HomeMy WebLinkAboutPermit M10-013 - WHITLEY ADDITIONWHITLEY ADDITION
11711 40 AV S
M10 -013
Parcel No.: 7340600247
Address:
Suite No:
City* Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Inspection Request Line: 206- 431 -2451
Web site: http: / /www.ci.tukwila.wa.us
11711 40 AV S TUKW
MECHANICAL PERMIT
Permit Number:
Issue Date:
Permit Expires On:
M10 -013
02/24/2010
08/23/2010
Tenant:
Name:
Address:
Owner:
Name:
Address:
WHITLEY ADDITION
11711 40 AV S , TUKWILA WA
WHITLEY D KIRK
11711 40TH AVE S , SEATTLE WA
Contact Person:
Name: MICHAEL L TRACY
Address: PMB #220 1402 LK TAPPS PY E #104 , AUBURN WA
Contractor:
Name: OWNER AFFIDAVIT - KIRK WHITLEY
Address:
Contractor License No:
Phone:
Phone: 253 970 -5008
Phone:
Expiration Date:
DESCRIPTION OF WORK:
INSTALLATION OF FAN /LIGHT /HEAT FIXTURE
Value of Mechanical: $75.00
Type of Fire Protection: NONE
Fees Collected: $116.25
International Mechanical Code Edition: 2006
EOUIPMENT TYPE AND OUANTITY
Furnace: <100K BTU
>100K BTU
Floor Furnace
Suspended/Wall/Floor Mounted Heater
Appliance Vent
Repair or Addition to Heat /Refrig /Cooling System....
Air Handling Unit <10,000 CFM
>10,000 CFM
Evaporator Cooler
Ventilation Fan connected to single duct
Ventilation System
Hood and Duct
Incinerator: Domestic
CommerciaUIndustrial
0
0
0
0
0
0
0
0
0
1
0
0
0
0
Boiler Compressor:
0 -3 HP /100,000 BTU 0
3 -15 HP /500,000 BTU 0
15 -30 HP /1,000,000 BTU.. 0
30 -50 HP /1,750,000 BTU.. 0
50+ HP /1,750,000 BTU 0
Fire Damper 0
Diffuser 0
Thermostat 0
Wood/Gas Stove 0
Water Heater 0
Emergency Generator 0
Other Mechanical Equipment0
* *continued on next page **
doc: IMC -10/06
M10 -013 Printed: 02 -24 -2010
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Inspection Request Line: 206 - 431 -2451
Web site: http: / /www.ci.tukwila.wa.us
Permit Number: M10 -013
Issue Date: 02/24/2010
Permit Expires On: 08/23/2010
Permit Center Authorized Signature:
LYALL-0.
Dater ` ^tO
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 • oes not presume to give authority to violate or cancel the provisions of any other state or local laws regulating
construction or the • erfo e o ork. I am authorized to sign and obtain this mechanical permit.
Signature:
Print Name:
Date: CJ �` O-/
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.
doc: IMC -10/06
M10-013 Printed: 02 -24 -2010
Parcel No.: 7340600247
Address:
Suite No:
Tenant:
• •
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
11711 40 AV S TUKW
WHITLEY ADDITION
PERMIT CONDITIONS
Permit Number:
Status:
Applied Date:
Issue Date:
M10 -013
ISSUED
01/27/2010
02/24/2010
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
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
granted.
4: Insulating materials, where exposed as installed in buildings of any type of construction, shall have a flame spread
index of not more than 25 and a smoke development index of not more than 450. Where facings are installed in concealed
spaces in buildings of Type III, IV, or V construction, the flame spread and smoke - developed limitations do not apply
to facings, that are installed behind and in substantial contact with the unexposed surface of the ceiling, wall or
floor finish.
5: All construction shall be done in conformance with the approved plans and the requirements of the International
Building Code or International Residential Code, International Mechanical Code, Washington State Energy Code.
6: Manufacturers installation instructions shall be available on the job site at the time of inspection.
7: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy can be
obtained at City Hall in the office of the City Clerk.
8: Ventilation is required for all new rooms and spaces of new or existing buildings and shall be in conformance with the
International Building Code and the Washington State Ventilation and Indoor Air Quality Code.
9: 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.
* *continued on next page **
doc: Cond -10/06
M10 -013 Printed: 02 -24 -2010
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and
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
construction or the performance of work.
Signature:
Print Name: / " < �C Vim— / ?2 -
ordinances governing
or local laws regulating
doc: Cond -10/06 M10 -013
Printed: 02 -24 -2010
CITY OF TUKWII
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
hup://wwweitukwila.wa.us
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 Address: 1 (1 1 1 14,044 140.e. 5t3vlfk
Tenant Name:
King Co Assessor's Tax No.: —I l dS Z b 3 3
Suite Number: Floor:
New Tenant: ❑ Yes ❑ .. No
Property Owners Name: - in & A 12.v vOi., 4-Ley
yea l
Mailing Address:
Lir
City
State
G7.f9°4y'.
Zip
CONTACT PERSON - who do we contact' when your permit is,ready.to be issued
Name: 1114 I C I♦ 14 G t_ T✓1-t't C t/ Day Telephone: ?J' 310- 500E3
Mailing Address: P Pne# ZZV 14Q Z LK Tip PP PANN e* 104 A1efAiu WA- ego, 7 .
City
/�
State Zip
E -Mail Address: (k) 1 LA--I D 2.4 ? eovoktci ST' . &I€1 Fax Number: 2Cf — (344 " 7109 2.
GENERAL CONTRACTOR INFORMATION,-,
.(Contractor Information for Mechanical (pg.4)'for Plu mbing and Gas Piping (pg 5))
Company Name:
Mailing Address:
City
Contact Person: . Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number: Expiration Date:
State
Zip
ARCHITECT
T:OF�RECORD - .�hplans.must be,wetstamped by Architect of:Record ..
Company Name: -
Mailing Address:
Contact Person:
E -Mail Address:
City
Day Telephone:
FaxNumber:
State
Zip
ENGINEER OF RECORD — Alt plaits must be wet stamped by-Enginerol'Recor
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
H:\ Applications \Forms- Applications On Line\2009 Applications \1 -2009 - Permit Application.doc
Revised: 1 -2009
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City
Day Telephone:
Fax Number:
Page 1 of 6
State
Zip
BUILDING PERMIT INFORM•ION- 206431 °3670.
oto
Valuation of Project (contractor's bid price): $ �et... o Existing Building Valuation: $
Scope of Work (please provide detailed information): 0 mia%11Uu, er' A. le De sr
\ °a l 1`7 c • - - bc�,J .2 t (1
Pan1JC1(L
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 :.f
Existing
Structure' �:
a
,; ^ t
New .
-T
,.._ pe of;
, y
Construction per,-
' ` IBC -...
� Type of
Occupancy,pe
. ' IBC, '
IS` Floor
"
aelf3
\il r��
V,
21'd Floor. '
3rdFloor
Floors thruuT
__
Basement m
Accessory Structure*
■ : Vii:; '•:o.. ,' G
Attached Qarage ;,
firn,v
`Detached: Garage:
''Attach'e'd Carport`:
Detached;Carport
•;Covered"Deck.
Uncovered Deck C
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 dwelling, provide the following:
Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling:
*Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard:
Will there be a change in use?
❑ Yes
Compact: Handicap:
❑ No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑.......Sprinklers ❑ Automatic Fire Alarm None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No
If 'yes', attach list of materials and storage locations on a separate 8-1/2" x I1 " paper including quantities and Material Safety Data Sheets.
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.
H:\Applications\Forms- Applications On Line\2009 Applications \1.2009 - Permit Application.doc
Revised: t -2009
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Page 2 of 6
A
MECH NICAL PERMIT INFOTION - -206= 431- 3670'
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number: Expiration Date:
Valuation of Mechanical work (contractor's bid price): $
Scope of Work (please provide detailed information):
jr-4/0/k1<r:, fkit-r
A
Use: Residential: New .... ❑ Replacement .... ❑
Commercial: New .... ❑ Replacement .... ❑
Fuel Type: Electric ❑ Gas .... ❑ Other:
Indicate type of mechanical work being installed and the quantity below:
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Compressor:
Qty
Furnace <100K BTU
Air Handling Unit >10,000
CFM
Fire Damper
0 -3 HP /100,000 BTU
Furnace >100K BTU
Evaporator Cooler
Diffuser
3 -15 HP /500,000 BTU
Floor Furnace
Ventilation Fan Connected
to Single Duct
Thermostat
15 -30 HP /1,000,000 BTU
Suspended/Wall/Floor
Mounted Heater
Ventilation System
Wood/Gas Stove
30 -50 HP /1,750,000 BTU
Appliance Vent
Hood and Duct
Emergency
Generator
50+ HP /1,750,000 BTU
Repair or Addition to
Heat/Refrig /Cooling
System
Incinerator - Domestic
Other Mechanical
Equipment
Air Handling Unit
<10,000 CFM
Incinerator — Comm /Ind
H:\Applications\Fomis- Applications On tine \2009-Applicatioas\I -2009 - Permit Application:doe
Revised: 1 -2009
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Page 4 of 6
PUBLIC' WORKS PERMIT I?
ATION = 206 -433 -0179
Scope of Work (please provide detailed information):
Call before you Dig: 1- 800 - 424 -5555
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ ...Tukwila
❑ ...Water Availability Provide
Sewer District
❑ ...Tukwila
❑ ...Sewer Use Certificate
Septic System:
❑ On -site Septic System — For on -site •;.tic system, provide 2 copies of a current septic deli: . /approved by King County Health Department.
❑... Water District #125
❑.
❑ .. Highline
.. Valley View ❑ .. Renton
Sewer Availability Provided
❑ .. Renton
0 the
Submitted with Application (mark boxes `; ich apply):
❑ ...Civil Plans (Maximum Paper Size — 22 \;: 34 ")
❑ ...Technical Information Report (Storm Drains :e)
❑ ...Bond ❑ .. Insurance ❑ ••
Proposed Activities (mark boxes that apply):
❑ ...Right -of -way Use - Nonprofit for less than 72 hours
❑ ...Right -of -way Use - No Disturbance
❑ ...Construction/Excavation/Fill - Right -of -way ❑
Non Right -of -way ❑
❑ .. Geotechnic• %' eport
asement(s) ❑ .. Mainten 'e Agreement(s)
❑ ...Total Cut
❑ ...Total Fill
cubic yards
cubic yards
❑...Sanitary Side Sewer
❑ ...Cap or Remove Utilities
❑...Frontage Improvements
❑ ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Wate
❑ ...Permanent Water Meter Size...
❑ ,..Temporary Water Meter Size ..
❑ ...Water Only Meter Size
❑ ...Sewer Main Extension ,' ublic
❑ ...Water Main Extension .Public
FINANCE INFORMATION
Fire Line Size at Property
❑...Water '■ ...Sewer
Monthly Service Billi
Name:
❑.
❑.
❑.
❑ ... Traffic Impact Analysis
❑...Hold Harmless — (SAO)
❑ ...Hold Harmless — (ROW)
❑ .;; lght -of -way Use - Profit for less than 72 hours
Right -of -way Use — Potential Disturbance
❑ .. Work in Flood Zone
.. Storm Drainage
. Aban ' : n Septic T
. Cu ,.Cut
. P ement Cut
ooped Fire Line
❑❑
WO#
WO#
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
WO # ❑...De• :�t Water Meter Size
Private ❑
Private ❑
Number of Public Fire Hydrant(s)
❑...Sewage Treatment
Day Telephone:
Mailing Address:
Water Meter R fund/Billing:
Name:
Mailing Address:
City
State
Zip
Day Telephone:
City
State
Zip
H: Apptications\Forms- Applications On Line \2009 Applications \1-2009 Permit Apptication.doc
Revised: 1.2009
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Page 3 of 6
PERMIT APPLICATION NO.T— Applicable to. all 'permits „inrthits;a cation
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.
Building and Mechanical Permit
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).
Plumbing Permit
The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested
in writing and justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing Code (current edition).
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 OWN
Signature:
Print Name:
• OR AU ZED AGENT:
TfrAl,N(
Date: 01, V 2'11
Day Telephone:
Mailing Address:
Zip
City
State
Date Application Accepted:
i � LA - �V
Date Application Expires:
V I IV' 11 J
Staff Initials:
H:\Applications\Forms- Applications On Line\2009 Applications \1 -2009 - Permit Application.doc
Revised: 1-2009
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Page 6 of 6
PLUMBING. AND GAS PIPIN ERMIT INFORMATION 226 -43' .
PLUMBING AND GAS PIPING CONTRACTOR INFORMATION
Company Name: —P•
Mailing Address:
City state Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number:
Expiration Date:
Valuation of Project (cont tor's bid price): $ 0-ND
Scope of Work (please provi detailed information):
Building Use (per Int'1 Building Code):
Occupancy (per Int'l Building Code):
Utility Purveyor: Water:
Indicate type of plumbing fixtures and /or gas piping ou'I�,ts being in led and the quantity below:
Fixture Type:
Qty
Fixture Type:
1 ty
Mixture Type:
Qty
Fixture Type: _
Qty
Bathtub or combination
bath/shower
Bidet
, ;1
f'
Clothes washer, domestic
Dental unit, cuspidor
Dishwasher, domestic,
with independent drain
Drinking fountain or
water cooler (per head) :• '
-
Food -waste grinder,
_. mmercial
Floor Drain
Shower, single head trap
Lavatory ;�
i h fountain
Receptor, indirect waste
Sinks
1
Urinals p'
i .
Wate ac, loset
\
1
Building sewer and each
trailer park sewer
Rain water system — per
drain (inside building)
Water heater ; Is d/or vent
Industrial `x,„ to treatment
interceptor, i"t luding trap
and vent, exce or kitchen
type grease intercitors
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Repast' or alteration of
was' piping and/or water
t ':tment equipment
Repair or alteration `.,
drainage or vent pipin
Medical gas piping
system serving 1 -5
inlets /outlets for a
specific gas
Each additional medical
gas inlets/outlets greater
than 5
F Backflow protective
device other than
atmospheric -type vacuum
breakers 2 inch (51 mm)
diameter or smaller
Backflow protective device t.
other than atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
`�
Each lawn sprinkler
system on any one meter
including backflow
protection devices
Atmospheric -type vacuu t°
breakers not included i ; -'
lawn sprinkler backfl./
protections (1 -5)
Atmospheric -type
vacuum breakers not
included in lawn
sprinkler backflow
protections over 5
Gas piping outlets
H: Applications\Fortns- Applications On- Line\2009 Applications \1-2009 Permit Application, doc
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Page 5 of 6
Cif of Tukwila.
•
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: //www. ci. tukw ila. wa. us
SET RECEIPT
RECEIPT NO: R10 -00134
Initials: JEM
Payment Date: 01/27/2010
User ID: 1165 Total Payment: 183.00
Payee: MICHAEL L TRACY
SET ID: S000001337 SET NAME: Tmp set/Initialized Activities
SET TRANSACTIONS:
Set Member
D10 -024
M10 -013
PG10 -010
TOTAL:
Amount
132.19
23.25
27.56
132.19
TRANSACTION LIST:
Type Method Description Amount
Payment Cash 183.00
TOTAL: 183.00
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
BUILDING - RES
PLAN CHECK - RES
000.322.100 .63
000.345.830 182.37
TOTAL: 183.00
PAYMENr
RECEIVED
10i'F;501.• -1 000'..-5 02/24/20)0 001 int
'r Plu_ Fu.it_ MIKE
City off- Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
Parcel No.: 7340600247
Address: 11711 40 AV S TUKW
Suite No:
Applicant: WHITLEY ADDITION
RECEIPT
Permit Number: M10-013
Status: APPROVED
Applied Date: 01/27/2010
Issue Date:
Receipt No.: R10 -00318
Payment Amount: $93.00
Initials: WER Payment Date: 02/24/2010 11:04 AM
User ID: 1655 Balance: $0.00
Payee: MIKE TRACY
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Cash
Authorization No.
ACCOUNT ITEM LIST:
Description
93.00
Account Code Current Pmts
MECHANICAL - RES
000.322.102.00.00 93.00
Total: $93.00
doc: Receiot -06 Printed: 02 -24 -2010
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
(206)431 -3670
Project:
tk) , +L1 4a(;4 'aa
Type of Inspection:
r; n1 .4 r
Address:
L(71) 1-4 0 AU
S
Date Called:
Special Instructions:
Date Wanted:
— (0 — It
a.m.
Cm-
Requester:
Phone No:
253-370 -Savo
ExApproved per applicable codes. El Corrections required prior to approval.
COMMENTS:
29 rw., 4 i A A,
died
F/r.00 REINSPECT! FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Date
-/5
Receipt No.:
Date:
INSPECTION RECORD
Retain a copy with permit
EMIT :10. . I�
CITY OF TUKWILA BUILDING DIVISION P-. �
/6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3 f 0
INSPECTION NO I NO.
A n^ +X< 1r
Type o Inspection: �� Ae-eli
Add6Vcs
Addressn: /
lI,,, 4)
,�
_S-
Date Called:
Special Instructions:
Date Wanted:3 _ 2-4 rr a.m.
Requester:
Phone No:
2.S3 -37L -S60S
kijApproved per applicable codes. Corrections required prior to approval.
COMMENTS:
D te:
REINSPECTION EE REQUIRED. Prior to inspection, fee must be
t 6300 Southcente Blvd., Suite 100. Call to schedule reinspection.
R _ - pt No.:
Date:
nom,.. a.a
INSPECTION RECORD
Retain a copy with permit
IN PECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION 4-
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
tAfo, a/3
Projec :)/ i � AA a ,I,
4L r 3�
Type of ,lnspel i, e
K o,,, y (,� cli
Address: yt.
r1ii1 -4 A
-5-
Date Called: f
Special Instructions:
Date Wanted:
3 —2-3 'I J p.m.
Requester:
Phone No'
2s3 - 3x70 -5oo'
0 Approved per applicable codes.
COMMENTS:
Corrections required prior to approval.
Acei. e i-04A 7 (A.
n • ector:
U
V
Date:
23
El $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -3670 FAX (206) 431 -3665
E -mail: tukplanc ci.tukwila.wa.us
Permit Center /Building Division
206 431 -3670
Public Works Department
206 433 -0179
Planning Division
206 431 -3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
) ss.
COUNTY OF KING )
6//l' A)1-07-6(71
[please print name]
, states as follows:
PERMIT NO: 1) I, 01 0 .a Ll
1. I have made application for a permit from the City of Tukwila, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington, a copy of which is printed on the reverse side of this Affidavit. I have
read or am familiar with RCW 18.27.090.
3. I understand that prior to issuance of a permit for work which is to be done by any contractor, the
City of Tukwila must verify either that the contractor is registered by the State of Washington, or that
one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,
I consider the work authorized under this permit to be exempt under number . and will therefore
not be performed by a registered contractor.
5. I understand that the licensing provision of RCW 19.28.161 through 19.28.271 shall not apply to
persons making electrical installations on their own property or to regularly employed employees
working on the premises of their employer. The proposed electrical work is not for the construction
of a new building for rent, sale or lease.
I understand that I may be waiving certain rights that I might otherwise have under state law in any decision
to engage an unregistered contractor to perform construction work.
JONATHAN M. FORD
NOTARY PUBLIC
STATE OF WASHINGTON
MY COMMISSION EXPIRES
03 -23 -13
/(fe016
Owner /Owner's Agent*
Signed and sworn to before me this
Z 1 day of -3 A-K, v kft , 20 i n .
NQ`i`ARY PUBLI nd for the State of Washington
'TV County
Residing at
Name as commissioned:
My commission expires:
3 /2.3f/ 3
18.27.090 Exemptions, The regiion provisions of this chapter do not apply
1. An authorized representative of the United States by a registered contractor;
government, the state of Washington, or any incorporated
city, town, county, township, irrigation district, reclamation
district, or other municipal or political corporation or
subdivision of this state;
z. Officers of a court when they are acting within the scope
of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their own
business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground mine
or mineral deposit when performed by an owner or lessee;
5. The sale of any finished products, materials, or articles of
merchandise that are not fabricated into and do not become
a part of a structure under the common law of fixtures;
6. Any construction, alteration, improvement, or repair of
personal property performed by the registered or legal
owner, or by a mobile /manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW who shall
warranty service and repairs under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site or
reservation under the legal jurisdiction of the federal
government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them into, or consuming
them in the performance of, the work of the contractor;
9. Any work or operation on one undertaking or project by
one or more contracts, the aggregate contract price of
which for labor and materials and all other items is less
than five hundred dollars, such work or operations being
considered as of a casual, minor, or inconsequential nature.
The exemption prescribed in this subsection does not apply
in any instance wherein the work or construction is only a
part of a larger or major operation, whether undertaken by
the same or a different contractor, or in which a division of
the operation is made into contracts of amounts less than
five hundred dollars for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in this
subsection does not apply to a person who advertises or
puts out any sign or card or other device which might
indicate to the public that he or she is a contractor, or that
he or she is qualified to engage in the business of
contractor;
io. Any construction or operation incidental to the
construction and repair of irrigation and drainage ditches
of regularly constituted irrigation districts or reclamation
districts; or to farming, dairying, agriculture, viticulture,
horticulture, or stock or poultry raising; or to clearing or
other work upon land in rural districts for fire prevention
purposes; except when any of the above work is performed
11. An owner* who contracts for a project with a registered
contractor, except that this exemption shall not deprive the
owner of the protections of this chapter against registered
and unregistered contractors. The exemption prescribed in
this subsection does not apply to a person who performs
the activities of a contractor for the purpose of leasing or
selling improved property he or she has owned for less than
twelve months;
12.* Any person working on his or her own property,
whether occupied by him or her or not, and any person
working on his or her personal residence, whether owned
by him or her or not but this exemption shall not apply to
any person who performs the activities of a contractor on
his or her own property for the purpose of selling,
demolishing, or leasing the property;
13. An owner* who performs maintenance, repair, and
alteration work in or upon his or her own properties, or
who uses his or her own employees to do such work;
14. A licensed architect or civil or professional engineer
acting solely in his or her professional capacity, an
electrician certified under the laws of the state of
Washington, or a plumber certified under the laws of the
state of Washington or licensed by a political subdivision of
the state of Washington while operating within the
boundaries of such political subdivision. The exemption
provided in this subsection is applicable only when the
person certified is operating within the scope of his or her
certification;
15. Any person who engages in the activities herein
regulated as an employee of a registered contractor with
wages as his or her sole compensation or as an employee
with wages as his or her sole compensation;
16. Contractors on highway projects who have been
prequalified as required by RCW 47.28.070, with the
department of transportation to perform highway
construction, reconstruction, or maintenance work;
17. A mobile /manufactured home dealer or manufacturer
who subcontracts the installation, set -up, or repair work to
actively registered contractors. This exemption only applies
to the installation, set -up, or repair of the
mobile /manufactured homes that were manufactured or
sold by the mobile /manufactured home dealer or
manufacturer;
18. An entity who holds a valid electrical contractor's
license under chapter 19.28 RCW that employs a certified
journeyman electrician, a certified residential specialty
electrician, or an electrical trainee meeting the
requirements of chapter 19.28 RCW to perform plumbing
work that is incidentally, directly, and immediately
appropriate to the like -in -kind replacement of a household
appliance or other small household utilization equipment
that requires limited electric power and limited waste
and /or water connections. An electrical trainee must be
supervised by a certified electrician while performing
plumbing work.
• Per Washington State Department of Labor and Industries, lessee has been
Interpreted to be equivalent to owner for the purpose of these exemptions.