HomeMy WebLinkAboutPermit B96-0157 - PALMER RESIDENCE - SINGLE FAMILY RESIDENCE DEMOLITIONThis record contains information which is exempt from public disclosure
pursuant to the Washington State Public Records Act, Chapter 42.56 RCW
as identified on the Digital Records Exemption Log shown below.
B96 -0157
Palmer, Fred
4243 South 146th Street
RECORDS DIGITAL D- ) EXEMPTIO
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
Page # tode Exemption = Brief Explanatory DeSctiptiop �t�tutel ule
The Privacy Act of 1974 evinces Congress' intent that
Personal Information —
social security numbers are a private concern. As
such, individuals' social security numbers are
Social Security Numbers
redacted to protect those individuals' privacy pursuant
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
to 5 U.S.C. sec. 552(a), and are also exempt from
552(a); RCW
552(a); RCW
disclosure under section 42.56.070(1) of the
42.56.070(1)
42.56.070(1)
Washington State Public Records Act, which exempts
under the PRA records or information exempt or
prohibited from disclosure under any other statute.
Redactions contain Credit card numbers, debit card
Personal Information —
numbers, electronic check numbers, credit expiration
5
DR2
Financial Information —
dates, or bank or other financial account numbers,
RCW
RCW 42.56.230(4 5)
which are exempt from disclosure pursuant to RCW
42.56.230(5)
42.56.230(5), except when disclosure is expressly
required by or governed by other law.
City of Tukwila C
Community Development / Public Works • 6300 SouthcenterBoulevard, Suite 100 • Tukwila, Washington 98188
Permit No: B96 -0157
Type: B -DEMO
Category: RES
Address: 4243 S 146 ST
Location:
Parcel #: 004000 -0720
Wetlands:
Water Dist: 125
Units: 001
Contractor License No:HIGHLTS153C7
Permit Description:
PeTniit Center Authorized Signature
Pr i n t Name /AO 1 1 ) .. p ...
DEMOLITION PERMIT
Slopes: N
Sewer Dist: VAL VUE
Buildings: 001
TENANT PALMER FRED
4243 S 146 ST, TUKWILA, WA 98168
OWNER PALMER FRED
13916 42ND AVE S, TUKWILA WA 98168
CONTRACTOR HIGHLINE TRACTOR SERVICE
17102 MILITARY RD S', SEATTLE, WA 98188
CONTACT FRED PALMER
1391.6 42 AV S, TUKWILA, WA 98168
� q C° D
Title:_
- > (206) 431 -3670
Status: ISSUED
Issued: 06/12/1996
Expires: 12/09/1996
Phone: 206 244 -6247
Phone: 206 243 -4328
* * * * * * ** ** * * * ** * * * * ** * * * ** k***********• k** * ** * * * * **•k** ***** *** * * * ** **** *** **
Valuation: 875.00
DEMOLISH EXISTING SINGLE - FAMILY RESIDENCE.
Demolition Fee: 42.00 Investigation Fee: .00
Cash Bond: 2,000.00 Total Permit Fee: 4,046.50
Bond Number: CHECK #7585
*•k ** * * 'k * * * * * * * * * * * * * * * * * * ** * * * ** * * * * * * * * *•k* k * *•k *•k *•k * * * * ** * * ** k ** k k * * * * * **
I hereby certify that I have read and examined this permit and know the
same to'be true and correct. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate
or cancel 'the, provisions of any other state or local laws regulating
construction. or the performance of work. I am authorized to sign for an
obtain this •building permit.
Signature �t.�.�_ j(_141V L.:
Date: /..) -96'
This permit shall become null and void if the work is not commenced within
180 days from the date of issuance, or if the work is suspended or
abandoned for a period of 180 days from the last inspection.
ALL PERMITS FOR DEMOLITION PROJECTS REQUIRE CONSTRUCTION, DEMOLITION AND
LANDCLEARING WASTE MATERIAL FROM THESE PROJECTS TO BE RECYCLED AT A KING
COUNTY LICENSED OR APPROVED FACILITY, OR TAKEN TO REGIONAL DISPOSAL
FACILITIES.
Addrelf.s: 4243 S 146 ST Permit No: 896-0157
Suite:
Tenant: PALMER FRED Status: ISSUED
lype: 0•DEMO Applied: 06/04/1996
Parcel 4: 004000-0720 Issued: 06/12:1996
440,444,44 4444****44444441 4 4444
i
Permit Conditions:
1. TemOorary erosion control measures shal/ be implemented as
the first order of bu.ine to. pr.etant. edimentation off-
site or into existing.
2. DEMOLITION ACTIWV:SHALL LIMITEDT0 10 OF 1111:.
1
BUILDING EXTERIORJO'CONTROLJHE EXTENT OF CLEAR1UG/LAND 1
ALTERING. i
3. APPLICANT SHALL oppousEidER. ..0ERMI1 fROM-VALVUE SEWER
DISTRICT 042-3236F CAPPING .THE EXISTING''SEWEP LINE. i
4 APPLICANTSHALt OBOIN PJJGET tiour40 AIR .POLLUTION ,CONTROL
,r ,,I, ; , , ,: • '
AGENCY cp:..ARI: - FOR, DEMOLITIOT. CONTACT :.MR. TOM
„._ .
Hurrsom ,J. . , i
' .
5. No cOOpe13, wiif be madeto• the plans unless approved by'the !
i
ArchA.OcV or Enaineer:and the Tul;;Wila Building .0ivis.ion.'
6. All'AiermitS., inSpection records and approved planS.shall'jle 1
i
avapab)e a,t the job ':site prjor to._ start of
_
str,iittion These dOOMentS',are to and avail-.;
ati,10. until insPeot,lowapproVal 1t granted.
.i.
Al;Tdoonstruction in„ with apOrotied
plans „andreuirements:oftbe:OrafprM'Buttding Code(1954
Ed4tioni as amended.
8 . VO'JldiW.of PerIlli- 1 1...:.:!.ance 6 f a permit or approvof
ptans, Specificat.AO0S,, Shall not pe
serNed be ',a per Mft or'apapprovaT:of. any violation
t
ofi of the601ding or of any-*
ot.iiordi of the jurisdic,tibn ,p _t17 to
giveauthor4y'rto violate or cancel the Rrov,i.S,ions Of 'this::..' i•
ood6, valid. •
. . . t
. ,
CITY OF TUKWILA
k *:k *:1• * *:t * *4 *. '4•h k*
:ITV OF TUKW) :LA.
kx *•4k *•k *k* ** ** *k4c
TRANSMIT Number:
Payment Method:
Permit No:
Parcel No:
Site Address:
a'
* *k *k *k* *:c *4 **A * * *ie*4:*4 * *44 * *44444 *'4*4 *k *•k *•4
WA TRANSMIT
kdr•h* k * r:4 ** h k * *ir ;k *•4•k:k1•k :l * *fi•k•4 **•A. *oh'h •k ;l •4 :4*
`_96004247 Amount: 4.000.00 06/12/96 10:07
CHECK Notation: STAR NURSERY Init: SLf3
096.015? •Type: 13•-DEMO DEMOLITION PERMIT
004000 -0720
4243 8 1.4r'i ST
Total Fees: 1.046.50
This Payment 4.000.00 Total ALL Pmts: 4.000.00
U iu I ance: 46.50
kk*****•:**• 11* k4k•k4*44* *4*ti.•44** **4 *A *4* *;4 *444444 *4 *J *:4*444 **44444*
Account Code Description Amount
00.0. /386.908 BUILDING BOND /DEPOSIT 4,000.0()
0450 06/12 9616 TOTAL 4000.00
C
;4• *4 *4*4*4 * *•4 **•k* *'•4444 *444{: * *4*44•444* .*k *44.4 *4*** *4st4.* *.4 41 4 4 4444
C316- 0151
CITY OF TUKWILA, NA
TRANSMIT
** 4.* kk A**• A** A *** *44 **• * *A *A *AA.A *•A* *;4 **h ** *4* 44.44 *A4 * **$4*44•.' A• * *h:4
TRANSMIT Number: 96004252 Amount: 46.50 06/12/96 14:51
Payment Mc t:hod: CHECK Notation: hinhl ir,e tractor Init: MEV
Permit No: 696-0157 Type: 1)--DEMO DEMOLITION PEI%i<iI1
Parcel No: 004000•°() ?20
Site Address: 4243 5 1'36 ST
Tali1 Teas: 4,046.50
this Payment 46.50 •fetal FALL Pmtst 4,046.50
Balance: .00
4* A* k*&: 4• tth4* Al kAA* k* o4* k* 4*4 1k*** 4***• A *A *k* * ** * *Ik4.4: *4 *A *4 * *1***k **
Account " Code Description Amount
000/322.100 BUILDING - RES 42.00
000/386.904 STATE BUILDING SURCItAftCil! 4.50
4-
0445 06/12 9616 TOTAL 46.50
TO THE ORDER OF
DATE
DESCRIPTION
CHECK NO.
•
g .
d TO TEST AUTHENTICITY OP THE OAREON NANO P C THE CHECK PACE UP ON TOP OP A 0110INARY' ICS OP PAPER AND RUO CANNON AND AREA WON A COTNA CAR EON MARKS MALI..TRANSFEN ONTO THE PAPE R Q
E!' 'THIS .0. OAT warm wawa ESOROS ANO *CARBONOAHO
CHECK AMOUNT
'6: = <i;*,; ^;> OLZVZS:ga.:Wm.M"..0 Nti.
PAY
STAR NURSERY & LANDSCAPING
13916 42nd AVENUE SOUTH
SEATTLE, WASHINGTON 98188
(206) 241.2115
A.. ;1, Yf ?+1r U.A i'.;K"MCHYAYI'Pxbn,'11rA ,6,ar vanri am.s+rr.+w.......hw.....r...v ..s e..arrOrt.n,enuw....«.wwe..w.m.I AMtat1 .7!el*nXV1anhPA+MPERYM2rWY4
WASHINGTON 1. 6tMSEATTLE,4WA SAVINGS
1166
REMITTANCE ADVICE
STAR NURSERY & LANDSCAPING
19-7095/3250
DOLLARS
9 5 fl rrJ +'.t^.Or ? ��.
:. �x�"x#" �
DE ' TM .N:: N{
.s5 z' � cww ? x d rx ..��
:.s �: +. �.�
rl8 fi�rc:' "1�3.
DAT Y1N
tt;•� os e �+t: ..
:'1+:n^
D' TAE �
w :� �
P,< P R O.V:E D...
:.: �i , 'f' �(•4�t1.J1i 1 .J.': .'{i �i:� l: ✓`s' f L� }':S ?e '�X.i L C'i�. .: w.i 4 •�l'. k ., �.•;
r p r; •� �;- � � r t� j 3 .�,� •
, $ ' ¢� REQ U IREMENTS /„ ° COMMENT S `° i s .r. Y
< .... , ,,..,, , ■.. , . ,..1,.. , . , ,V 1..;kt., �,r,: : ,::.,.. r.,:", ; " r... • ' 5 1
Ri � Plan Review
Meeting
�_ L1_9.,
lc- "U�
3RD NOTIFICATION
INIT: 141
BUILDING -
initial review
_ S _c ,
(ROUTED)
CONSULTANT: Date Sent - Date Approved -
FIRE
((°
"../M
FIREPROTECTION: O Sprinklers O Detectors O WA
FIRE DEPT. LETTER DATED: INSPECTOR:
INIT: --)A1 A,
O LANNI NG
/t l A
k (7)
ZONING: PAR /LANDUSECONDFTIONS? OYes O No
REFERENCEFILENOS.:
INIT:
VIINIMUMSETBACKS: N- S- E- W-
PUBLIC
WORKS
6 -S -Q6
e_ 1 0- Q(
UTILITYPERMITSREQUIRED? OYes t54 No
PUBLICWORKS LETTER DATED: el o/ `r6
INIT:
- F�. "ft
ROO (P
--e. r
BUI LDING
OFFICIAL
"( � `c `' "INIT:
r2 6 1(p
•
‘
AMOUNT
OWING:
4 ( , Jt�
CONTACTED
DATE NOTIFIED
BY:
(init.)
2nd NOTIFICATION
BY:
(init.)
3RD NOTIFICATION
BY:
(init.)
PLAN CHECK
NUMBER
:bq
REVIEW COMPLETED
CITY OF TUKWILA ■ _
Department of Community Development — Permit Center
6300 Southcenter Boulevard - #100, Tukwila, WA 98188
(206) 431 -3670
Building Permit Application Tracking
a/o Bond
PROJECT NAME
Yal r / VGQJ
SITE ADDRESS LI3 .5 ( CD 54—
SUITE NO.
INSTRUCTIONS TO STAFF
• Contacts with applicants or requests for information should be summarized in writing by staff so
that the status of the project may be ascertained at any time.
• Plan corrections shall be completed and approved prior to sending to the next department.
• Any conditions or requirements for the permit shall be noted in the Sierra system or summarized
concisely in the form of a formal letter or memo, which will be attached to the permit.
• Please fill out your section of the tracking chart completely. Where information requested is not
applicable, so note by using "N/A ", date and initial.
DEPARTMENTAL REVIEW
"X" in box indicates which departments need to review the project.
02/15/96
SITE // ADDRESS 7 SUITE #
VALUE OF CONSTRUCTION - $ f- ,. €-
PROJECT NAME/TENANT
A 7 c ' - e/ / ‘/ 1'
ASSESSOR ACCOUNT #
O Q � �
(commercial) Demolition (building)
0 Other
TYPE OF U New Building U Addition U Tenant Improvemen
WORK: 0 Rack Storage 0 Reroof 0 Remodel (residential)
DESCRIBE WORK TO BE DONE:
[7e- de ` -:,__ / c Se. /L 1 1 f' / /2-26_1 / " [,
BUILDING USE (office, warehouse, etc.)
/1 / / - A . / —
NATURE OF BUSINESS: 1i iS , r � re - 4/ / /
requirements may need to be met. Please explain:
WILL THERE BE A CHANGE IN USE? 0 No (J Yes If Yes, new building
T c..:--, A, / A.,a,l,', ,%
SQUARE FGE - Building: Tenant Space: Area of Construction:
WILL THERE BE STORAGE OR USE OF FLAMMABLE, COMBUSTIBLE OR HAZARDOUS MATERIALS IN THE BUILDING?
S No 0 Yes IF YES, EXPLAIN:
FIRE PROTECTION FEATURES: 0 Sprinklers 0 Automatic Fire Alarm System
PROPERTY OWNER "-re el /61,-/c4-- } � ,
PHONE 4 , 3 ��
ADDRESS / i Q/z / pro/ sl ,
,.7 <2 77/x L( /,,
zll ,y l ,
— .2 67
CONTRACTOR
:„. Weini c Yi' 1)t
�- ,-
�/y/: /,'/L r) i7 )' �'Y j � it.
.S; �S e, , 7 / /c' ki /c)
PHONE - 12/
C —� ic .47
I ,1 � � .
ADDRESS /7/ �/ / ' /i' 7 a 1' ' 1 '4
WA. ST. CONTRACTOR'S LICENSE #%//w./ �
' S
EXP. DATE 1 _ (D _ 9 v
ARCHITECT ., , , ,
fll11C.-
PHONE
ADDRESS
ZIP
CITY OF TUKWILA
Department of Community Development - Building Division
6300 Southcenter Boulevard, Tukwila WA 98188
~I
(206) 431 -3670 -� 5.1
PLAN CHECK
NUMBER
•
APPLICATION MUST RE
FILLED OUT COMPLETELY
0
BUILDINI PERMUT
APPLICATION
DESCRIPTION
BUILDING PERMIT FEE
PLAN CHECK FEE
BUILDING SURCHARGE
OTHER:
TOTAL •
AMOUNT
UQ:
RCPT #
DATE
I •HEREBY CERTIFY THAT •);:HAVE READ AND;:: EXAMINED: THI APPLICATION;: AND KNOW THE SAME T
'BE AND CORRECT AND I'AM AUTHORIZED;TO APPLY FOR THI PERMIT
SIGNATURE
BUILDING OWNER
OR
AUTHORIZED
AGENT
CONTACT PERSON
PRINT NAME pee( Pa_t� r�
ADDRESS (s ?f, ti
DATE APPLICATION EXPIRES
DATE G 3 ?G,
PHONE c z
CITY/ZIP ri
PHONE
APPLICATION SUBMITTAL In order to ensure that your application is accepted for plan review, p :a e s.: to fill out the
application completely and follow the plan submittal checklist on the reverse side of this form. Handouts are available at
the Building counter which provide more detailed information on application and plan submittal requirements.
Application and plans must be complete in order to be accepted for plan review.
VALUATION OF CONSTRUCTION Valuation for new construction and additions are calculated by the Department of
Community Development prior to application submittal. Contact the Permit Coordinator at 431 -3670 prior to submitting
application. In all cases, a valuation amount should be entered by the applicant. This figure will be reviewed and is
subject to possible revision by the Building Division to comply with current fee schedules.
BUILDING OWNER / AUTHORIZED AGENT If the applicant is other than the owner, registered architect/engineer, or contractor
licensed by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this
permit application and obtain the permit will be required as part of this submittal.
EXPIRATION OF PLAN REVIEW Applications for which no permit is issued within 180 days following the date of application shall
expire by limitations. The building official may extend the time for action by the applicant for a period not exceeding 180
days upon written request by the applicant as defined in Section 304(d) of the Uniform Building Code (current edition).
No application shall be extended more than once.
If you have any questions about our process or plan submittal requirements, please
contact the Department of Community Development Building Division at 431 -3670.
DATE APPLICATION ACCEPTED
COMMERCIAL
NEW COMMERCIALBUILDINQS /ADDITIONS
fn Completed building
g permit application (one for each structure)
n Assessor Account Number
Two sets (2) of the following:
EI Specifications
n Structural calculations stamped by a Washington State licensed •
engineer •
n Soils report stamped by a Washington State licensed engineer
n
n Working drawings, stamped by a Washington State licensed
architect, which Include:
• Site plan
• Architectural drawings
• Structural drawings
• Mechanical drawings
• Elevations
•:Civil drawings
• Landscape plan
I Completed utility permit application (one for entire project)
ri Six (6) sets of civil drawings
NOTE: See utility permit application and checklist for specific utility
submittal requirements.
RACK STORAGE
Completed building permit application
n Assessor Account Number
Two (2) sets of plans; which include:::
1 1
Building floor plan showing:
• Entire space where racks will be located
• Exit doors
• Dimensions of all aisles
Tenant space floor plan showing rack storage layout, aisles and
exits.
NOTE: Include dimensions of racks (height, width and length), aisles
and exit ways op plan.
n Structural calculations stamped by a Washington State licensed
engineer (rack storage 8' and over).
11
RESIDENTIAL
11
SUBMITTAL CHECKLIST
Topographical. survey
Energy calculations stamped by a Washington State licensed
engineer or architect
Legal description
NEW SINGLE-FAMILY DWELLINGS /ADDITIONS •
•
Completed building permit application (one for each structure)
I I Legal description
ri Assessor Account Number
Lj Two sets (2) of working drawings, which include
• Site plan ..- ► (On plan, show closest hydrant location
• Foundation plan Include access to building, showing
• Floor plan width and length of access.)
• Roof plan
• Building elevations (all views)
• Building cross - section
• Structural framing plans
Washington State Energy Code data
n Completed utility permit application
n Six (6) sets of site plans showing utilities
NOTE: Building site plan and utility site plan may be combined,; See
utility permit application and checklist for specific submittal requirements:
Additional topographical and soils information may be required if unique
',
site conditions.
COMMERCIAL TENANT IMPROVEMENTS
Completed building permit application (one for eacfi
tenant)
Assessor Account Number
• Two (2) sets of construction plans, which include
I Site plan
C Construction details
• Cross sections. showing wall construction and method of
attachment for floor and ceiling
Structural calculations stamped by a Washington State licensed
engineer may be required if structural work into be done (2 sets)
NOTE: 11 any utility work is to be done, submit separate utility permit
application and plans.
REROOF
n Completed building permit application (one for each structure)
n Assessor Account Number
Narrative describing existing roof, material being removed, and
material being installed. .:
NOTE: A Certification letter is required prior to final inspection and sign-
off of the permit
ANTENNA/SATELLITE DISHES
• : Location of tenant: space
Existing end proposed parking
• Landscape plan (if applicable, i.e., Change of use)
•
Overall building plan
Tenant location
•: Use .;of adjacent (common wall) tenant
• Overall dimensions of building or square foota
Floor plan of proposed tenant space
Completed building permit application
Assessor Account Number
Two (2) sets of plans; which include::
• *.Tenant space plan with use of each room labelled.;:
• Exit doors; egress patterns.
• New wails, existing wall, and Walls to be demolished
n . Site Plan (showing building and location of antenna/satellite dish)
n Details antenna/satellite dish and method of attachment •.
Structural calculations stamped by a Washington State licensed
engineer may be required
RESIDENTIAL REMODELS
Completed building permit application (one for each structure)
Assessor Account Number
Two (2) sets of working drawings, which include:
• ; Site plan =<
• Foundation plan
• Floor plan
• Roof plan
• Building elevations (all views
• Building cross- section
• framing plans .
NOTE: If any utility work is to be done provide utility permit application
and plans must be submitted,
REROOFS
L Completed building permit application (ono for each structure)
ri Assessor Account Number
Narrative describing • existing roof, being
material being installed
NOTE: A Certification n letter is required prior to final inspection and sl
off of the permit
removed, and
Project: rQ mmQx fi. `,
Type of inspectio k na 1
Address:
Date called:
� a�u 1
Special instructions:
\O O ILQ mo
T 1 tl X) fit l� h° 'VA
Date wanted:
( 0 _ Qq _r, v am :
Requester:
1
i401 Jo 01/4Y Oil
Phone No.:
M _ f ^ ,( t-1
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 981
1 Approved per applicable codes.
COMMENTS:
Inspector:
.uroxecasranskesvi—' 93 '
INSPECTION RECORD
1 Retain a copy with permit •
Q15
PERMIT NO.
1
(206) 431 -3670
Corrections required prior to approval.
Date: 2 (6.1
L f�,�..� v t (1
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection.
Receipt No.:
Date:
w
.`.a- „;,'.v%.
/t5r5o -/ -/
---- ._._..Fi -�—E- -CO �,..r..
1 ^,'4!'rS1&nd that if
r
tin �. "i;.inir .il J
;;'t7i�•t,;c?Ltlkl;�r•i;'i =. I ` p.( ;•+sn-
`1:iFi i eCE;ipt
acknowle
•
• ••:
REC`ELVi=D
• CITY OF..TUKWILA ,
J U 0.41996
PERMIT : CENTER .
•
' �rtr C �;� C 'T s e�nu tttt: r r.•,�,n.,ryY ,,.�, ;. ...g�w•�•j w j?_ra,"�'-a `�1",.,1' "' 'Rm, f. .P_ tY+x i {•)
'i::ctit2.iSi w6�'.�-. n�ra`�� � ii "�s.:f�;�i cEif:: #,.i��S?..•�i;:�t 4,:�7i�.��i�t+�.t+a.d�s ��a��.». r�l 4,':( ��t7k li�'.,�Y; zr: �Y s: ... �,�A .a,i ,.� }'�:�+*x.. >... ...ta's<xSN: +y _N.'
OW
A/ rh
Z3
Q e
PC
P r \9
-- C yegrs , /// 42e. a ,` /ve
--- 4% a ,7e1 77' �� Cry a �- J= / /. .:
Y
pv 49 //° ,S' r /1/ Y' y
�f r s e- 77 s 7 o /") w /// 612 ;'
EYp5RiY Gail/ . /0/ /lg-s/../ re-5'
RECEIVED
CITY OF TUKWILA
it 0)(1 M -}-n NI c w. JUN 0 it 1996
.5n, eir it.) ; 1 b c nn c PERMIT CENTER
AO
City of Tit'
Kwila
6200 Southcenter Boulevard • Tukwila, Washington 98188 (206) 433 -1800
TO. f RM/7$
FROM e/o9)Nt c/ S��Nt
DATE. 6A0/76
P
SUI3JECT P %L / SFR tEMOL /77 OM () 4,243 a 146 sr 89.6
THE St f8JEC7 gooecki& - c7 e i4S 1%wN p v /E) f) B{' Pa). No P ,/G - D/5 7
1,))ORKS P N /7S , E eEeW / ,D, / T/ oNS ,_e4 7//E 4:3L465
I/1 BE- 0/117 /4)70 r/./ PE,ekiT s 5 rEM,
Cr: C --
Q�,
NIEMORANDUM
• PROJ >' 1 Site Address: 9� -SG) - 1 74r /f yv. ./ 14/� s A •
n. tI1MA (.Ohl Name of Project: /7 / //%-r - 7"
Property Owner: Are /-/ ",53/fwf 7-
Street Address: /3
Engineer:
Street Address:
Contractor:
Street Address: / 7/0
� - .
King Cty Assessor Acct #:cl,j (pm Contractor's License #:
'iPM.TS €' > >< > ❑ Channelization /Striping /Signing
UESTED :< ❑ Curb Cut/Access/Sidewalk
❑ Fire Loop/Hydr. (main to vault).- No.: _ Sizes:
NO PIA) Peen' irs ❑ Flood Zone Control
d►,re. re.d ❑ Hauling
❑ Land Altering cubic yards
6(ioIqf '' ❑ Landscape Irrigation
❑ Moving an Oversized Load
Est. start/end times:
Date:
❑ Sanitary Side Sewer- No.:
WATRKI.. ME
R EFUND /BILL
NT
LLIN
. ❑ Water
SCRIP.TION 0
❑ Multiple - Family Dwelling ❑ Hotel
No. of Units: ❑ Motel
❑ Commercial/industrial • ❑ Office
❑ Retail
ISCEL ANEO
ED New Building
. F.ORMATION < ; Square
Footage:
Date Application Accepted:
City Of Tukwila Applic:.. °n
Central Permit System - Engineering Division •
6300 Southcenter Blvd., Suite #100, Tukwila, WA 98188
/ �-
Awe e >r7 7 rte?' S Y .Y
j '' i Cit /State2ip:
Name:
Street Address:
Name:
Street Address:
❑ Sewer
❑ Metro
l HEREBY CERTIFY
Applicant/Authorized
Agent Signature:
Print Name: .e. r)
Date: G 3 ' 6 Phone: cRr3• —`f /2
UTILITY PERMIT APPLICATION
- .776_ (--w
❑ Duplex
❑ Tri•lex
❑ Warehouse
❑ Manufacturing
❑ Remodel/
Addition
King County Assessors valuation of existing structures: $
El Apartments
❑ Condominiums
❑ Church
Date Application Expires:
Phone No.:
Cit /State/ZI • :
Phone No.:
City /State/Zip:
Phone No.:
❑ Sewer Main Extension ❑ Private
❑ Storm Drainage
❑ Street Use
❑ Water Main Extension ❑Private ❑ Public
❑ Water Meter / Exempt: - No.: ^. Sizes:
Deduct ❑ Water Only ❑
❑ Water Meter / Permanent - No • — Sizes:
❑ Water Meter/ Temporary: - No.:— Sizes•
Estimated quantity:
Schedule:
❑ Other:
Phone No.:
City /State/Zip:
Phone No.:
City /State/Zip:
K NOW: THE: SAME '
? -*0 05 - 1
Phone: (206) 433.0179
Exp. Date:
❑ School/College /University
❑ Hospital ❑ Other:
Square footage of original building space:
Square footage of additional building space:
Valuation of work to be done: $ .
❑ Public
Phone:
Contact Person
(print nanle)• oward
Address:
04/22/92
w _ c ..
� RE �STRAI I N:NUMBER ,
•
� . : .41.:-
EXP R 10 ' Ei
l yyt��,
_
f
M
.ly■
`w
a te
Mr
t
1
r
)
Z •
+^j.
.�.''
b..
y;
.
•
�
.:
4.Y ,
{!r
t `
. •
.
t.
=
L
;R AS PROVIDED. BYLA AS
•
•
:l IGNATURE"v . - . �...�. �- �.�: �........... _ . _...
ISSUED BY DEPARTMENT OF LABOR AND INDUS ` IES_ • •