITIONBURNS RESIDENCE
5026 S 118 ST
D04 -373
City o. Tukwila
Department of Con:ntunity Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: ci.tukwila.wa.us
DEVELOPMENT PERMIT
Steven M. Mullet, Mayor
Steve Lancaster, Director
Parcel No.: 3348400784 Permit Number: D04 -373
Address: 5026 S 118 ST TUKW Issue Date: 03/09/2005
Suite No: Permit Expires On: 09/05/2005
Tenant:
Name:
Address:
Owner:
Name:
Address:
Contact Person:
Name:
Address:
BURNS RESIDENCE
5026 S 118 ST, TUKWILA WA
BURNS GEORGE H
5022 S 118TH ST, TUKWILA WA
ROBERT W. WADE
10024 S 46TH ST, PHOENIX, AZ
Contractor:
Name: COBBLESTONE COMPANY, THE
Address: 411 WEST GAZER, STE B, SEATTLE, WA
Contractor License No: COBBLC *033BM
Phone:
Phone: 480 -221 -3769
Phone: 206 365 -6595
Expiration Date: 11 /10/2005
DESCRIPTION OF WORK:
DEMOLISH EXISTING 600 SQ FT SINGLE FAMILY RESIDENCE.
PUBLIC WORKS ACTIVITIES INCLUDE: SANITARY SIDE SEWER FOR SEPTIC ABANDONMENT, EROSION CONTROL, AND
CAPPING THE WATER SERVICE /RETIREING THE WM FOR THIS RESIDENCE PLUS CAPPING AND RETIREING TWO
ADDITIONAL WATER SERVICES AND WATER METERS.
Value of Construction: $3,000.00 Fees Collected: $447.05
Type of Fire Protection: International Building Code Edition: 2003
Type of Construction: Occupancy per IBC: 0022
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant:
N
Number: 0
Size (Inches): 0
Flood Control Zone:
N
Hauling:
N
Start Time:
End Time:
Land Altering:
N
Volumes: Cut 0 c.y.
Fill 0 c.y.
Landscape Irrigation:
N
Moving Oversize Load:
N
Start Time:
End Time:
Sanitary Side Sewer:
N
Sewer Main Extension:
N
Private:
Public:
Storm Drainage:
N
Street Use:
N
Profit: N
Non - Profit: N
doc: IBC- Permit D04 -373 Printed: 03 -09 -2005
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Water Main Extension:
Water Meter:
Cit y oY Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: ci wkwila. wa. its
N Private:
N
* *continued on next page **
Steven M. Mullet, Mayor
Steve Lancaster, Director
Public:
doc:IBC- Permit D04 -373 Printed: 03 -09 -2005
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Permit Number:
Issue Date:
Permit Expires On:
Steven M. Mullet, Mayor
Steve Lancaster, Director
DO4 -373
03/09/2005
09/05/2005
Permit Center Authorized Signature: �'' ���z��� -�-� 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.
City oY Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 -431 -3665
Web site: ci.tukwila.wa.us
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.
Signature /: l Date: / (���
Print Name: -�
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.
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City of Tukwila
face
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
PERMIT CONDITIONS
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Parcel No.: 3348400784 Permit Number: D04 -373
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Address: 5026 S 118 ST TUKW Status: ISSUED
2
Suite No: Applied Date: 10/06/2004
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Tenant: BURNS RESIDENCE Issue Date: 03/09/2005
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1: ** *BUILDING DEPARTMENT CONDITIONS * **
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2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
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3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
start of any construction. These documents shall be maintained and made available until final inspection approval is
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granted.
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' 4: All construction shall be done in conformance with the approved plans and the requirements of the International
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f Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code.
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5: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of,
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any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits
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presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila
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shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the
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Building Official from requiring the correction of errors in the construction documents and other data.
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6: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
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7: Contractor shall notify Public Works Utility Inspector Mr. Greg Villanueva at (206)433 -0179 of commencement and
completion of work at least 24 hours in advance.
8: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation
off -site or into existing drainage facilities.
9: From October 1 through April 30, cover any slopes and stockpiles that are 31-1: IV or steeper and have a vertical rise of
10 feet or more and will be unworked for greater than 12 hours. During this time period, cover or mulch other disturbed
areas, if they will be unworked more than 2 days. Covered material must be stockpiled on site at the beginning of this
period. Inspect and maintain this stabilization weekly and immediately before, during and following storms.
10: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at least monthly. All
disturbed areas of the site shall be permanently stabilized prior to final construction approval.
11: The site shall have permanent erosion control measures in place as soon as possible after final grading has been
completed and prior to the Final Inspection.
12: Any material spilled onto any street shall be cleaned up immediately.
13: SINCE AT THE TIME OF PERMIT APPLICATION THE LOCATION OF THE SEPTIC TANK SYSTEM WAS UNKNOWN THE
CONTRUCTOR SHALL CONTACT
PUBLIC WORKS PROJECT INSPECTOR, MR GREG VILLANUEVA
AT (206)431 -2442 MINIMUM 24 HOURS PRIOR TO HOUSE DEMO TO ESTABLISH LOCATION OF ONE (1), POSSIBLE TWO (2)
SEWER LINES
doc: Conditions 004 -373 Printed: 03 -09 -2005
. City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
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LEAVING THE HOUSE.
14: 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 City Utilities Inspector.
15: PRIOR TO WATER SERVICE CAPPING AND REMOVAL OF THE WATER METERS CONTRACTOR SHALL VERIFY THAT WATER
SERVICE CAPPING AND
WATER METER REMOVALS ARE FOR THE PROPERTIES THAT MR G. BURNES OWNS. CONTRACTOR SHALL MAKE
ARRANGEMENTS WITH CITY OF
TUKWILA FINANCE DEPARTMENT AT (206) 433 -1870 FOR FINAL WATER METERS READINGS.
* *continued on next page **
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1906 Cit y of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
I hereby certify that I have read these conditions and will comply with them as outlined. 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 work or local laws
regulating construction or the performance of work.
Signature: �--- Date:
Print Name: �7 C C;
doc: Conditions D04 -373 Printed: 03 -09 -2005
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1806
CITY OF TUKWILA
Community Development De 'tment
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
Building Permit 1 7 3
Mechanical Permit No.
Public Works Permit No.
Project No.
or ojjrce use
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 Ass ssor's Tax No.: o r
Site Address: Suite Number: Floor:
Tenant Name: G e_° `- -r- t_t to S New Tenant: ❑ .... Yes []..No
Property Owners Name: ' 5w v.i'�
Mailing Address: t o O a..l_f
CONTACT PERSON
r k D e A-t tt'Z-
City State
Zip
Name: k o 6 t k r UJ6_.1A e_ Day Telephone: l 80 –, ;Z a I 3 7 - 67
Mailing Address: A D 0 ,P— T J O �'6` - �1 k-1) �- t K v F5_6 AF
City State Zip
E -Mail Address: 9.1 to COX " P- Fax Number: —'
GENERAL CONTRACTOR INFORMATION, (Mechanical Contractor information on back page)
Company Name: 7 Q:0 b l'_edt1) xJ..e C� .
Mailing Address: P. 0 r (_) %� ' n 9 a 19 SG
Contact Person: S t � - yA e Q d- -C VI L�
E -Mail Address:
411Q a - 9�19
City State Zip
Day Telephone: ;Z6 6 – 36.5'
Fax Number:
Contractor Registration Number: Expiration Date:
* *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
ARCHITECT OF: RECORD –.All plans must be wet stamped by Architect of Record
Company
Mailing Address:
Contact Person:
E -Mail Address:
City State Zip
Day Telephone:
Fax Number:
ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Record
Company N
Mailing Ad(
Contact Person:
E -Mail Address:
\permits plus \icc changes \permit application (7.2104)
Page l
City
Day Telephone:
Fax Number:
State Zip
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BUILDING PERMIT INFORMATION - 206 -431 -3670
Valuation of Project (contractor's bid price): $ _ �tU
Scope of Work (please provide detailed information):
Dt2 1M. D i s+i o-G � ,00
ExistinE, Alding Valuation: $
5 1 V',.C
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Will there be new rack storage? ❑ ..Yes ❑.. No If "Yes", see Handout No. for requirements.
Provide All Building Areas in Square Footage Below
PLANNING DIVISION:
Single - family building footprint (area of the foundation of all structures, plus any decks over inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling:
*Provide documentation that shows that the principal owner lives ' o of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Com pact: Handicap:
Will there be a change in use? ❑ ....Yes ❑ ..No If" yes ", explain:
FIRE PROTECTIONMAZARDOUS MATERIAL /rhazardous
❑..Sprinklers []..Automatic Fire Alarm ❑..None E] . Other (specify)
Will there be storage or use of flammable, combustibl materials in the building? ❑ .. Yes ❑ ..No
If ' yes ", attach list of materials and storage locations arate 8 -112 x 11 paper indicating quantities and Material Safety Data Sheets.
1pennits pluskicc chsnsm*rntit application (7.2004)
Page 2
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Existin
Interior
Remodel
Addition to
Existing
Structure
New
Type of
Construction
per IBC
Type of
Occupancy per
IBC
I' Floor
2 Floor
3t 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 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling:
*Provide documentation that shows that the principal owner lives ' o of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Com pact: Handicap:
Will there be a change in use? ❑ ....Yes ❑ ..No If" yes ", explain:
FIRE PROTECTIONMAZARDOUS MATERIAL /rhazardous
❑..Sprinklers []..Automatic Fire Alarm ❑..None E] . Other (specify)
Will there be storage or use of flammable, combustibl materials in the building? ❑ .. Yes ❑ ..No
If ' yes ", attach list of materials and storage locations arate 8 -112 x 11 paper indicating quantities and Material Safety Data Sheets.
1pennits pluskicc chsnsm*rntit application (7.2004)
Page 2
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MECHANICAL PERMIT INFOiL,,IATION — 206 - 431 -3670
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:_
E -Mail Address: Fax Number:_
Contractor Registration Number: Expiration Date:
* *An original or notarized copy of current Washington State Contractor License must be presep
Valuation of Project (contractor's bid price) $
Scope of Work (please provide detailed information):
Use: Residential: New .... ❑
Commercial: New .... ❑
Fuel Type Electric .....
❑ Gas ... .❑
Replacement..... ❑
Replacement..... ❑
Other:
Indicate type of mechanical work being installed and the quantit)
Unit Type:
Qty
Unit Type:
Oty I
Unit Type:
Q
Boiler/Corn pressor:
Q
Furnace <IOOK BTU
Air Handling Unit >I0,000
Fire Damper
0 -3 HP /100,000 BTU
CFM
Furnace>100K BTU
Evaporator Cooler
Diffuser
3 -15 HP /500,000 BTU
Floor Furnace
Ventilation Fan Co ccted
Thermostat
15 -30 HP /1,000,000 BTU
to Single Duct
Suspended/Wall /Floor
Ventilation Sy em
Wood /Gas Stove
30 -50 HP /1,750,000 BTU
Mounted Heater
Appliance Vent
Hood and uct
Water Heater
50+ HP /1,750,000 BTU
Repair or Addition to
Inciner or - Domestic
Emergency
Heat/Refrig/Cooling
Generator
System
Air Handling Unit
Incinerator — Comm/Ind
Other Mechanical
<I0,000 CFM
Equipment
PERMIT APPLICATION NOTES. — Applicable to all permits in this application
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.
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 I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNE OR T , 0 ZED / AoGEN " ` f
Signature: " ° y ___ _ _ Date: /D O /
3 Print Nam /� e: D be,.y '� `l� , �� Day Telephone: 3 7 r�
Mailing Address: . D� a- y�
City State Zip
Date Application Accepted: Date Application Expires: I Staff Initials:
%permits plus \icc changes \permit application (7.2004)
Page 4
State Zip
at the time of permit issuance **
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Cit of Tukwila
Igoe
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
RECEIPT
Parcel No.: 3348400784
Address: 5026 S 118 ST TUKW
Suite No:
Applicant: BURNS RESIDENCE
Permit Number:
Status:
Applied Date:
Issue Date:
D04 -373
PENDING
10/06/2004
Payee: GEORGE H. BURNS
TRANSACTION LIST:
Type Method Description Amount
---- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - --
Payment Check 1056 272.50
ACCOUNT ITEM LIST:
Description Account Code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
PW BASE APPLICATION FEE 000/322.100 250.00
PW PERMIT /INSPECTION FEE 000/342.400 11.25
PW PLAN REVIEW 000/345.830 11.25
Total: 272.50
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R04 -01620
Payment Amount:
272.50
Receipt No.:
Initials:
SKS
Payment Date:
12/02/2004 03:30 PM
User ID:
1165
Balance:
$0.00
Payee: GEORGE H. BURNS
TRANSACTION LIST:
Type Method Description Amount
---- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - --
Payment Check 1056 272.50
ACCOUNT ITEM LIST:
Description Account Code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
PW BASE APPLICATION FEE 000/322.100 250.00
PW PERMIT /INSPECTION FEE 000/342.400 11.25
PW PLAN REVIEW 000/345.830 11.25
Total: 272.50
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,�..�:� City of Tukwila
t�os i 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 (206) 431-3670
RECEIPT
Parcel No.: 3348400784
Address: 5026 S 118 ST TUKW
Suite No:
Applicant: BURNS RESIDENCE - DEMO
Permit Number:
Status:
Applied Date:
Issue Date:
D04-373
PENDING
10/06/2004
Receipt No.:
R04-01370
Initials:
SKS
User ID:
1165
Payment Amount:
Payment Date:
Balance:
174.55
10/06/2004 01:59 PM
$0.00
Payee: GEORGE H. BURNS
TRANSACTION LIST:
Type Method Description Amount
---------- -------- --------------------------- ------ - - - - --
Payment Check 1090 174.55
ACCOUNT ITEM LIST:
Description 'Account Code Current Pmts
------------------------------ ---------------- ------------
BUILDING - NONRES 000/322.100 103.06
PLAN CHECK - NONRES 000/345.830 66.99
STATE BUILDING SURCHARGE 000/386.904 4.50
Total: 174.SS
3 10. 97'-
doc: Receipt Printed: 10-06-2004
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INSPECTION RECORD
Retain a copy with permit / .?
INSPECTION NO. PERMIT
CTI /
CITY OF TUKWILA BUILDING DIVISION ✓
6300 Southcenter Blvd., #100, Tukwila, WA 98188 '(206)431 -3670
Projp=
Type of Inspect' n:
Addr ss: C
SL
Date Called: �S
Special Instructions:
C
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Dat W me .
lRequetter:
Phone No:
lJ ; paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
Receipt No.: 7te:
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Approved per applicable codes. Corrections required prior to approval.
J INSPECTION RECORD
l Retain a copy with permit���`�
INSPECTION NO. PE T
CITY OF TUKWILA BUILDING DIVISION `
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Project: J / �7 ( ,A
Type of Inspection;
Address:
Date Called:
Special Instructions:
Date Want V , ,
Request
Phone No: _ _
Approved per applicable codes. Corrections required prior to approval.
M ENTS:
R
Inspector: � Date: — &9:=� 1 3 — 11--05
$58. EINSPECTIO EE REQUIRED. Prior to inspection, fee must be
„? paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
' Receipt No.: Date:
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INSPECTION RECORD
Retain a copy with permit 0 �
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Project:
!.O M S Z° t Gtt°i?C
Type of Inspe do
7 l�l
Address / v a �o ` - 9-
Date Calle
Special Instructions:
Date Wanted: o3 a. .
p.m
00 / / -�y �. f
/ it 1�c f f
.
Requester:
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4 70
Ph ne No:
16/
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COMMENTS:
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16/
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E] $58.00 REINSPECTION FEE REQUIRED. Prior to inspectionjee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
--
Fl Approved per applicable codes. Corrections required prior to approval.
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Project:
Type of Inspection:
pA
Address:
Date Called:
Special Instructions:
Date Wanted: a.m.
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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
Project:
Type of Inspection:
'RtAn -N, A
Address:
-To Vo S' )]B 'S I
Date Called.
Special Instructions:
Date Wanted: a.m.
p.m.
Requester:
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Phone No:
Fl Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
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Inspector: ate:
I Receipt No.: ate: I
$58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Cal.l to sechedule reinspection.
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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
Project
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Type of spection:
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Date Called:
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Inspector: ` Date:
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.: Date:
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN
THIS NOTICE, IT _IS. DUE TO THE QUALITY OFT H DOCUMENT.
Return to:
City Clerk
City of Tukwila
6200 Southcenter Boulevard..
Tukwila, WA 98188
Above this line reserved for Recorder's use
HOLD HARMLESS - SENSITIVE AREA
Grantor /Borrower:
Grantee /Beneficiary: CITY OF TUKWILA, a municipal corporation of King County, .
Washington
Document Reference Number(s):
Section/Township /Range: NE 10 -23 - 7
Assessor's Tax Parcel Number(s): 54840 " 0784'� 334040 -0787
Property Legal Description (abbreviated):
COVENANT AND HOLD HARMLESS AGREEMENT — Sensitive Area
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Return to:
City Clerk
City of Tukwila
6200 Southcenter Boulevard..
Tukwila, WA 98188
Above this line reserved for Recorder's use
HOLD HARMLESS - SENSITIVE AREA
Grantor /Borrower:
Grantee /Beneficiary: CITY OF TUKWILA, a municipal corporation of King County, .
Washington
Document Reference Number(s):
Section/Township /Range: NE 10 -23 - 7
Assessor's Tax Parcel Number(s): 54840 " 0784'� 334040 -0787
Property Legal Description (abbreviated):
COVENANT AND HOLD HARMLESS AGREEMENT — Sensitive Area
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SENSITIVE AREA COVENANT AND HOLD HARMLESS AGREEMENT
This covenant and hold harmless agreement is entered into between
10, rZ4 (�() • � '� , (Individual(s) (Corporation)
( "Grantor), and the City of Tukwila, a Washington municipal
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corporation ( "Grantee ").
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RECITALS
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WHEREAS, Grantor owns and has applied for necessary permits to develop
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certain real property (the "Property ") legally described in Exhibit A, which is attached and
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incorporated by reference.
WHEREAS, a portion of the Property contains sensitive areas of potential geologic
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instability (potential slide areas) as depicted in Exhibit B, which is attached and
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incorporated by reference...
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WHEREAS, as a condition of the issuance of subdivision plat approval, land use
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permits, and /or construction permits for the Property, the Grantee required the Grantor to
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execute and record this "Sensitive Area Covenant and Hold Harmless Agreement" to hold
incurred as a result of an landslide or seismic
the City of Tukwila harmless from all loss y
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activity, or soil disturbance.
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WHEREAS, Grantor assumed this obligation in order to obtain said subdivision
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plat approval, land use permits, and /or construction permits for the Property.
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WHEREAS, the parties agree that this agreement constitutes an arms length,
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bargained -for agreement, which includes a waiver of liability that runs with the land for
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risks created by the proposed use of property because of the shape, composition, location
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or other characteristic unique to the Property sought to be developed.
NOW, THEREFORE, the parties agree as follows:
AGREEMENT
1. In consideration of Grantee issuing subdivision plat approval and /or other
development permits, which constitutes good and valuable consideration, the receipt of
which and the sufficiency of which the Grantor hereby acknowledges, the Grantor shall
defend, indemnify, and hold the Grantee, its officers, officials, employees, agents, and
assigns harmless from any and all claims, injuries, damages, losses, or suits, whether
brought by grantor' or third parties, including all legal costs and reasonable attorney fees,
arising out of or in connection with any injuries or damages to persons or property caused
in whole or in part by any landslide or seismic activity or soil disturbance on the Property,
legally described in Exhibit A, which is attached and incorporated by reference.
COVENANT AND HOLD HARMLESS AGREEMENT — Sensitive Area Page � of _
2. Grantor on its own behalf and on behalf of its heirs, successors and assigns
hereby waives any right to assert any claim against the Grantee, its officers, officials,
employees, agents, and assigns for any loss, or damage to people or property either on or
off the site resulting from any landslide or seismic activity or soil disturbance on said
Property by reason of or arising out of the issuance of the permit(s) by the City for
development on said Property except only for such losses that may directly result from the
sole negligence of the City.
3. Grantor will inform its successors and assigns of said Property that the Property
is in an area of potential geologic instability (potential slide area), of the risks associated
with development thereon, of any conditions or prohibitions on development imposed by
the City of Tukwila, and of any features in this design which will require maintenance or
modification to address anticipated soils changes.
4. Grantor will maintain continuous insurance coverage as required by the permit
authorizing the development.
5. Grantee's inspection or acceptance of any of the Grantor's construction or other
work either during construction or when completed shall not be grounds to avoid any of
these covenants of indemnification.
6. This covenant and hold harmless agreement shall be a covenant running with
the land and the rights and obligations contained herein shall run with and burden the
Property, including each parcel comprising the Property and shall inure to the benefit of
and be binding upon the Grantor and Grantee, their successors and assigns.
COVENANT AND HOLD HARMLESS AGREEMENT — Sensitive Area Page 3 of _
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4 STATE OF WASHINGTON)
)ss.
County of King )
I certify that I know or have satisfactory evidence that AC 6 �� �J (ICJ 0,_,
and
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i are the person(s) who appeared before me, and said individual(s)
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acknowledged thrfd /she /they signed this instrument and acknowledged it to be
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s hi /her /their free voluntary act for the uses and purposes mentioned in this
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instrument.
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Notary Public in and for the State of Washington
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DATED this day of , 20
GRANTEE: CITY OF TUKWILA
Mayor
ATTEST:
City Clerk
STATE OF WASHINGTON )
ss.
County of King )
On this day of , 20 , before me,
the undersigned, a Notary Public in and for the State of Washington, duly
commissioned and sworn, personally appeared
and
known to me to be the
Mayor and City Clerk, respectively, of CITY OF TUKWILA, the municipal
corporation that executed the foregoing instrument, and acknowledged it to be the
free and voluntary act of said municipal corporation, for the uses and purposes
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mentioned in this instrument, and on oath stated that he /she was authorized to
execute said instrument.
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WITNESS my hand and official seal hereto affixed the day and year above written.
print name
NOTARY PUBLIC in and for the
State of Washington, residing at
COVENANT AND HOLD HARMLESS AGREEMENT — Sensitive Area
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EXHIBIT A
LEGAL DESCRIPTION OF PROPERTY
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ION OF SENSITIVE AREAS
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City of Tuk
Department of Community Development Steve Lancaster, Director
Steven M. Mullet, Mayor
1908
November 4, 2004
Mr. Robert W. Wade
10024 South 46` Street
Phoenix, Arizona 85044
RE: CORRECTION LETTER #1
Development Permit Application Number D04 -373
Burns Residence — 5026 South 118` Street
Dear Robert:
This letter is to inform you of corrections that must be addressed before your development permit(s) can be approved.
i All correction requests from each department must be addressed at the same tune and reflected on your drawings. I
! have enclosed comments from the Public Works Department. At this time, the Building, Planning and Fire Departments
i
have no comments.
Public Works Department: Joanna Spencer, at (206) 431 -2440, if you have questions regarding the
attached memo.
i Please address the attached comments in an itemized format with applicable revised plans, specifications, and /or
! other documentation. The City requires that four (4) complete sets of revised plans, specifications and /or other
documentation be resubmitted with the appropriate revision block.
In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany. every resubmittal. I have
enclosed one for your convenience. Corrections /revisions must be made in person and ivill not be accepted throuklh
the mail or by a messenger service.
If you have any questions, please contact me at (206) 433 -7165.
Sincerely,
i
Stefania Spencer
Permit Technician
{! encl
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c: File No. D04 -373
i
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 -431 -3670 * Fax: 206 - 431 -3665
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1908
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City of Tukwila Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
PUBLIC WORKS DEPARTMENT COMMENTS
DATE:
PROJECT:
PERMIT NO:
PLAN REVIEWER:
October 20, 2004
Burns SFR Demo
D04 -372 an (D04 -373
Contact Joanna Spencer at (206) 431 -2440 if you have any questions regarding the
following comments.
) Please show north arrow and scale on your site plan. Label location of S 118' Street and property addresses so the houses can be located in
the field.
2) . Both properties are on septic system. Please show location of existing septic tank for each property. As part of the demo permit, each septic
tank shall be abandoned. Refer to enclosed Public Works Development Bulletin C6 for septic tank abandonment. Please note that a copy of
the documentation from the business that performed pumping of each tank shall be provided to the Public Works Project Inspector, Mr. Greg
Villanueva, at (206)431 -2442.
3) Show location of existing water meter and water service to each house. Water service shall be capped at the main if you are planning to
abandon water service to each lot. If these water service lines will be used again in the near future, they shall be capped at the property line
and at the water meter respectively. If you need assistance in locating the existing water meters, please call Mr. Bryan Still, Tukwila Water
Superintendent, at (206)433 -1863.
4) City Finance Department records indicates that there are unpaid water bills for the subject properties. There is $18.00 owing on 5022 S. 1 18'
St. and $20.98 on 5026 S. I I8' St. Applicant shall contact Mr. Richard Takechi, Tukwila Finance Department, at (206)433 -1870 to pay
these charges.
5) Applicant shall have Mr. G.H. Burns, property owner, execute a "Sensitive Area Covenant and "Hold Harmless Agreement" for both
properties. A portion of subject property contains sensitive access and /or the property is adjacent to sensitive areas of potential geologic
instability. As a condition of the issuance of these permits, the property owner is required to execute and record a "Sensitive Area Covenant"
and "Hold Harmless Agreement" to hold the City of Tukwila harmless from all loss incurred as a result of any landslide, seismic activity, or
soil disturbances.
(P:Laurie Admin /Joanna /Comments D04 -372 & D04 -373)
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
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PLAN REVI B/V/R0 U T1 N G suP
ACTIVITY NUMBER D04 -373
PRD,MT NAM E Burns Demo
DATE 12/10/04
Si TE AD D RES& 5026 S 118 St
Original Plan Submittal _,_Response to Incomplete Letter #
Response to Correction Letter # 1 Revision # After Permit Is Issued
DEPARTMENTS
Building Division ❑ Fire Prevention ❑ Planning Division ❑
Public Work tit Structural F] Permit Coordinator R
�. G / 1, _7
DETG2MINATI0N OFCOMPLUENESS (rues, Thurs.) DUEDATE 12/14/04
Complete 12 Incomplete ❑ Not Applicable ❑
Comments
Fbrmit Center Use Only
I NCOM PLETE LETTER MAI L®: LETTER OF CO PLETEV E SS MAI LIED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials
TU E51TH U RS ROUTI G:
Please Route Structural Review Required ❑ No further Review Required ❑
REVIEWERSINITIALS DATE
APPROVALS OR CORRECTION& DUEDATE 01/11/05
Approved ❑ Approved with Conditions Not Approved (attach comments)[]
Notation:
REVI L3/VHRS IN IMALS DATE
Flrmit Center Use Only
CORREC' IO N LETTER MAILED:
Departments issued corrections Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents/routing dip.doc
2-28-02
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PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D04 -373 DATE: 10 -06 -04
PROJECT NAME: BURNS RESIDENCE - DEMO
SITE ADDRESS: 5026S.118 TH STREET
X Original Plan Submittal
_Response to Incomplete Letter #
Response to Correction Letter #
Revision # afteribefore permit is issued
DEPARTMENTS:
Buildin ivision Fire revention
Public Work L ,(�/� Structural El
I J, DETERMINA N OF COMPLETENESS: (Tues., Thurs.)
Complete E Incomplete ❑
Comments:
Planning Division IM
Permit Coordinator
DUE DATE: 10 -07 -04
Not Applicable ❑
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TOES /THURS 7U Structural TING:
Please Route Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS:
DATE:
APPROVALS OR CORRECTIONS DUE DATE: - 11-04-04
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City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3674
Fax: 206 - 431 -3665
Web site: http : / /www.ci.tukwila.wa.us
Steven M. Mullet, Mayor
Steve Lancaster, Director
1; } :REVISION SUBMITTAL
y
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: 1 Z 1D I O 'f Plan Check/Permit Number: h _ 3 - 7 3
❑ Response to Incomplete Letter #
Response to Correction Letter #
❑ Revision # after Permit is Issued
❑ Revision requested by a City Building Inspector or Plans Examiner
Project Name: 1. &U/(`YLS w -� ,.
Project Address: 502 6 S 11 44,�, S-�
Contact Person: Ob KV" Phone Number: 460 '22 - 376 ? ce it
Summary of Revision: w M w\, 4
rITY OF TI IKWII c
P ERMIT CENT
Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by:
Entered in Permits Plus on I � Nl 0 c l
\applications orms -app Icatlons on Ime\revlslon submittal
Created: 8 -13 -2004
Revised:
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Look Up a Contractor, Electria_�7 or Plumber License Detail Pagel of 3
[S Topic Index � Contact Info Search
Home " Safety Claims Ek Insurance Workplace Rights Trades $ Licensing
Find a Law or Rule Get a Form or Publication
Look Up a Contractor, Electrician or Plumber
General /Specialty Contractor
A business registered as a construction contractor with L81 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.
i License Information
License
COBBLC *033BM
Licensee Name
COBBLESTONE COMPANY, THE
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
1
601758979 Verify Workers Comp Premium
Status
Ind. Ins. Account
Y Id
i
Business Type
CORPORATION
Address 1
PO BOX 77219
Address 2
City
SEATTLE
County
KING
s State
WA
Zip
98177
Phone
2063656595
Status
ACTIVE
t Specialty 1
CONCRETE
e
i Specialty 2
EXCAVATION /GRADING
Effective Date
1/14/1997
Expiration Date
11/10/2005
Suspend Date
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File: 10
DO4 -0373
35mm Drawing
#1
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II _ S O I LINE TABLE
LINE BEARING DISTANCE
O I SO I oo I L I N 71 °03'56 "W 0.16 I N 0 266,. 2
L 2 N 06 58'35 "W 26, 89
TI L 3 N 06° 5B'35 "W 47.47 r.
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LEGEND L 5 N 06 25.00 E
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BASIS OF BEARINGS IS ASSUMED V N 20b 5 '_' S 0 5 - 1 -� S' SgG90 N 0l
INSTRUMENT USED; 6 SECOND SEMI - TOTAL STATION
2
UNADJUSTED TRAVERSE CLOSURE; 1;41,071
FND. I. R. W /CAP =4596 -J Z �NoRF
ALL MONUMENTS TIED DEC. 1991: 0.62'N �� 41 o „ v
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DATED 3/1 8
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DEC 1 0 2004
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