HomeMy WebLinkAboutPermit D03-182 - YOSHIKAWA RESIDENCE - RESIDENCE DEMOLITIONYOSHIKAWA -DEMO
13041 TUKWILA
INTERNATIONAL BL
EXPIRED
5 -18 -04
D03-782
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 7359600655 Permit Number: D03 -182
Address: 13041 TUKWILA INTERNATIONAL BL TUKW Issue Date: 08/14/ 2003
Suite No: Permit Expires On: 02/10/2004
Tenant:
Name: YOSHIKAWA RESIDENCE
Address: 13041 TUKWILA INTERNATIONAL BL, TUKWILA WA
Owner:
Name: YOSHIKAWA TERRANCE
Address: 2416 32ND AVE W, SEATTLE WA
Contact Person:
Name: TERRANCE YOSHIKAWA
Address: 3714 W COMMODORE, SEATTLE, WA
Contractor:
Name: BAZALA INC
Address: 2416 32ND AVE W, SEATTLE, WA
Contractor License No: BAZALI *163PR
DESCRIPTION OF WORK:
DEMOLITION OF EXISTING RESIDENCE - PER RESPONSE TO CODE ENFORCEMENT ACTION
Value of Construction: $ $1,000.00 Fees Collected: $51.50
Type of Fire Protection: Uniform Building Code Edition: 1997
Type of Construction: VN Occupancy per UBC: 0007
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
DEVELOPMENT PERMIT
Phone:
Phone: 206 282 -5442
Phone: 206 286 -3574
Expiration Date :01/11/2004
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: N
Storm Drainage: N
Street Use: N Profit: N
Water Main Extension: N Private: N
N
Water Meter:
doc: Devperm
D03 -182
Public: N
Non - Profit: N
Public: N
Printed: 08 -14 -2003
Permit Center Authorized Signature:
Print Name:
doc: Devperm
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
/L„y_g
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 permit does not presume to give authority to violate or cancel the provisions of any other state or local laws
regulating constructiojor the performance of wor , , , m authorized to sign and obtain this development permit.
Sig ure: '`. Date: - —
Yob/4
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.
D03 -182
Printed: 08 -14 -2003
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
6: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
PERMIT CONDITIONS
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5: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations shall not be 8
construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any o'-
other ordinance of the jurisdiction. No permit presuming to give authority to violate or cancel the provisions of this = w
code shall be valid. F-
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Parcel No.: 7359600655 Permit Number: D03-182
Address: 13041 TUKWILA INTERNATIONAL BL TUKW Status: ISSUED
Suite No: Applied Date: 06/11/2003
Tenant: YOSHIKAWA RESIDENCE Issue Date: 08/14/2003
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any
construction. These documents are to be maintained and available until final inspection approval is granted.
4: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997
Edition) as amended, Uniform Mechanical Code (1997 Edition), and Washington State Energy Code (1997 Edition).
7: The applicant must notify the City Utility Inspector at (206)433 -0179 upon commencement and completion of work at least
24 hours in advance. All inspection requests for utility work must also be made 24 hours in advance.
8: Work affecting traffic flows shall be closely coordinated with the City Utilities Inspector. Traffic Control Plans
shall be submitted to the Inspector for prior approval.
9: Any material spilled onto any street shall be cleaned up immediately.
10: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation
off -site or into existing drainage facilities.
11: The site shall have permanent erosion control measures in place as soon as possible after final grading has been
completed and prior to the Final Inspection.
12: Any septic tanks in the area shall be pumped empty and removed or filled with sand. A copy of the documentation from
the business that performed the pumping shall be provided to the City Utilities Inspector.
13: Abandoned side sewers shall be capped at the main.
14: Disconnected side sewers which will be reconnected in the near future shall be capped at the property line.
15: Sewer and water utilities shall be plugged at the mains if they are to be abandoned. If they will be used again in the
near future for a new building, they shall be capped at the property line and at the water meter respectively.
doc: Conditions
D03 -182
Printed: 08 -14 -2003
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Signature:
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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 not presume to give authority to violate or cancel the provision of any
regulating construction or the performance of wor
G-
Print Name: . 7 6 1 a q 6544
D03 -182
Date:
of law and ordinances
other work or local laws
gni-03
Printed: 08 -14 -2003
CITY OF TUKWILA '
Community Development Department
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 **
King Co AS sor's Tax No.:
7 3 4 i \ \6 1. Li — N t (7 uite Number:
Tenant Name: N 0 1- ` - D t t-
Site Address:
Property Owners Name:
Mailing Address: . 1 l U C=Cj l A (-> LA-A
Name: T67. -'.' �- � L 1.11
Mailing Address: -5 cc)m
E -Mail Address:'( 'd ` - CJJ
NERAL CQNTRACTOR :INFORMATIO
Company Name:
Mailing Address:
City State Zip
Day Telephone: ' Z-5 (' 'lam ,, 1 - 7
Fax Number: G _- - 2.4 3.5 J I
Expiration Date: G 0'i'
* •An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
Contact Person:
E -Mail Address:
Contractor Registration Number: V
Contact Person:
E -Mail Address:
Contact Person:
'applicationslpermit application (3.2003)
3/2003
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Page 1
ARCHITECTS • ORRECORD. -•All plans must be wet stamped by Airchitect of Recori
Company Name:
Mailing Address:
E -Mail Address:
Gol
City
Fax Number:
7 36 togs
New Tenant: [] .... Yes
(!JJ V8( 9 9
State Zip
Day Telephone:2-'k f?) 9,
City State Zip
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City
Day Telephone:
Fax Number:
State
State
Floor:
..No
Zip
Company Name:
Mailing Address:
Zip
City
Day Telephone:
Fax Number:
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11�7Yf fi' - S 3;147l*d$
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,.� 7� c 'w •+� � ^ '�° y..,,'�•��`'R }('ise`. irk l 1 �11'",y l '`�C���:�
Valuation of Project (contractor's bid price):.. -' /OOO Existing Builc...4 Valuation: $
Scope of Work (please provide detailed information): 1"706 L.( (. Ut'Q - FA) il•J(:)
Will there be new rack storage? ..Yes ❑ .. No If "yes ", see Handout No. for requirements.
rovtde;All Building; Areas in Square Footage Below
; s
1" Floor
2" °:Floor
3i0. Floor
Floors
;Basement.
Accessory Structure'",
Attached Garage
Detached: Garage
Attached Carport
Detached: Carport;
• Covered Deck
Uncovered Deck
Additionao
Existing
Structure.
Construction
perUBC:......
. of .
• Occupancy per
UBC
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:
Will there be a change in use? J .... Yes ❑ ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑..Sprinklers ❑..Automatic Fire Alarm ❑..None 0.Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ -Yes 0 ..No
If"yes", attach list of materials and storage locations on a separate 8 -1/2 x I I paper indicating quantities and Material Safety Data Sheets.
la pplicationslpesmit application (3.2003)
312003
Page 2
+all. is.. •._ ..
Handicap:
`r°P.,UBLI
Scope of Work (please provide detailed ini,,.tnation):
Water District
❑ ...Tukwila 0... Water District #125
❑ ...Water Availability Provided
Sewer District
❑ ... Tukwila 0... ValVue ❑ .. Renton ❑ ...Seattle
❑ ...Sewer Use Certificate 0... Sewer Availability Provided ❑ .. Approved Septic Plans Provided
❑ ...Septic System - For onsite septic system, provide 2 copies of a current septic design approval by King County Health Department.
Submitted with Application (mark boxes which apply):
❑ ...Civil Plans (Maximum Paper Size — 22" x 34 ")
❑ ...Technical Information Report (Storm Drainage)
❑ ...Bond ❑ .. Insurance ❑ .. Easement(s)
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
❑ ...Total Cut
❑ ...Total Fill
❑ ...Sanitary Side Sewer
❑ ...Cap or Remove Utilities
❑ ...Frontage Improvements
❑ ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑ ...Permanent Water Meter Size...
❑ ...Temporary Water Meter Size..
❑ ...Water Only Meter Size
❑ ...Sewer Main Extension Public _
❑ ... Water Main Extension Public
\applicationalpermit application (3.2003)
3/2003
tPER1yiI�' IIYFQRZki 'T.10
Please, refer to Public Work's Bulletin #1 for fees and estimate sheet.
cubic yards
cubic yards
)
I ,
Call before you Dig: 1- 800 - 424 -5555
❑ .. Abandon Septic Tank
❑ .. Curb Cut
❑ .. Pavement Cut
❑ .. Looped Fire Line
WO#
WO#
WO#
Private
Private
t 433,4!
❑ .. Highline
❑ ...Renton
❑ .. Geotechnical Report ❑...Traffic Impact Analysis
❑ .. Maintenance Agreement(s) ❑...Hold Harmless
❑ .. Right -of -way Use - Profit for less than 72 hours
❑ .. Right -of -way Use — Potential Disturbance
❑ .. Work in Flood Zone
❑ .. Storm Drainage
FINANCE INFORMATION
Fire Line Size at Property Line
❑ ...Water ❑ ... Sewer
Monthly Service Billing to:
Name:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
Number of Public Fire Hydrant(s)
❑ ...Sewage Treatment
Day Telephone:
City State Zip
Day Telephone:
City
State
Zip
Page 3
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
❑ ...Deduct Water Meter Size
Unit Type: ' -
Qty"
,Unit Type: '
Unit Type:
Yp
Qty
Boiler/Compressor:
P
Qty
Y
Furnace <I00K BTU
Air Handling Unit
>= 10,000 CFM
Other Mechanical
Equipment
0 -3 HP /100,000 BTU
Furnace >100K BTU
Evaporator Cooler
3 -15 HP /500,000 BTU
Floor Furnace
Ventilation Fan
15 -30 HP/I,000,000 BTU
Suspended/Wall/Floor
Mounted Heater
Ventilation System
30 -50 HP /1,750,000 BTU
Appliance Vent
Hood
50+ HP /1,750,000 BTU
Heat/Refrig/Cooling
System
Incinerator - Domestic
Air Handling Unit
<= 10,000 CFM
Incinerator — Comm/Ind
?MECIIANI
; :MSS '
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City
Day Telephone:
Fax Number:
Contact Person:
E -Mail Address:
Contractor Registration Number:
Expiration Date:
* *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
Valuation of Project (contractor's bid price): $
Scope of Work (please provide detailed information):
Use: Residential: New .... ❑ Replacement ....
Commercial: New ....0 Replacement ....0
Fuel Type: Electric El Gas ....0 Other:
Indicate type of mechanical work being installed and the quantity below:
Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject
to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation.
The Building Official may extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant as
defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
R AUTHORIZ AG
\applicationa\permit application (3.2003)
3/2003
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Print Name: / i� }' 1 V-� > ik-4 14
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Mailing Address: ,� ' J tit) C.0/4 ku/arz-��
Page 4
State
Zip
Date: 6 -
Day Telephone: C= Z SP
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City State Zi p
Date Application Accepted: z
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Date Application Expires:
Staff Initials:
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Payee:
TRANSACTION LIST•
ACCOUNT ITEM LIST:
Description
doc: Receipt
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
RECEIPT
CL Parcel No.: 7359600655 Permit Number: D03-182 6 o
Address: 13041 TUKWILA INTERNATIONAL BL TUKW Status: PENDING N o.
Suite No: Applied Date: 06/11/2003
Applicant: YOSHIKAWA TERRANCE Issue Date: - i
U) ii.
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Receipt No.: R03 -00724 Payment Amount: 51.50 tL
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Initials: SKS Payment Date: 06/11/2003 03:47 PM H w
User ID: 1165 Balance: $0.00 z H
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Type Method Description Amount I- 0
Payment Check 1600 51.50 tllZ
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TERRANCE YOSHIKAWA
BUILDING - NONRES
STATE BUILDING SURCHARGE
Account Code Current Pmts
000/322.100 47.00
000/386.904 4.50
Total: 51.50
9540 06/12 9716 TOTAL. 1.19.94
Printed: 06 -11 -2003
Pr ct:
Type of Ins ction:
Ad rgs�
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'
3
Date Called: i 0/31/0..?
Special Instructions:
Date Wanted /
l Itp
'
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Requestut.
Ph ne No:
- ,2 — 5 L/
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
\,
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(206)431 -3670
COMMENTS:
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Approved per applicable codes. Corrections required prior to approval.
El $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
105h I rct)ct lVr -��
Type of Inspection
p io F �nccr
Address•
1 dOY 1 - r - 15
Date Called:
10/31 1 / 0 3
.-„- --
Special Instruc ions:
/114
Date Wanted: .m.
1 1) 3 (C).3 p: h
Requester:
— ?/r05/1 t
Phone No:
6 ` c4 i- 5 y` /a
ilcaN.W w::W: rC' Sk... lYLJ.:' isWn Adak:
:4"i.:5'o,(.Y°fcy'We9G'.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Approved per applicable codes.
El Corrections required prior to approval.
COMMENTS:
It /1/01 C
•
it /
Inspector:
Date:
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
COMMENTS:
Type ofOection•
R eppi-opte. oe//
Add ess:
/8617, 7i/ 2,W
-1e--(4 ( - 6; 2 e..)ri e
...,
4/i 4), /.'4; )9 - lx _
Date Want'
:,40,4,/fri-i /--) ei r,
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Reques--
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Phone No:
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Project:
AV.CieecdA •
Type ofOection•
.7C)
Add ess:
/8617, 7i/ 2,W
Date Called:
Special Instructions:
&fa,
Date Want'
p.m.
/2/
. .
Reques--
40>eree-7
Phone No:
42•W 22
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INSPECTION RECORD
Retain a copy with permit
1
INSPiCTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd.,#100, Tukwila, WA 981 88
f t
b0 3. 18 a
(206)431-3670
Approved per applicable codes. Corrections required prior to approval.
Date:
El $47.00 REINSPECTI�N FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
COMMENTS:
Type of Inspeptip: ,\
fe-e DeAeto
Ad8ress:
/3 3 1 1) I/6
--r,,,,4411
Edoc.d (aNllz d Mx
474f
/9(1- A)..14,1 (,o le c 4 4 - - /-.0.-id .
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Project:
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Type of Inspeptip: ,\
fe-e DeAeto
Ad8ress:
/3 3 1 1) I/6
Date Called:
ajl VA
Special Instructions:
Date Wanted: /
7/ / )7 3
a.m.
p.m.
Requester:
raky
Phone No: /
INSPECTION RECORD
Retain a copy with permit
■ • • •, ■ , •
•
003-
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431-3670
PERMIT NO.
12 ) Approved per applicable codes. Di Corrections required prior to approval.
Inspector:
Date: ge -p
El
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
"-j paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
(Co
These plans have been
Works Department for
City standards. Acceptan
omissions which do not a
adopted standards or ordi
for the adequacy of the d
designer. Additions, delctio
drawings after this date will
and will require a resubmitt
for subsequent approval.
Final acceptance is subject t
the Public Works utilities in
Date:
reviewed by the Public
onformance with current
e is subject to errors and
thorize violations of
ances. The responsibility
sign rests totally with the
s or revisions to these
void this acceptance
1 of revised drawings
field inspection by
pector.
y:
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o m
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I understand that the Pla -
subject to er and omissions and approval of
plans does rot authorize the violation of any
adopted code or ordinan e. Receipt of con-
tractor's copy of approv d plans acknowledged.
Date
Permit No.
FILE COPY
• ... •
Building to be demolished.
13041 Tukwila International Bl.
31311 2 5 n‘.'i J
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Parcel Number 7359600655
Address 13041 PACIFIC HW S
Zipcode 98168
Taxpayer YOSHIKAWA
The Information included on this map has been compiled by King County staff from a
variety of sources and is subject to change without notice. King County makes no
representations or warranties, express or implied, as to accuracy, completeness,
timeliness, or rights to the use of such information. King County shall not be liable for any
general, special, Indirect, incidental, or consequential damages including, but not limited
to, lost revenues or lost profits resulting from the use or misuse of the information
contained on this map. Any sale of this map or information on this map is prohibited
except by written permission of King County."
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Comments
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06/11/2003
April 6, 2004
Terrance Yoshikawa
3714 West Commodore
Seattle, WA 98199
RE: Permit Application No. D03 -182
13041 Tukwila International Boulevard
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 Uniform Building Code and/or Uniform Mechanical Code, every permit issued by the
Building Official 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 or request and receive an extension prior to May 01, 2004,
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
city of Tukwila
Department of Community Development Steve Lancaster, Director
Xc: Permit File No. D03 -182
Bob Benedicto, Building Official
Steven M. Mullet, Mayor
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
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ACTIVITY NUMBER: D03 -182 DATE: 06 -12 -03
PROJECT NAME: YOSHIKAWA - DEMOLITION
SITE ADDRESS: 13041 TUKWILA INTERNATIONAL BLVD
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision # After Permit Is Issued
DEPARTMENTS: 6/-0-05 Build ng Div ision r
Public Works Af !)-z3.03
Lim
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 06 -17 -03
Complete
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
AA 61 Pvta.
Fire Prevention M
Structural ❑
Incomplete
L 6.--(2O
Planning Division
Permit Coordinator
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 R�TING:
Please Route Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS: DUE DATE: 07 -15 -03
Approved ❑ Approved with Conditions Not Approved (attach comments) ❑
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents /routing slip.doc
2 -28.02
PERMIT COORD COPY
•
•
REGISTERED'•AS PROVIDED BY LAW AS
:ONST ' CONT GENERAL
f .) EXP . ,DATE
CC01 ;BAZALI *163PR 01/11/2004
EFFECTIVEDATE 10/19/1984
BAZALA.INC
2416 32ND: AVE W
SEATTLE WA •: 98199 -1031.
Signature
Issued by DEPARTMENT OF LABOR AND INDUSTRIES