HomeMy WebLinkAboutPermit D05-097 - OLD SAIGON PHO RESTAURANT - WALLSOLD SAIGON PHO
RESTAURANT
977 INDUSTRY DRIVE
D05 -097
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Cit y o Tukwila
Departure: :t of Community Developn :ent
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: ci.wkwila.tiva.us
DEVELOPMENT PERMIT
Parcel No.: 2523049034
Address: 941 INDUSTRY DR TUKW
Suite No:
Permit Number:
Issue Date:
Permit Expires On:
Steven M. Mullet, Mayor
Steve Lancaster, Director
DOS -097
04/01/2005
09/28/2005
Tenant:
Name:
Address:
Owner:
Name:
Address:
Contact Person:
Name:
Address:
OLD SAIGON PHO RESTAURANT
941 INDUSTRY DR, TUKWILA WA
CALWEST INDUSTRIAL PROP
C/O DELOITTE & TOUCHE LLP, 2235 FARADAY AVE #0
DAVID PHAM
971 INDUSTRY DR, TUKWILA WA
Contractor:
Name: OWNER AFFIDAVIT IN FILE
Address: ,
Contractor License No:
Phone:
Phone: 206 - 575 -4678
Phone:
Expiration Date:
DESCRIPTION OF WORK:
TENANT IMPROVEMENT - CONSTRUCT 2 PARTITION WALLS.
Value of Construction: $200.00 Fees Collected: $52.35
Type of Fire Protection: SPRINKLERS /AFA International Building Code Edition: 2003
Type of Construction: Occupancy per IBC: 0008
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:
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Storm Drainage: N
Street Use: N Profit: N Non - Profit: N
Water Main Extension: N Private: Public:
Water Meter: N
doc: IBC-Permit D05-097 Printed: 04-01-2005
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City Tukwila , Steven M. Mullet Ma
y o or v
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone. 206 -431 -3670
Fax: 206- 431 -3665
Web site: cOukwila.wa.us
Permit Number:
Issue Date:
Permit Expires On:
Steve Lancaster, Director
DOS -097
04/01/2005
09/28/2005
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 per It :)es not presume to give authori violate or cancel the provisions of any other state or local laws
regulating constructio or th performance of �ork. I am Ohorized to sign and obtain this development permit.
Signature:
Print Name:
Date: U4 - 01 V
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: IBC - Permit D05 -097 Printed: 04 -01 -2005
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City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
PERMIT CONDITIONS
Parcel No.:
Address:
Suite No:
Tenant:
2523049034
941 INDUSTRY DR TUKW
OLD SAIGON PHO RESTAURANT
Permit Number:
Status:
Applied Date:
Issue Date:
DOS -097
ISSUED
03/25/2005
04/01/2005
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
granter;.
4: Partition walls that are tied to the ceiling and all partitions greater than 6 feet in height shall be laterally braced
to the building structure.
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: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary
sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other
excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of
this requirement.
7: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the Department of
Public Health - Seattle and King County (206/296- 4932).
8: All electrical work shall be inspected and approved under a separate permit issued by the Washington State Department
of Labor and Industries (206/248- 6630).
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.
10: ** *FIRE DEPARTMENT CONDITIONS * **
11: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the
following concerns:
12: Maintain fire extinguisher coverage throughout.
13: Fire extinguishers shall not be obstructed or obscured from view. In rooms or areas in which visual obstruction cannot
be completely avoided, means shall be provided to indicate the locations of the extinguishers. (IFC 906.6)
14: Egress doors shall be readily openable from the egress side without the use of a key or special knowledge or effort.
(IFC 1008.1.8.3 subsection 2.2)
doc: Conditions
D05 -097
Printed: 04 -01 -2005
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City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
15: Dead bolts are not allowed on auxiliary exit doors unless the dead bolt is automatically retracted when the door handle
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is engaged from inside the tenant space. (IFC Chapter 10)
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16: Exit hardware and marking shall meet the requirements of the International Fire Code. (IFC Chapter 10)
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$ 7
17: Maintain sprinkler coverage per N.F.P.A. 13. Addition /relocation of walls, closets or partitions may require relocating
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and /or adding sprinkler heads. (IFC 901.4)
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18: Sprinklers shall be installed under fixed obstructions over 4 feet (1.2 m) wide such as ducts, decks, open grate
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flooring, cutting tables, shelves and overhead doors. (NFPA 13- 8.6.5.3.3)
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19: All new srpinkler sysetms and all modifications to existing sprinkler systems shall have fire department review and
approval of drawings prior to installation or modification. New sprinkler systems and all modifications to sprinkler
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systems involving more than 50 heads shall have the written approval of the W.S.R.B., Factory Mutual, Industrial Risk
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Insurers Kemper or any other representative designated and /or recognized by the City of Tukwila, prior to submittal to
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the Tukwila Fire Prevention Bureau. No sprinkler work shall commence without approved drawings. (City Ordinance #2050)
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20: Contact The Tukwila Fire Prevention Bureau to witness all required inspections and tests. (City Ordinances #2050 and
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#2051)
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21: All electrical work and equipment shall conform strictly to the standards of the National Electrical Code. (NFPA 70)
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22: Required fire resistive construction, including occupancy separations, area separation walls, exterior walls due to
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location on property, fire resistive requirements based on type of construction, draft stop partitions and roof
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coverings shall be maintained as specified in the Building Code and Fire Code and shall be properly repaired, restored
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or replaced when damaged, altered, breached, penetrated, removed or improperly installed. (IFC 703.1)
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23: This review limited to speculative tenant space only - special fire permits may be necessary depending on detailed
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description of intended use.
24: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of
such condition or violation.
25: These plans were reviewed by Inspector 512. If you have any questions, please call Tukwila Fire Prevention Bureau at
(206)575 -4407.
* *continued on next page **
doc: Conditions D05 -097 Printed: 04 -01 -2005
City 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 performance of work.
Signature: Date: v U V
Print Name:
doc: Conditions D05 -097 Printed: 04 -01 -2005
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%1 LA CITY OF TUKWIL`
j Community Development Department
o Public Works Department
" 2 Permit Center
rsoe f 6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
Project No.
use
Building Permit No.
Mechanical Permit No.
Public Works Permit No.
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
Site Address:
I
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King Co Assessor's Tax No.:
�Q.l 1G Suite Number: Floor:
Tenant Name:
�j
New Tenant: ❑ .... Yes .No
Property
Mailing
CONTACT PERSON
Name: T W Day Telephone:
Mailing Address: G7 k � -
City State Zip
E -Mail Address: Fax Number: �L � .d -Q y )
GENERAL CONTRACTOR INFORMATION - (Mechanical Contractor information on back page)
Company N
Mailing Ad(
T -- City State Zip
i Contact Person: Day Telephone:
t
E -Mail Address: Fax Number:
i
1
Contractor Registration Number: Expiration Date:
i * *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
ENGINEER OF RECORD -.All plans. must be wet stamped by Engineer of Record
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
\permits plus \icc changes \permit application (7.2004)
Page 1
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BUILDING PERMIT INFORMAWN - .206 -431 -3670
k Valuation of Project (contractor's bid price) Existing Building Valuation: $
Scope of Work (please provide detailed inform 'on):—
A LES:
Will there be new rack storage? ❑ ..Yes. No If "yes ", see Handout No. for requirements.
x
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 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 for 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: Compact: Handicap:
Will there be a change in use? .... Yes .No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
9 .. Sprinklers 25..Automatic Fire Alarm ❑..None ❑ . Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes
If yes ", attach list ojmaterials and storage locations on a separate 8 -112 x 11 paper indicating quantities and Material Safety Data Sheets.
\permits plus\icc changes \pennit application (7 -2004)
Page 2
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Existing
Interior
Remodel
Addition to
Existing
Structure
New
Type of
Construction
per IBC
Type of
Occupancy per
IBC
1` Floor
4 (q
l
2" Floor
3` Floor
.Floors thru
Basement
Accessory Structure*
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
PLANNING DIVISION:
Single- family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory 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 in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Compact: Handicap:
Will there be a change in use? .... Yes .No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
9 .. Sprinklers 25..Automatic Fire Alarm ❑..None ❑ . Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes
If yes ", attach list ojmaterials and storage locations on a separate 8 -112 x 11 paper indicating quantities and Material Safety Data Sheets.
\permits plus\icc changes \pennit application (7 -2004)
Page 2
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MECHANICAL PERMIT INFORMATION — 206 -431 -3670
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:,
Contractor Registration Number: Expiration ate
* *An original or notarized copy of current Washington State Contractor License must be reset
Valuation of Project (contractor's bid price): $
Scope of Work (please provide detailed inform
State Zip
at the time of permit issuance **
Use: Residential:
Commercial:
Fuel Type Electric
New
.... ❑
New
... ❑
❑
Gas .. ❑
Replacement..... ❑
Replacement..... ❑
Other:
Indicate type of mechanical work being installed and the quant� below:
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Com pressor:
Q
Furnace <100K BTU
Air Handling Unit >I0,00
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 et ted
Thermostat
15 -30 HP /1,000,000 BTU
�16
to Single Duct
Suspended /Wall /Floor
Ventilation S stem
Wood /Gas Stove
30 -50 HP /1,750,000 BTU
Mounted Heater
Appliance Vent
Hood Duct
Water Heater
50+ HP /1,750,000 BTU
Repair or Addition to
Inci rator - 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) o application shall be extended more than once.
I HEREBY CERTI�� T T I HAVE READ AND EXAMfN THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJ�JRY B THE LAWS OF THE STATE 0 WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER OR AU IZED AGE
ignature: Date: 5
Print Name: �2&III -T7�tm Day Telephone / 9A ) ( 515 -)/ ('5
Mailing Address: C1 � I K &-mm \1t� ::D \ 1 — Oil
- tt % — State Ztp `-
Date Application Accepted: Date Application Expires: Staff Initials:
'ZS ` O5� !
\permits plus \icc changes \parmit application (7.2004)
Page 4
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CITY P TUKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Application # 1 5 — Dq - 1
ALTERNATE PLAN SUBMITTAL AUTHORIZATION
FOR LIMITED SCOPE OF WORK
U.B.C. Section 106.3.2 exception
Project name
Address
Description of work
Related reference number
The above project permit applicant, due to the limited . scope of work is authorized to submit reduced plan
requirements describe as noted below.
1. Complete permit application required: ( Note, all application must include; 1) property assessor
number, 2) copy of contractors license or completed owner waiver form. )
Building Mechanical Other -
2. Minimum plan and/or specification requirement:
Site plan —Y— Floor plan Elevations Foundation
Cross sections Roof plan W.S.E.C.'compliance Narrative
Structural calculations ( stamped by Washington State licensed engineer )
Specific required information
3. Other special instructions:
Authorization by,
TBD3 /96 -form 12
Date
_.. . _id 30 days after the date issued. )
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT..
I
1906 �g Cit y of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
RECEIPT
Y
Parcel No.: 2523049034 Permit Number: D05-097
Address: 941 INDUSTRY DR TUKW Status: APPROVED
Suite No: Applied Date: 03/25/2005
Applicant: OLD SAIGON PHO RESTAURANT Issue Date:
Receipt No.: R05 -00465 Payment Amount:
Initials: SKS Payment Date:
User ID: 1165 Balance:
32.35
04/01/2005 03:57 PM
$0.00
Payee: DAVID PHAM
TRANSACTION LIST:
Type Method Description Amount
---- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - --
Payment Cash 32.35
ACCOUNT ITEM LIST:
Description Account Code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
BUILDING - NONRES 000/322.100 27.85
STATE BUILDING SURCHARGE 000/386.904 4.50
Total: 32.35
i
1655 04/04 0 716 TOTAL
doc: Receipt Printed: 04 -01 -2005
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1
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
RECEIPT
Parcel No.: 2523049034 Permit Number: DOS-097
Address: 941 INDUSTRY DR TUKW Status: PENDING
Suite No: Applied Date: 03/25/2005
Applicant: OLD SAIGON PHO RESTAURANT Issue Date:
Receipt No.:
Initials:
User ID:
R05 -00420
BLH
ADMIN
Payment Amount:
Payment Date:
Balance:
20.00
03/25/2005 11:09 AM
$32.35
Payee:
DAVID PHAM
TRANSACTION LIST:
Type - - - - -- Method Description - - - - -- Amount
-- - - - - -- ----------------------------
Payment Cash 20.00
ACCOUNT ITEM LIST:
Description Account Code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
BUILDING - NONRES 000/322.100 1.15
PLAN CHECK - NONRES 000/345.830 18.85
Total: 20.00
14t18 03/25 9716 TOTAL 20.00
doc: Receipt Printed: 03 -25 -2005
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INSPECTION RECORDF F
Retain a copy with permit ' S�
INSPECTION N0. PERM 0631--3670,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (2
Proje t:
Type of Ins eetidn: r,
Ad ress:
41
Ad 1 �
Date Calle : D
Speci I Instructions:
Date Wanted: ;f`
p.m
Requester* .,
Phone No: U
Approved per applicable codes. El Corrections required prior to approval.
to M ENTS:
r
Inspector Date:
$58.0 INSPECTIO FEE 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
INSPECTION NO. P MI
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Project:
jFype of Inspection,:.
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A dress:
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Date Called:
..� �---
Special Instructions:
/ Y!
Date Wanted:
P
Requester:
Phone No:
Receipt No.: Date:
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u paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reirispection.
2- INSPECTION RECORD
] Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
i
-3670
Pr * V j
Type of Inspection:
A ess:
Date Called:
Special# Inst u ction'sF
Date Wanted: a.m.
M.
Requester `
Phone No:
Approved per applicable codes. Corrections required prior to approval.
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Receipt No.: Date: ::1
'—' paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
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INSPECTION RECORD
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INSPECTION NO. PER T
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 0 ). 1-3670
Project: I , o V Type of Inspection: x"pi4q,0 V/
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Address Date Called:
Special Instructions: Date Wanted: a- m.
,41- p.m.
Requester
Phone No.
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I Receipt No.: Dat e:
I
F� $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
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Inspector.
I Receipt No.: Dat e:
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F� $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
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1908
7777
7
City of Tul"ila Steven M. Mullet, Mayor
Fire Department Thomas R Keefe, Fire Chief
TUKWILA FIRE DEPARTMENT
FINAL APPROVAL FORM
7
Permit No. "1
Fire Alarm:
Hood & Duct:
Halon: A
Monitor:
Pre -Fire :
Permits:
Authorized
FINALAPP.FRM
Rev. 2/19/98
Da te '
T.F.D. Form F.P. 85
Headquarters Station: 444 Andover Park East e Tukwila, Washington 98188 9 Phone: 206-575-4404 • Fax: 206-575-44T
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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'PE M' COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D05 -097
DATE: 03 -25 -05
PROJECT NAME: OLD SAIGON PHO RESTAURANT
SITE ADDRESS: 971 INDUSTRY DRIVE
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision #_after /before permit is issued
DEPARTMENTS: -K $It Aw(o ; -30 0 OM 4106
B Nn g Division ® Fire Prevention Planning Division ❑
Public Wor Q Structural ❑ Permit Coordinator
DETERMINATION OF COMPLETENESS (Tues., Thurs.) DUE DATE: 03 -29 -05
Complete []� Incomplete ❑ Not Applicable ❑
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS ROUTING:
Please Route i Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS:
DATE:
APPROVALS OR CORRECTIONS
Approved ❑ Approved roved with Conditions
PP
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
PERMIT COORD COPY
Documents /routing slip.doc
2 -28.02
DUE DATE: 04 -26 -05
Not Approved (attach comments) ❑
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1908
CITY OF TUKWIL4 Permit Center /Building Division:
Community Development Department 206 -431 -3670
Permit Center Public Works Department:
6300 Southcenter Blvd., Suite 100 206- 433 -0179
Tukwila, WA 98188 Planning Division-
206-431-3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
PERMIT NO.: L�� J ?7
STATE OF WASHINGTON)
) ss.
COUNTY OF KING )
[please print]
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states as follows:
I have made application for a building permit from the City of Tukwila, Washington.
2. 1 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. 1 understand that prior to issuance of a building 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, 1 consider the work authorized
under this building permit to be exempt under No. � , and will therefore not be performed by a registered
contractor.
understand that I may be waiving certain rights that I might have under state law in any dec Ito engage an
unregistered contractor to perform construction work.
APPLI
Signed and sworn to before me this
1-57 day of A )21/ / , 20 0 5 .
�r G�... h
'S P �g$ioN�C.00�'lop
N;A p UB L%G i
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OF WAS�\�
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NOTARY PUBLIC in and for thEgState of Washington,
Residing at KkoG , County.
Name as commissioned: A lice A DCacV
My commission expires: — 6 — /6 - 09
\applications \8 -2004 affidavit in lieu of contractor registration
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18.27.090 Exemptions. This chapter shall not apply to:
1.
2. An authorized representative of the United States
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;
3. Officers of the court when they are acting within
the scope of their office;
4. Public utilities operating under the regulations of
the utilities and transportation commission in
construction, maintenance, or development work
incidental to their own business;
contracts of amounts less than $500.00 for the
purpose of the 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 is
a contractor, or that he is qualified to engage in
the business of contractor;
11. 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 then any of the above work is performed
by a registered contractor;
5. 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;
6. The sale or installation of any finished products,
materials, or articles of merchandise which are not
actually fabricated into . and do not become a
permanent fixed part of the structure;
7. Any construction, alteration, improvement or
repair of personal property, except this chapter
shall apply to all mobile, manufactured housing. A
mobile /manufactured home may be installed, set
up, or repaired by the registered or legal owner,
by a contractor licensed under this chapter, or by
a mobile /manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW;
8. 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;
9. 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;
10. Any work or operation on one undertaking or
project by one or more contractors, the aggregate
contract price of which for labor and materials and
all other items is less than $500.00, such work, or
operations being considered as of a casual, minor,
or inconsequential nature. The exemption
prescribed in this subsection does not apply in all
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
\applications \8 -2004 affidavit in lieu of contractor registration
12. An owner who contracts for a project with a
registered owner;
13. Any person working on his own property, whether
occupied by him or not, and any person working
on his residence, whether owned by him or not but
his exemption shall not apply to any person
otherwise covered by this chapter who constructs
an improvement on his own property with the
intention and for the purpose of selling the
improved property;
14. Owners of commercial properties who use their
own employees to do maintenance, repair, and
alteration work in or upon their own properties;
15. A licensed architect or civil or professional
engineer acting solely in his professional capacity,
an electrician licensed under the laws of the state
of Washington, or a plumber licensed under the
laws 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 licensee is operating
within the scope of his license;
16. Any person who engages in the activities herein
regulated as an employee of a registered
contractor with wages as his sole compensation;
17. Contractors on highway projects who have been
prequalified as required by chapter 13 of the Laws
of 1961, RCW 47.28:070 with the department of
transportation 'to perform highway construction,
reconstruction, or.maintenance work.
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SEPARATE PERMIT
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