HomeMy WebLinkAboutPermit D04-455 - FROLAND RESIDENCE - RENOVATIONFROLAND RESIDENCE
3509 S 137 ST
D04-455
Parcel No.: 8864000735
Address: 3509 S 137 ST TUKW
Suite No:
Tenant:
Name: FROLAND RESIDENCE
Address: 3509 S 137 ST, TUKWILA WA
Owner:
Name: HENRY SCOTT G 7R
Address: 3509 S 137TH, TUKWILA WA
Contact Person:
Name: RHONDA FROLAND
Address: P.O. BOX 13125, MILLCREEK, WA
Contractor:
Name: OWNER AFFIDAVIT IN FILE
Address: P.O. BOX 13125, MILLCREEK, WA
Contractor License No:
DESCRIPTION OF WORK:
INTERIOR RENOVATION TO INCLUDE DRYWALL, INSULATION,
Value of Construction: $2,000.00
Type of Fire Protection: SMOKE DETECTOR
Type of Construction: VB
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant:
Flood Control Zone:
Hauling:
Land Altering:
Landscape Irrigation:
Moving Oversize Load:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter:
doc: IBC - Permit
City o1'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
N
N
N
N
DEVELOPMENT PERMIT
Number: 0
Start Time:
Volumes: Cut
Start Time:
Private:
Profit: N
Private:
D04 -455
Permit Number:
Issue Date:
Permit Expires On:
Expiration Date:
Phone:
Phone: 425 778 -5297
Phone: 425 778 -5297
Size (Inches): 0
End Time:
0 c.y. Fill 0 c.y.
End Time:
Public:
Non - Profit: N
Public:
Steven M. Mullet, Mayor
Steve Lancaster, Director
D04 -455
12/22/2004
06/20/2005
CABINETS, FLOORING AND WINDOW FRAMING
Fees Collected: $145.91
International Building Code Edition: 2003
Occupancy per IBC: 0022
Printed: 12 -22 -2004
Ira ,::laf.: .:.:r.). ha:.u.tw..... �'. L^ L"... n. •.......a•::'.+s:..:•V�:A�.�.`
Permit Center Authorized Signature:
The grantinf of th
regulating co s
doc: IBC - Permit
City 6x 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
D04 -455
Steven M. Mullet, Mayor
Steve Lancaster, Director
Permit Number: D04 -455
Issue Date: 12/22/2004
Permit Expires On: 06/20/2005
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 •e complied with, whether sp- -d herein or not.
to or cancel the provisions of any other state or local laws
o sign and obtain this develo nt pe it.
p z ......
Date. .
Signature:
Print Name: l r Q ai
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.
Printed: 12 -22 -2004
s_ .:�1 0'. %,�i� ,i Itf:ru': :ri.iuA,. »JI /idTPir'Q•
S.:
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 8864000735
Address: 3509 S 137 ST TUKW
Suite No:
Tenant: FROLAND RESIDENCE
1: ** *BUILDING DEPARTMENT CONDITIONS * **
PERMIT CONDITIONS
Permit Number: D04 -455
Status: ISSUED
Applied Date: 12/22/2004
Issue Date: 12/22/2004
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: 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.
5: 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.
6: 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).
7: 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).
8: 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.
doc: Conditions
* *continued on next page **
D04 -455
Printed: 12 -22 -2004
Signature:
Print Name:
doc: Conditions
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
governing this work will be complied with, whether specified herein or not.
The granting of this permit does n•t pr
e.
ume to give authority to violate or cancel the provision of any
regulating constru «'•n or ; e pe orm anc
of
jz�rnicP� (
D04 -455
of law and ordinances
other work or local laws
Date: 1 - 22- 0
Printed: 12 -22 -2004
CITY OF TUKWIL4.
Community Developmer. .epartment
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
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: "350 q 5 , 1,
Tenant Name:
r orri)a F:,(7)(nAlk .
Mailing Address: ) 0 ( l 3i25 YT) i
Property Owners Name:
y CONTA T PERSON
Name:
Mailing Address:
City
E -Mail Address: Fax Number: a ;
v i GENERAL CONTRACTOR INFORMATION - (Mechanical Contractor information on back page)
Contact Person:
E -Mail Address:
Company N. •' -:
Mailing Address:
Contractor Registration Number: Expirati
* *An original or notarized copy of current Washington State Contractor License must be presented at
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
\permits ptus\icc changes \permit application (7.2004)
I
Page 1
Building Permit No. 1)0 4 45
Mechanical Permit No.
Public Works Permit No.
Project No.
(For office use only)
King Co Assessor's Tax No.:
Suite Number: —� Floor:
ity
New Tenant: ❑ .... Yes ❑ ..No
Day Telephone:�I
&�� yDD -0
State
, (
ip
5 TOD -
Cit
Day Telephone:
Fax Number:
State
Zip
it issuance **
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:
BUILDING PERMIT INFORMATION - 206- 431 -3670
Valuation of Project (contractor's bid price): $ Q� 1
Sco a e of Work (please provide detailed information):
AA41. L
Will there be new rack storage? 0 ..Yes
\permits plus\icc changes \permit application (7.2004)
Number of Parking Stalls Provided: Standard: Compact:
®' Existing Building Valuation: $
4: Ang . // f ,■
o 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 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.
Page 2
Handicap:
7060 ,00
Will there be a change in use? 0 ....Yes 0 ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑..Sprinklers 0..Automatic Fire Alarm 0..None . Other (specify) Ef
Will there be storage or use of flammable, combustible or hazardous materials in the building? 0 .. Yes q. No
If "yes", attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Material Sa ty Data Sheets.
Existing
Interior
Remodel
Addition to
Existing
Structure
New
Type of
Construction
per IBC
Type of
Occupancy per
IBC
1' Floor
G) C)
i.--
—
` �
I _ 0
1
2n Floor
q /`
l/
1
3r Floor
Floors thru
Basement
-
Accessory Structure*
Attached Garage
Detached Garage
/ 1' 00
� -t
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
( r+ C)
BUILDING PERMIT INFORMATION - 206- 431 -3670
Valuation of Project (contractor's bid price): $ Q� 1
Sco a e of Work (please provide detailed information):
AA41. L
Will there be new rack storage? 0 ..Yes
\permits plus\icc changes \permit application (7.2004)
Number of Parking Stalls Provided: Standard: Compact:
®' Existing Building Valuation: $
4: Ang . // f ,■
o 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 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.
Page 2
Handicap:
7060 ,00
Will there be a change in use? 0 ....Yes 0 ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑..Sprinklers 0..Automatic Fire Alarm 0..None . Other (specify) Ef
Will there be storage or use of flammable, combustible or hazardous materials in the building? 0 .. Yes q. No
If "yes", attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Material Sa ty Data Sheets.
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
Water Heater
50+ HP /1,750,000 BTU
Repair or Addition to
1-leat/Refrig/Cooling
System
Incinerator - Domestic
Emergency
Generator
Air Handling Unit
<10,000 CFM
Incinerator — Comm/Ind
Other Mechanical
Equipment
MECHANICAL PERMIT INFOK 1ATION - 206- 431 -3670
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City Slate Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number:
* *An original or notarized copy of current Washington State Contractor
Indicate type of mechanical work being installed and the quantity below:
BUILDING 0
Signature:
Print Name:
Mailing Address:
permits *Mice changes \permit application (7 -2004)
trC,„ FY0
It7
Page 4
Expiration Date:
License must be presented at the time of permit issuance **
Valuation of Project (contractor's bid price): $
Scope of Work (please provide detailed information):
Use: Residential: New ....❑ Replacement ❑
Commercial: New ....❑ Replacement ❑
Fuel Type: Electric ❑ Gas ....0 Other:
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 P BY THE L S OF T - • TE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
Day Telephone: L Z 5 - 77 , 52-9
�1I xee I,v
City State
Date:I2- 2 0
Date Application Accepted:
Date Application Expires:
Staff Initials:
i
.c.hM.w:S,ti... :.4...:.S.I.;+aa:ru+n/+ -: -.. ...m.x....w.w.......w.v.. —... -- .- ........�,... «.-- ...•- ..... -.
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431-3670
Parcel No.: 8864000735
Address: 3509 S 137 ST TUKW
Suite No:
Applicant: FROLAND RESIDENCE
Payee: JERRY OR RHONDA FROLAND
RECEIPT
Receipt No.: R04-01709 Payment Amount: 145.91
Initials: SKS Payment Date: 12/22/2004 01:27 PM
User ID: 1165 Balance: $0.00
TRANSACTION LIST:
Type Method Description Amount
ACCOUNT ITEM LIST:
Description
doc: Receipt
Payment Check 2589
BUILDING - RES
PLAN CHECK - RES
STATE BUILDING SURCHARGE
Account Code Current Pmts
000/322.100
000/345.830
000/386.904
Permit Number: D04-455
Status: PENDING
Applied Date: 12/22/2004
Issue Date:
145.91
85.70
55.71
4.50
Total: 145.91
12•23 77.1.0 TOTAL
Printed: 12-22-2004
Project: / /
/� fit /4/l
Type of Inspection:
1 )'
Address
1�
Date Called:
Special Instructions:
Date Wanted: am
14' ---21-0 4c- -.5. .
Requester �
Phone No:
1 7 1 425 - 7 - 7g -5-2 7,
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
P
(206)431 -3670
Ap proved per applicable codes. 0 Corrections required prior to approval.,
COMMENTS:
Date: /' 2/✓ O
$58.00 REINSPECTION FE ' REQUIRES. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
Receipt No.:
Date:
li,:
Project:
Type of In pettio
/446
l�Cb
Address:
`357 . 'S"' , /:""? 7 I
Date Called:
‘ --/ -- 5
Special In tructions:
0 1' 0.46l
,,/e<
3/ 7 c G L. m 667 P//
Date W nted: c a.m.,
• — 7/ --&- p.m.
Requester:: ,,� , J
/C ii / 7J0D4
Phon N ;6 c ` 77 f- £',
Approved per applicable codes.
INSPECTION RECORD'
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
20•)431 -3670
Corrections required prior to approval.
ri $58.00 REINSPECTI FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
Receipt No.:
Date:
COMMENTS:
2,e) / .4 .4
h PeJi - - 2 S /? G v /1 S
Inspector:
Date:
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Requester:
- y7--)
Phone No:
Pro ct:
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(.Zc S '
Type of Inspection:
, /itlAI L
Address:
Date Called:
Special Instructions:
Date Wanted:
/ — 3 / — 0
a.m.
p.m.
Requester:
- y7--)
Phone No:
5-
Approved per applicable codes.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
5 5's
(206)431 -3670
Corrections required prior to approval.
Date:
/ -3 / --x.5_
00 REINSPECTIbN FEE REQUJRED. Prior to inspection, fee must be
aid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
Project:
h/41■11
,e-5..
Type of Inspection: .
Address:
25 —5;
/3 7ll'
Date Called:
r - zg -as
Special Instructions:
rPhonOlo:
( (72O6
Date Wanted:
/ ' 3 / -OS-
a.m.
p.m.
Requester:
WO% iy75
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 981 88
INSPECTION RECORD
Retain a copy with permit
PER
(206)431-3670
proved per applicable codes. Corrections required prior to approval.
COMMENTS:
Date:
1- 3 /- OS
$ 7.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
aid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
Proj Ht!
Type of Inspec ion:
Address:
CO .So, R s r ,
Date Called:
Special Instructions:
Date Wanted: i r 11 a.m.
/ I k / 05
Reques,tec;
I Ai
Phone
1 0i, (,OC?� ti sa - i ( 4 7'
INSPECTION RECORD
Retain a copy with permit
INSPE6FIPJN NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
(20•)4 ' -3670
'Receipt No.:
i
14 Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
Inspector:
Date: /
5
$47,ot(EINSPECTIpN FEE REQUIRED. Prior to inspection, fee must be
pal at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Date:
_V)
Project:
/
377 !/1/
Type of Ins e tion:
! " 4 7' 444•
Address:
� Z-Z
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D ate Called:
Specs
tructions:
Date Wanted:
a.m.
p.m.
Requester:
`r'
Phone No:
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
pproved per applicable codes.
t
P E R M I T . .
216)431-3670
El Corrections required prior to approval.
COMMENTS:
S47.00 EINSPECTION ¥EE REQUERED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
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COMMENTS:
Type of Ins ection: N
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j) 5 /4 if I ;:, (47( heA14,6 A ,..x..d
;,-.,/,,,
,,
L A.. - , 1 4 1/16477-4 .1 ( :., ..-7,..
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Date Wantedm
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Requester:
0
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P .ject: f.
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Type of Ins ection: N
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Addre§5:
1 7 V _So. -- ic-i•
Date Cal ed:
',...
04,
0
Special Instructions:
Pi s - —viDet/Ve—'
Date Wantedm
a.m.
Requester:
0
Phone No:
• 0
— 1 i4 -
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431-3670
j Approved per applicable codes.
Ej Corrections required prior to approval.
Date: /
$47.00 REINSPECTIO FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
Project name
Address
Description of work
Related reference number
Authorization by,
TBD3 /96 -form 12
CITY OFlJKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
ALTERNATE PLAN SUBMITTAL AUTHORIZATION
FOR LIMITED SCOPE OF WORK
U.B.C. Section 106.3.2 exception
LM-t - gm6
.550ci 5 I VS 7 dZi Ku) tioAr
Application # W
•ZG¶ �4 re "N -4 NDOW V; O. -aAccok E
1-A ver4 UJ I N Oce vstIsqt. cvw Si4t kU5 al1m ei:Q(4 cocE Mr
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 V Mechanical Other
Minimum plan and/or specification requirement:
Site plan Floor plan Elevations Foundation
Cross sections Roof plan W.S.E.C. compliance Narrative / 0/ Kr
INIO Structural calculations ( stamped by Washington State licensed engineer) 1 'P
Pe0P ,
Specific required information N� '1 ? g-e I N UC.4f (f, N 204-M (NC
3. Other special instructions: L IJ .A1'i wale, watt- CA it t t+ To t.JL.L
-0501( or 6101D TSPACS ItyriV - Mot. I t• U 1 410 . itou IDB.
Date /2 -222 - L 4-
( Authorization void 30 days after the date issued. )
NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR IRAN
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUM:4T.
06 -07 -2005
RHONDA FROLAND
P.O. BOX 13125
MILLCREEK, WA 98082
RE: Permit No.DO+
3509 S 137 ST TUKW
Dear Permit Holder:
In reviewing our current records the above noted permit has not received a final inspection by the City of Tukwila Building Division.
Per the International Building Code and/or the International Mechanical Code, every permit issued by the Building Division under the
provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not
commenced within 180 days from the date of such permit, or if the building or work authorized by such permit is suspended or
abandoned at any time after the work is commenced for a period of 180 days.
Based on the above, you are hereby advised to:
Call the City of Tukwila Permit Center at 206 - 431 -3670 to arrange for the next or final inspection.
This inspection is intended to determine if substantial work has been accomplished since issuance of the permit or last inspection; or if
the project should be considered abandoned.
If such determination is made, the Building Code does allow the Building Official to approve a one- time extension up to 180 days.
Extension requests must be in writing and provide satisfactory reasons why circumstances beyond the applicants control have
prevented action from being taken.
In the event you do not call for the above inspection and receive an extension prior to 07/30/2005, your permit will become null and
void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
Stefania Spencer,
Permit Technician
xc: Permit File No. D04-455
Bob Benedicto, Building Official
City of Tukwila
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
w.. 4,4,44 ,:am.: „_.;,,:++...Ua.LA i;:wWi.a,— ..+.ww...ry:12 , ..•
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
STATE OF WASHINGTON)
COUNTY OF KING
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
Permit Center /Building Division:
206 - 431 -3670
Public Works Department:
206 - 433 -0179
Planning Division:
206 - 431 -3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
ss.
[please print]
1. I have made application for a building permit from the City of Tukwila, Washington.
PERMIT NO.:
TY/ 1/55
, states as follows:
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.
4.
I 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.
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 building permit to be exempt under No. /3 , and will therefore not be performed by a registered
contractor.
I understand that I may be waiving certain rights that 1 might otherwise have under state law in any decision to engage an
unregistered contractor to perform construction w
\applications\8 -2004 affidavit in lieu of contractor registration
APPLICANT
Signed and sworn to before me this
'22nd day of December , 20 0.
Of,(.ae. 6Z. Ae,0/44-p-
NOTARY PUBLIC in and for tie State of Washington,
Residing at king , County.
Name as commissioned: /'fil -e '4. Deac y
My commission expires: 6 -/6 -O g
w.:rnk4itii:w :tsti.4;r2'r:'�'� cstt'::�+3� hiNn
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;
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
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;
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.