HomeMy WebLinkAboutPermit D01-130 - ANDERSON MOBILE HOME RELOCATION - MOVE TRAILERCARLANDERSON
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D01 -130
City of Tukwila
Community Development / Public Works • 61300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 9818,
WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES.
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
Parcel No: 161000 -0076 Permit No: DO1 -130
Address: 14005 42 AV S Status: ISSUED
Suite No: Issued: 05/25 /2001
Location: Expires: 11/21/2001
Category: ASFR
Type: DEVPER61
Zoning: NCC �.
Const Type: Occupancy: DWELLING
Gas /Elec.: UBC: 1997
Units: 001 Fire Protection: N/A
Setbacks: North: .0 South: .0 East: .0 West: .0
Water: N/A Sewer: N/A
Wetlands: Slopes: N Streams:
Contractor License No:
OCCUPANT ANDERSON MOBILE HOME RELOCATION Phone:
14005 42 AV S, SPACE #3', TUKWILA, WA 98188
OWNER ANCORP,INC.
14004 PACIFIC HWY. So., SEATTLE WA 98168
CONTACT CARL ANDERSON OR LAURIE BROWN Phone: 206 - 439 -1055
14005 42 AV S SPACE #3, TUKWILA WA 98168
************** k*********** k** k*********k** k***** kk** k* kk * *kkAkk* **kk*k * ** *kk *k,l * * * *k
Permit Description:
TAGED FOR MOVING TRAILER WITHIN PARK WITHOUT PERMI
T AND TO CLOSE TO PROPERTY LINE. PERMIT IS TO MOVE
TRAILER TO ANOTHER SPACE.
* * * * * * * * * * * * k * * * * * k * * * * * * * * k * * ' k * * * A k * * k * * k k * * * k k k * k k k k k k A k * A * k k k k * k k k k k A k k A k k * k # * k A A
Construction Valuation: $ 600.00
PUBLIC WORKS PERMITS: A(Water Meter Permits Listed Separate) Eng. Appr:
Curb Cut /Access /Sidewalk /CSS: N
Fire Loop Hydrant: N No: Size(in): .00
Flood Control Zone: N
Hauling: N Start Time: End Time:
Land Altering: N Cut: Fill:
Landscape Irrigation: N
Moving Oversized Load: N Start Time: End Time:
Sanitary Side Sewer: N No:
Sewer Main Extension: N Private: N Public: N
Storm Drainage: N
Street Use: N
Water Main Extension: N Private: N Public: N
**k* A****** k********• A****** k* k** AkA* A***k* k** *A *A4 * * * *AA * *k *AA *14A *kk * * * * *AAk #AAA *AAA
TOTAL DEVELOPMENT PERMIT FEES: $
****** * * * * * *k * *k * * * * * *kA *A *A * * * *k * * *A
Permit Center Authorized Signatur
I hereby certify that I have read and examined th s permit Ord know the same
to be true and correct. All pro .is ins of law an 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 state or local laws regulating construction
or the performance of work. I am authorized to sign for and obtain this
development permit.
Signature: CZ Date: /
Print Name:_Ln 1
DEVELOPMENT PERMIT
_L / 1_LLL
74.8
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(206) 431 -3670
a te
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.
Tenant.
Tvve. t
Par.* gi 163C
* 4 k t Jr 4 4 4 k 4 4 A, 4- 4 it 4 4 4 I 1 4 4 4 4 4 4 4 1 1 4 4 4 4 k 4 4 4 4 * « 4 • 1 4 4 - 4 k
Permit 1 .:ondition ,, ..
1. No charnle.: WI to the 1..1.3f.,
n9inee and the Tut SvildinQ
A con t he done in
3hd reouirementi. t nifo;'m fu i
Editir a: amended. ijn:fo.'m mechan;c:al . :997
and W3..F.htn9ton '2.tato Fneco-
plumhinQ oht'ained
f:ountv Deoartment of cohlk: He..11th
inloec•ed by that 3, u
(,.:96-47
4. Nottfy the 1:it‘ of Tvitoii,„3 r:
ulacino 3ny rhil 1:
requirement
5. validit:i of Fecmit. Vh h3".:ance ..*:f A
.:pecification'l. and , :omiwtat)on - . , zna!i
r,troed to be a oermit or : Aboco-3i cth,
of Any of the bt the hui
other ocdiilance th.A
9ive authoritv to ,.iolate •:anc.e! the rovi:to-,::! thF7
code lhall he valid.
;. Electrioal peymit': I tt obratned th:C.%.411:! shinnioo
DiviSiOti of L,kbOr Ar.ti Indu:Ft, ano all .1e.:t.'11
wort will be inT,he
, , Al . uerm
avatItl!e at the i0t:' :!te 0! th.; .F.rart
T.truction, ai to
able until final in:,:veton ahurod! .)rant.ao
herehy Cectif• th,:‘t f nave the:e ati6
with them outlined. ATI 14.w
ti' ir wiil be .:0)1i010 whethtl.* sheifieo hece!r.
Th,?
•i of tni..3, oermit doe.f pce:,.Ume to
violate or c.incel the i of ,ihy other wori. or 1.:.cztl •
.'e9ulatint; i:onstion oc of
f.i9nature
: ‘r 3 nt .
:
;.:1, • ,
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Project Name/Tenant ertata t
/wwx6ne
Value of Construction :t „ _ od
,�J
Address:
/qc 5 _ 42a -e S .51
City
Cit S to /Zi p
3 W./ a/tA . WA•
Tax Parcel Number:
, y - voe:s'- a s
Propgtty r j
��Qj( 4V...1 t do�Z
CO /4ig
Phone: _
/006 / 057 - 6--
Fax #
vG - �,r3� - /3s"s
Street Address:
/9,10 za eke S. J ` 2 / V
City State /Zip:
u C 9 8/6
Contractor: Oc jy
' Provide documentation that shows the principal owner lives in one of the dwellings as his or her primary residence.
Phone-
Street Address:
City State /Zip:
Fax #:
Architect: 40
Phone: _
Street Address: .__.
City State/Zip:
Fax #:
'
Engineer: // %9
Phone:
Street Address:
— Contact
City State /Zip:
Fax #:
..
art ,} �
C 'a p l�i,�iG4 /4( - C.:t s2 4 �/r 0 ,014 Mt �4
Phone: h 2' Q6 - ya -1 t✓J 6-5---
5 ---
Street Address: City State /Zip:
Sac.
Fax #: ,,�
c6 Y- 1 - l3s s
Description of work to be done: d'�ZYU �� t. tJ �J
9/6 -We in e . i
Type of work: New Single- Family Residence ❑ Addition - Single- Family Residence
❑ Interior Remodel- Single - Family Residence ❑ Residential Accessory Structure'
❑ RemodeVAddition to Accessory Structure ❑ Garage(s)
❑ Deck(s - Covered & Uncovered ❑ Residential Retool
Is this site served by: jsir Sewer ❑ Septic (King County Health Dept. approval required - 296-4722)
Existing Square Footage for Structure: 8'16 sq. ft. Dwellin sq. ft. Covered Deck(s)
���� Q�!
sq. ft. Garage /Carport £4 sq. ft. Accessory St'ru�ctUre(s) sq. ft. Uncovered Deck
—
Proposed New Square Footage: J" te sq. ft. Dwelling sq. ft. Covered Deck(s)
^
sq. ft. Garage /Carport sq. ft. Accessory Structure(s) sq. ft. Uncovered Dock
Floor Area Ratio: (total floor area of all structures divided by the area of the lot) 924: 3/4 c.) ._ .34
For an Accessory dwelling, provide the following:
Lot area Floor area of principal dwelling Floor area of accessory dwelling
' Provide documentation that shows the principal owner lives in one of the dwellings as his or her primary residence.
CITY OF TUKWILA
Permit Center
6300 Southcenter Blvd., Suite 100, Tukwila, WA 98188
(206) 431 -3670
FOR STAFF USE ONLY
Prole( ember:
Permit Number:
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
Single - Family Residential Permit Application
APRGCANTREQUEST FOR PUBLIC WORKS SITE/CIVIL PLAN REVIEW OF THE FOLLOWING:
Additional reviews shall be determined b the Public Works Department
❑ Channelization/Striping ❑ Curb cut/Access /Sidewalk ❑ Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Flood Control Zone ❑ Hauling ❑ Land Altering: 0 Cut cubic yds. 0 Fill cubic yds.
❑ Moving an Oversized Load: Start Time: End Time:
❑ Sanitary Side Sewer #: ❑ Sewer Main Extension 0 Private 0 Public
❑ Storm Drainage ❑ Street Use ❑ Water Main Extension 0 Private 0 Public
❑ Water Meter /Permanent # Size(s):
❑ Water Meter Temp # Size(s): Est. quantity: gal Schedule:
❑ Miscellaneous
Value of Construction - In all cases, a value of construction amount should be entered by the applicant. This figure will be re-
viewed 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 ex-
pire 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.
Data application ac opted:
S Gi s )( 0 . -- o f
PLEASE SIGNBACK OF APPLICATION FORM
SFPERMIT.DOC 2/13/97
Date application expires:
Application taken by: (initials)
<<
ALL SINGLE- FAMILY RESIDENTIAL PERMIT APPLICATIONS MUST BE SUBMITTED WITH THE FOLLOWING:
N/A
11/
DRAWINGS PREPARED BY A REGISTERED ARCHITECT OR PROFESSIONAL ENGINEER MAY BE
REQUIRED BY THE BUILDING OFFICIAL
ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
SUBMITTED
Copy of recorded Legal Description from King County
❑ Certificate of water /fire flow availability (Form H -11 a). Contact the Public Works Department
(206) 433 -0179 for servicing district.
Certificate of sewer availability (Form H -11). Contact the Public Works Department (206) 433-
0179 for servicing district.
Metro: Residential Sewer Certification (if Tukwila Sewer District) (Form H -12)
King County Health Department approval for septic - 296 -4722
Four (4) sets of working drawings, which include:
Site Plan (see example Form H -16)
1. Existing fire hydrant location(s).
2. Proposed access road.
3. Driveway location- driveway shall be 10' wide minimum and 20' wide maximum. If driveway is over
150' long, driveway shall be 20' wide and have an approved turnaround (City Ordinance 1741).
4. North arrow and scale.
5. Building setback from property lines. Any proposed or existing easements must be shown on plan.
6. Public Works review requires the following on site plan: driveway location (10' min., 20' max. width),
show proposed and existing power, water and sewer lines, existing storm drainage system,
downspouts and foundation drains, and where drains tie -in.
7. Parking plan.
8. Lowest building elevation (if in Flood Control Zone).
9. Estimated /proposed topography at 2' intervals and proposed elevation of lowest floor level.
10. Identify location of sensitive areas slopes 20% or greater, wetlands, watercourses and their buffers.
11. Identify location and size of significant trees that are located in sensitive areas and buffers or the
shoreline zone. Of those, identify which are to be removed (Title 18, City of Tukwila Zoning Code).
12. Identify location of high water mark of the Green /Duwamish River if site is located within 200' of the
high water mark.
13. See Public Works Checklist for detailed site plan information required for Public Works Review (Form
H -9).
❑ Foundation plan and details
❑ Floor plan
❑ Roof plan
❑ Building elevations (all views)
❑ Building height
❑ Building cross - section
❑ Structural framing plans and details necessary to completely describe construction
❑ Washington State Energy Code Data (Gas /Electric /OII /Propane/Heat Pump) Form H -15 available
at Permit Center OR Prescriptive Heating System Sizing Chap 9 Form H -6.
❑ Complete Land Use Applications if not previously submitted (i.e., Reasonable Use Exception,
Variance, Shoreline or Tree Permit).
❑ Attach plans, reports or other documentation required to comply with Sensitive Area Ordinance
and other land use or SEPA decisions.
❑ If dwelling has a septic tank, and a bedroom or bathroom are added, provide written approval
from the King County Health Department or the Tukwila Public Works Department prior to
submittal of permit application.
❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the permit
is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit in Lieu of
Contractor Registration ".
tr11c11 p ? geiilAgt ot'Ize4 g ptl if the applicant is other thari the TOT C refit #t er�d, ..krchitectlengineer, or contractor licensed
bythe.Sfate;of Weshipgtpn;'.a notarized letter from the propertyoWner the agent to submit this permit application and
obtain fhe'permit will be required as part of this submittal. z'
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF
PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING Q R R' T /ZED AGENT:
Signature:
Print name:
A, At al= rz. 604
Date 2 j c '/
Ph4 6 -ic* ,3j Tr'
Address: /3/4906.-_4_2 4e6, 5' , w,64,1> #, ?6 Cityfia iPr� fid Q s me
SFPERh11T.DOC 2/13/97
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COMMENTS:
T ' e of ) nspection:
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Date called.
Special instructions:
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T ' e of ) nspection:
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INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
El Approved per applicable codes.
El $47.00 REINSPECTION EE REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd, Suite 100. Call to schedule reinspection.
Receipt No:
Date:
PERMIT NO.
(206)431 -3670
Corrections required prior to approval.
95/5
SOUTH .ATE MOBILE HOME PA" `%
14005 42nd Ave S " 21
Tukwila Wa 98168
We will be installing tie -downs in accordance with WAC, copies
of which are attached. Attached also find our rough drawing
of the placements of the tie - downs.
FILE COPY
I understand that the Plan Check approvals are
subject to errors and omissions and approval of
plans does not authorize the violation of any
adopted code or ordinance. Receipt of con-
tractors copy of approved plans acknowledged.
By
Date c�
Permit No. 1 ) O 1. 130
REVISIONS
NO CI- IANC.; SI.: "LL BE MADE TO
._ SCOPE. Cr WITHOUT
CF TUMNILA BUILDING MN
WILL F,Ea I!7 -.E A NEW PLAN SL:'
A...) MAY lf::LUDF: A TIS ;SAL PAN R :VI:W F4.-.�
May 15, 2001
EX ED
SEPARATE Pc. S t ?IT
REQUIRED FOR:
MECHANICAL
ELECTRICAL
Rf PLUMBWG
GAS PIPING
CITY OF TUKWILA
BUILDING DIVISION
MAR 21 ZQQZ
OM 11.1011),
APPRW
2 4 at
MAY 1 6 2001
DO ( )
206 -439-1055 5 Phone
206-439-1355 Fax
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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BOLT -ON TOP
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tl t for. T /OR NOTL_ X11., S11. I FOR
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NOTE It VMS. 1 '011
TR -DOWN tNPORMATICT+
/1CI STEEL
t 14 TALL3TWN,,
.TRUCTIQNS
I. I►rST41,6 ANCNCts HrTO soil APPi.rw0 CONSTANT
0OWNwAR0 PREISURt TO isms=Z= SOst. •oi3TURRAw:t.
JN11t1 MCAD Is rwss «am CURIUM PLATE
ANCHORS S•OUi10 It INSTALLED IMO* roes' ttws
S. Af*C14 SIAAP$ TO COUPS SLAW tN MAN•CR SIIQwH.
S. INStstt STRAP TAROuC$ SPLIT SW. CO Off CACt11
STRAP ANC TOWN TWAIN ROO UNTIL ITRAP IS 1*13.
g!412A.C2 11ts A11N1NG:
C 4tCK FIRST FOR usOtROROUND u''.L t$tt.
'.tip•' PLC[ STAMM* PLATO ;•
` ;1N Lx1 Ta R 1 yT 1LT* , I
'. A4 *NCMo AND CHASSIS
/1sA1+. AND DIM 04TO
CROWS*.
.J+ LCARUb
t
YLRTICAL OR ANGULAR
RISTau.1TON .S 3P'I0 •
GROusO Lott
4118 ;.0 A.
STAS$UZCo
PLATE
IPIIT ROiT
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CONTRACTORS VERIFICATION —
I CERTIFY THAT • HAVE INSTALLED 11K A/CSCO ANCNORDIQ. SY$1UH ALT PER THE INlTALLATION IN$TRUCTIOI$$.
HMI H( HAD( NO w001PiCAFIO$I 10 734 ANCHORING SYST OR TO T$C OYILDING STRUCTURE.
COMPANY NAJAt !_ «.. ..r.•.---- ••....�...��-.�.- CONTRACTORS L1C.9_
EXHRED-
MAR 2 1 2002
.a7CCA!
rYVt• yy
•
D ETAIL A"
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: /IN" 1oRNtk,: ANCHOR
ti s WTO at 04Ou1*O uNtss
ANCHOR s(417 3 SLY=►
wlt$ $1Mb.IZL4 PUltc
THIS PROV)D(S S(eu41
PR4Tf tf1o111 Aw•11 I.ATtIA
MOVCuENT
CITY OF TUKWILA
APPROVED
MAY 2 1t 2001
r�.1ic(i
$g:r• ,'»
05/15r :T 1 11:
TYPICAL MAIN SEAM TIEDOWN STRAP INSTALLATION INSTRUCTIONS
0 Wrap Stop Around Mal" O band hOOk oo�� o of midri
end al
Beam NOTE: strap to crusher head.
R io tha al ! s main been to prsv nt damage to
C) Inuit Ow tension boil Into die C) Plow the strap through_ he Monad
*MAW hued and loosely' Oath shank al the Ietwion boa and bend up to etr.
heit
a lensioned to fits point that
a sir open Mud wrench
be need to hold the swore
MAR 2 1 2002
L.L.•■•■•✓-r-- •
OTHER METHODS CONNECTING STRAP TO TOP Of MAIN BEAM MAY SE USED
o Once Kay lansioned. align the
swam neck ot the bolt with the
squats mows to the anchor heed
and tighten ha het rust. This wIl
*At mm k's i alp the
5.50
Example OAP
O O W pp Nf the tee d a t 8/1 e' socket a 4110
olf0otawtae Manner w Mate rapping the
scrap around the brrbn, bolt.
CAUTION
DO NOT TVINS$ON Ttt[OOWN STRAPS ON ONti SIO@ OR HOME ONLY.
IF TENSIONING IS NOT PERFORMED EQUALLY ON ALTERNATE
SIDES, THR HOM! MAY YE PULLED OFF ITS SUPPORTS.
If approved by the manufacturer.
doubts head wore may be
used tot ooh diagonal end M verliaal
recommended that the
dedown ship be * It
Follow SMOG 4 th ouch 8 to luau
serape to anchor head.
CITY Of TUKWIIA
APPROVED
MAY 2 4 2001
ri;iILI)
•••
05/15%2001 11:55 25? -939 -9631
(A). s
Doubt, Stop
Its
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•
EX
EXAMPLE ONLY
EVES MOBILE HM FPTS PAGE 02
(A)/ r S Zo,0 1
L
PrIPIO MOM
Q..
MAR 21 2002
Anchor Strap Location
O
4 0 0
5 -SB
CITY Of TUKMA.
APPROVED
MAY 242001
is hot r.t)
05/15/2001 .1.:55 25.3- 939 -97TYL
ZEKES MOBILE HM PPTS PAGE 09
EXAMPLE ONLY
(.;
TIE -DOWN INSTRUCTIONS FOR SINGLE- SECTION HOMES /
Willard tweetw. gybe . e
um. as.«r Jim tf ri' see.
Pererst
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ape. are asied • I no del
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TIE -DOWN INSTRUCTIONS FOR DOUBLE- SECTION HOMES
Serer try. * l 'd I i Nose urr u
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INNIttira
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CAUTION: CNIflIJC £UtINN WOW NO MtlAAIA20 !K
ICICNI A MT to A/I$IT L *TZ IAL
MAR 21 2002
Obledes isr � w
•
= irreb ge sae
err ere *sasrw
CAUTION: XYZ C. has A..$C+.r Noir
Noma Is war mobs Vie gm st kerne %sr Vibes seabed
read wMs fir ow Is e v am stow ma
Itw s . a iM ► niguie.
remind wits Ise trams Ire. Wok" i, resemetenese re w
NIMM rf impe le be used widoUt A.nr. I..
WWII 11+e ream is Mined r .i+sps the ssasW .d
ipt� stripe must be wand es .epee
. role
5.5C
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a Met �I aim be
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AN' ODOMETER DISCLO _ JRE MUST BE COMPLETED F- A TRANSFER OF
ALL VEHICLES LESS THAN TEN YEARS OLD. THiS SECTION IS NOT VALID
UNLESS FULLY COMPLETED AND IS NOT AN APPLICATION FOR TITLE.
1 S
. . t
Federal and state taw requires that you STATE THE MILEAGE in connection with the transfer of ownership. Failure to
complete odometer statement or providing a false statement may result in fines and/or imprisonment.
I certify to the best of my knowledge that the ODOMETER READING as shown below is : (CHECK ONE)
n 1. The mileage stated is the ACTUAL MILEAGE cf the vehicle
2 The mieage stated :s in EXCESS OF ITS MECHANICAL LIMBS.
3. The odometer readings NOT ACTUAL MILEAGE. — WARNING- -
AN ODOMETER DISCREPANCY EXISTS BETWEEN THE ODOMETER
READING AND THE ACTUAL MiLEAGE.
Transferee/buyer: unless licensed dealer, must transfer title within 15 calendar days from the date of delivery, I /we
warrant this Title and certify that the vehicle described on the face of this certificate of title has been purchased by the
following:
ODOMETER READING (IN MILES)
TENTHS
E S
Signature of Transteree/Buyer
.1 .
!l a m eo ame o T a .sfere/Bu ej.,.
Address MOS: H v4 �7 of Transferee/Buyer
it e i ct 70
ess o
•
ASSIGNMENT BY REGISTERED OWNER
MAR 2 1 2002
Data W D*Trvary
l _/z /off
Signatu. e o Transferor/ seor/ . e
DA 44 /r F JI' r.¢ !9 �o_ 0
an - Name pi -tier
_o_.Y3
J.1 (/ .s:_C 5' _V
Address of Transferor /Seller
Customer Account Number of TransfereetBuyer: _ _
(Washington Driver's License Number (PIC) or Unified Business Identifier (UBI)
LIENHOLDER OF TRANSFEREE/BUYER (IF APPLICABLE)
Name of Lienholder Address of Lienholder
Customer Account Number of Lienholder : . _....... . . _ �_____ _. _ _ ..
(Washington Driver's License Number (PIC) or Unified Business Identifier (UB1)
PENALTY FEE FOR LATETRANSFER
Transfer of title is required when there is a change in ownership. This includes, but is not limited to, adding
or deleting registered owner(s), when the vehicle is sold, traded or given as a gift. The transfereeibuyer
of a vehicle is required to transfer the vehicle title within 15 calendar days, from date of delivery. Failure
to transfer title may result in monetary penalty pursuant to RCW 48.12.101(6)
r
MAY 162001
UCENSE NUMBER
421185
VEHICLE IDENTIFICATION NUMBER (VIN) FLEETiEOUIP NUMBER
KW9453
COMMENTS/ BRANDS
6000 1 998
DATE CF APPLICATION MODEL YEAR
08/12/1999 1981
OAMIE 3
IA JESUS
AVE SW
08146.1422
TILE NUMBER
9922412302
MAKE
KENTW
SCALE WT
POWER/USE
MOB
MILEAGE
SERIES & BO(N STYLE
84/14
ODOMETER CODE
0000000 EXEMPT ODOMETER
DISCLOSURE
PRIOR TITLE STATE PRIOR TITLE NUMBER
WA 9826413313
SIGNAIU
INT
SALE PRICE
S 0NAT MEs5) OF LEGAL OWNERS) BELOW, HEREBY RELEASES ALL INTEREST IN
VEHICLE DEEBICCRISED MOVE,
ANY AI 11.HAIION 1)111..HASUIII VOIDS (NIS lUl I
)'. • i `ta`: •ti , ., r ...;
•. .14 . r (rIA . . •
r : .: f • . 1 ) • • •
EXP It
M1 100?
AR 2
kviNi 2 2
MAY 1 6 ZOO?
4 j. M
SOUTIL.ATE MOBILE HOME ]PA: t
14005 42nd Ave S # 21
Tukwila Wa 98168
May 3, 2001
This is a Kentwood Mobile Home, cream over green, manufactured
in 1981, 64/14. Lic # %21185, Vin # KW9453.
There is a sticker on it that says King County Building
Developement and a number of 7591. The model # is unreadable
on the plate.
This unit is valued at approximately $ 4,500.00.
EXPIRED
MAR 2 1 2002
CM il)010■
4.PpROYE
;AAA 2 4 2001
kS
rrrV
MAY 1 6 2001
206- 439 -1055 Phone
206 -439 -1355 Fax
iII
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506.78'
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539.85' (540.00 PLAT)
S0. 140TH ST.
IIo S
AREA
169791 S.F.
21.72"
FD REBAR & CAP
LS 15656
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October 1, 2001
City of Tukwila
Department of Community Development
Mr. Carl Anderson
14005 42nd Avenue South, #3
Tukwila, WA 98168
RE: Permit Application No. D01 -130
14005 42nd Avenue South
Dear Permit Holder:
Based on the above, you are hereby advised to:
Thank you for your cooperation in this matter.
Sincerely,
Permit Technician
Xc: Permit File No.001 -130
Duane Griffin, Building Official
• Call the City Of Tukwila Permit Center at (206) 431 -3670 to schedule a
progress / final inspection
Steven M. Mullet, Mayor
Steve Lancaster, Director
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.
A progress 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 November 21,
2001, your permit will become null and void and any further work on the project will require a new permit and
associated fees.
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 -431 -3670 • Fax: 206 - 431 -3665
Complete
Comments:
Y'RIt1)1■It IX )C
L•n
ACTIVITY NUMBER D01 -130
PROJECT NAME: CARL ANDERSON
SITE ADDRESS: 14005 42 AVE SOUTH SPACE 3 SUITE NO:
Original Plan Submittal
Response to Correction Letter # Revision # AFTER Permit Is Issued
DEPARTMENTS:
Buildhivision
PNe s -c1 vI
P •Ii Woks
A ,
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
TUES /THURS ROUTING:
Please Route
REVIEWER'S INITIALS:
PLAN REVIEW /ROUTING SLIP
ve
Fir Prevention `� J
Structural
Incomplete
Structural Review Required
APPROVALS OR CORRECTIONS: (ten days)
C
Response to Incomplete Letter #
C
C
Approved ri Approved with Conditions
REVIEWER'S INITIALS:
CORRECTION DETERMINATION:
Approved n Approved with Conditions n
REVIEWER'S INITIALS:
PERMIT COORD COPY
DATE: 05 -16 -01
Planning Division
- `/ - o/
Permit Coordinator
I r l
DUE DATE: 05 -t -01
Not Applicable
No further Review Required
DATE:
DUE DATE 06-14-01
Not Approved (attach comments)
•
n
DATE:
DUE DATE
Not Approved (attach comments) n
DATE:
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER D01 -130 DATE: 05 -16 -01
PROJECT NAME: CARL ANDERSON
SITE ADDRESS: 14005 42 AVE SOUTH SPACE 3 SUITE NO:
Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision it AFTER Permit Is Issued
DEPARTMENTS:
Building Division
Public Works
a
C
Fire Prevention
Structural
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete 1K
Comments:
TUES /THURS ROUTING:
Please Route n Structural Revi w Required n No further Review Required
REVIEWER'S INITIALS: 4. DATE:
APPROVALS OR CORRECTIONS: (ten days)
Approved n Approved with Conditions
REVIEWER'S INITIALS:
CORRECTION DETERMINATION:
Approved
1(tc>1111 D1x'
Incomplete n
Approved with Conditions
REVIEWER'S INITIALS:
Planning Division
Permit Coordinator
DUE DATE 06-14 -01
n
DUE DATE: 05-16-01
Not Applicable ri
Not Approved (attach omm Its)
DATE:
DUE DATE
Not Approved (attach comments)
DATE:
cr 113
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PERMIT NO.: OM • l 6.
BUILDING PERMITS
INSPECTIONS
00001 Progress inspection Status
00002 Pre - construction
00003 Investigation
00004 OK to Occupy
00005 Remove Stop Work Order
00006 Follow -up
00007 Pre -Move Inspection
00050 WSEC Residential
00060 WA Ventilation/Indoor AQC
070 NLEA Inspection /Modular Stnuct
0071 Mobile Home Tie Down Insp
00072 Marriage Lines
❑ 00090 Rested
❑ 00095 Footing Drains
❑ 00100 Foundation Footings
❑ 00200 Foundation Walls
❑ 00250 Foundation Insulation
❑ 00300 Concrete Slab /Slab insulation
❑ 00350 Crawl Space
❑ 00400 Shear Wall Nailing
❑ 00450 Plywood Wall Sheathing
❑ 00500 Roof Sheathing Nailing
❑ 00525 Plywood Deck Nailing
❑ 00550 Exterior Walt Sheathing
❑ 00600 Masonry Chimney
❑ 00610 Chimney Installation/All Types
❑ 00700 Framing
❑ 00750 Roof /Ceiling Insulation
❑ 00800 Floor Insulation
❑ 00801 Wall Insulation
❑ 00802 Exterior Roof Insulation
❑ 00803 Glazing Inspection
❑ 00815 Lighting and Controls
❑ 00900 Suspended Ceiling
❑ 01000 Interior Wallboard Fastening
❑ 01001 Exterior Wallboard Fastening
❑ 01110 Pre -Move Inspection
❑ 01115 Motor Inspection
❑ 01120 Pre-Demo
01140 Pre- reroof
01400 Final -Fire
❑ 01700 Final- Building
0I900 Final -Reroof
❑ 03100 Site Visit
❑ 04000 Special- Concrete
❑ 04001 Special -Bolts in Concrete
❑ 04001 Special - Mom/Resist Cone Frame
❑ 04003 Special -Reinf Steel Prestress
❑ 04004 Special - Welding
❑ 04005 Special -I sigh- Strength Bolting
❑ 04006 Special- Structural Masonry
❑ 04007 Special - Reinf Gypsum Concrete
❑ 04008 Special - Insulating Cone Fill
❑ 04009 Special -Spray Fireproofing
❑ 04010 Special - Piling, Piers, Caissons
❑ 04011 Special- Shotcrete
❑ 04012 Special- Grading, Excav /Fill
❑ 04013 Special - Retaining Wall
❑ 04014 Special - Panels
❑. 04015 Special -Smoke Control System
.1'
TENANT NAME:
Plan Reviewer:
Permit Tech:
0(It9
plans
CONDITIONS
le 0001 No changes to plans unless approved by Bldg Div
❑ 0010 Special inspection required, notify Bldg Div
❑ 001 I Special inspector shall submit final signed report
❑ 0012 New ceiling grid & light fixture shall meet lateral
bracing
❑ 0013 Partition walls attached to ceiling grid
❑ 0014 Readily accessible access to roof mounted equipment
❑ 0015 Engineered truss drawings & calcs shall he on site
❑ 0016 Exposed insulation backing material
❑ 0017 Suhgrade preparation including drainage, excavation
❑ 0018 Statement from rooting contractor verifying fire
retardant class of roof
AU construction to be done in conformance w /approved
"No work shall he done in addition to those modifications..."
0002 Plumbing permits shall be obtained through King Co
❑ 0020 Structural observation shall be provided for this project
❑ 0021 All trod preparation establishments must have King Co
❑ 0022 Fire retardant treated wood shall have filmic spread of
0023 Notify Building Division prior to placing any concrete
0(124 All spray applied fireproofing shall he special inspected
❑ 0025 All wood to remain in placed concrete shall be treated
S. 0026 All structural masonry shall be special inspected
0027 Validity of Permit
❑ 0028 Rack storage requires separate permit
0003 Electrical permits obtained through I. &
0030 No occupancy of Drilling until limn insp by Bldg Div
❑ 0032 Remove all weeds, concrete, stone foundations, fiat
concrete
❑ 0036 Manufacturers installation instructions required on site
❑ "I1111 maximum allowed per 1997 WA State Energy Code"
❑ 0035 Contact I'W l)iv to obtain insp for water /sewer connect
❑ 0038 A C of will be required for this permit
❑ 0039 Final approval for all TI w /in the limits of the SC Mall
❑ 0004 All mechanical work shall be under separate permit
❑ 01)401 All construction noise to be in compliance with 8.2 TMC:
0001 Ventilation is required fir all new rooms & spaces
0005 All permits, insp records & approved plans available
0006 All structural concrete shall be special inspected
❑ "Applicant shall obtain a separate plumbing permit from King Co'
❑ "Anchoring — All new construct and substantial improvement shall be
anchored to prevent flotation"
❑ 0007 All structural welding shall be done by WABO certified
inspector
❑ 0008 All high - strength bolting shall he special inspected
❑ 0009 Bolts installed in concrete shall be special inspected
❑ 0031 Comply with requirements of TMC 16.(4
❑ 0034 Removal of septic tanks require approval and
compliance with King Co I lealth Dept.
❑ "Obtain required inspections from appropriate water & sewer
districts"
❑ "Fuel burning appliances
❑ "Appliances, which generate...."
❑ "Water heater shall be anchored...."
❑ "Reroof'
Date: i r
Date:
01
ACTIVITY NUMBER D01 -130 DATE: 05 -16 -01
PROJECT NAME: CARL ANDERSON
SITE ADDRESS: 14005 42 AVE SOUTH SPACE 3 SUITE NO:
Original Plan Submittal Response to Incomplete Letter
Response to Correction Letter # Revision it AFTER Permit Is Issued
-
DEPARTMENTS:
Building Division
Public Works
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete ri
Comments:
TUES /THURS ROUTING:
Please Route Fl Structural Review Required
REVIEWER'S INITIALS: . � ft/f1
APPROVALS OR CORRECTIONS: (ten days)
Approved LI Approved with Conditions
REVIEWER'S INITIALS:
CORRECTION DETERMINATION:
Approved ri Approved with Conditions
REVIEWER'S INITIALS:
PLAN REVIEW /ROUTING SLIP
Fire Prevention
Structural
Incomplete n
•
Planning Division
Permit Coordinator
n
DUE DATE: 05-16-01
Not Applicable n
No further Review Required
DATE: 'C, /7/61
DUE DATE 06-14-01
Not Approved (attach comments) F
DATE:
DUE DATE
Not Approved (attach comments)
n
I I
DATE:
DEPARTMENTS:
Building Division
Public Works
Complete
Comments:
REVIEWER'S INITIALS:
Approved
Approved
YFgi iUl(
Dtri
NN
CORRECTION DETERMINATION:
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER D01 -130 DATE: 05 -16 -01
PROJECT NAME: CARL ANDERSON
SITE ADDRESS: 14005 42 AVE SOUTH SPACE 3 SUITE NO:
Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision It AFTER Permit Is Issued
n
n
APPROVALS OR CORRECTIONS: (ten days)
Fire Prevention
Structural
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Incomplete
TUES /THURS ROUTING:
Please Route ri Structural Review Required
Approved with Conditions
C
C
n
REVIEWER'S INITIALS:
REVIEWER'S INITIALS:
Planning Division
Permit Coordinator
DUE DATE: 05-1 6-01
Not Applicable
No further Review Required
DATE: E-, - ,
DUE DATE 06 -14 -01
Approved with Conditionsn Not Approved (attach comments)
n
DATE:
DUE DATE
Not Approved (attach comments)
DATE:
ACTIVITY NUMBER D01 -130 DATE: 05 -16 -01
PROJECT NAME: CARL ANDERSON
SITE ADDRESS: 14005 42 AVE SOUTH SPACE 3 SUITE NO:
Original Plan Submittal
DEPARTMENTS:
Building Division
Public Works
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete E
Comments:
TUES /THURS ROUTING:
Please Route Structural Review Required
REVIEWER'S INITIALS: V 43)'
APPROVALS OR CORRECTIONS: (ten days)
CORRECTION DETERMINATION:
Approved
V`NN(NIII INK
Response to Correction Letter # Revision r ^ AF fER Permit Is Issued
PLAN REVIEW /ROUTING SLIP
•
Fire Prevention
Structural
Incomplete ri
Response to Incomplete Letter #
n
n
Approved ri Approved with Conditions
REVIEWER'S INITIALS:
REVIEWER'S INITIALS: DATE:
Planning Division
Permit Coordinator
DUE DATE: 05-16 -01
Not Applicable E
No further Review Required �,•�
DATE: 5 / �7 /oi
DUE DATE 06 -14 -01
Not Approved (attach comments)
DATE:
DUE DATE
Approved with Conditions n Not Approved (attach comments)
P
P1
Part A: (To Be Completed by Applicant)
Purpose of Certificate:
Building Permit ❑ Preliminary Plat or PUD ❑ Other
❑ Short Subdivision ❑ Rezone
Proposed Use:
4J Residential Single Family ❑ Residential Multi- Family ❑ Commercial ❑ Other
Applicants Name: So 4i q_G )'Ic56 „L T4rrnEs Phone: 2cc.-, �-i'..sc; .1 G tz, j
Property Address or Approximate Location: . I 4-Pok 2.0 (r ” 4 -\ 3c1 _1-1Y5f;
- 1
1400 4a iV._.. S IAA 3
Legal Description(Attach Map and Legal Description if necessary):
152_304 -Ctoo
L 4 B1\.. 1 -.I nr C' A r 's CiV."e3er Acl
Part B: (To Be. Completed by Sewer Agency) .
1. ara. Sewer will be provided by side sewer connection only to an existing `t size sewer
0 N . feet-fromthe site and the sewer system has the capacity to serve the proposed use.
OR ❑ b. Sewer service will require an Improvement to the sewer system of:
❑ (1) feet of sewer trunk or lateral to reach the site; and /or
❑ (2) the construction of a collection system on the site: and /or
❑ (3) other (describe):
2. (Must be completed if 1.b above is checked)
❑ a. The sewer system improvement is in conformance with a County approved sewer comprehensive
plan,
OR ❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
3. ❑ a. The proposed project Is within the corporate limits of the District, or has been granted Boundary
Review Board approval for extension of service outside the District,
OR ❑ b. Annexation or BRB approval will be necessary to provide service.
4. Service is subject to the following:
a. District Connection Charges due prior to connection:
GFC: $ SFC: $ UNIT: $ TOTAL: $ ) C_
(Subject to Change on January 1st)
King County/METRO Capacity Charge: Currently, $1090 /residential equivalent, will be billed directly by
King County after connection to the sewer system. (Subject to change by King Co/Metro without
notice.)
b. Easements: ❑ Required ❑ May be Required
c. Other:
WORKING TOWARD A BETTa., ENVIRONMENT"
SEWER DISTRICT ,
14816 Milk., y Road South
P.O. Box 69550
Tukwila, WA 98168
Phone: (206) 242 -3236
Fax: (206) 242 -1527
CERTIFICATE OF SEWER AVAILABILITYINON- AVAILABILITY
IiCertificate of Sewer Availability OR ❑ Certificate of Sewer Non - Availability
I hereby certify that the above sewer agency information is true. This certification shall be valid for one year
MAY 162001
from th - • . to of si • nat re.
-,ice
By
//Sp -
Title
D afe
bo- t3o
30 I
T .— ROAD CENTERLINE
INT. SET RR SPIKE
E
AA\
NOTES
SURVEYI
SURVEYING SPECIALIST
190th St., Suite B -101
IT, WASHINGTON 98032
(2s) 656 -5977
Od
\IC
•
LEGAL DESCRIPTION
THAT PORTION OF LOT 8, BLOCK 1, JAMES CLARK'S GARDEN ADDITION
TO THE CITY OF SEATTLE, ACCORDING TO . THE THEREOF,
RECORDED IN VOLUME 13 OF PLATS, PAGE 12, IN KING',COUNTY,
WASHINGTON LYING WEST OF THE EASTERLY' MARGIN OF :STATE ROAD
NO. 1 (PACIFIC HIGHWAY S.) AS ESTABUSHED; BY: DEED•. RECORQED
UNDER RECORDING NUMBER 2014233;' • .
EXCEPT THAT PORTION THEREOF • CONDEMNED:if OR PUBUC ROAD AND
HIGHWAY PURPOSES IN KING. COUNTY SUPERIOR COURT CAUSE
NUMBER 609948;
TOGETHER WITH THE NORTH 322.7 FEET OF •THE : WEST 0;1 -.tt [ , OF
THE EAST 540 t- tt t OF THE SE .1/4 :: OF;TH
,,E §,W ;�1:% • ,OF`
.SECTION 15,
T 23 N, R 4 E, W.M., •IN •KING";: COUNTY . WASHINGTON;;: %'
EXCEPT THAT PORTION:. THEREOF CON • �� O, �THE :
WASHINGTON FOR D
TA'j'E'- ,RO•AD;t• N0:';1 ' (��PACI BY
DEED RECORDED RECORDINGTNUMBER2(1481��`4; ' D= ''`
EXCEPT THAT.. PORTION RTHEREOF CQQNDP�N,, Q jF,,o IO :�' OW i )e'..
NUMBER .
OF WAY (42nd 'AVE"',S )f.IN. KING CO .4,SUPERR�, OU �;T!;;CAUSE
61 ; , n s �:;... �.�.. ,
ER 4098• -.> x:4`4 :i'_ l : r.� : :.,f: ; .,�� P.;.. ,
+ •:.ar j tt:�i1% > ,: ' er r" � " ."� ��• ' r, ,.r P {' [t ,{ r
• 'r�. `�.: •ayr .ZI 4 2N' ��• �t � /1.� ('lr 1. �r ♦ �i 1 y
. i :.. t.ti N". .' .. .... .; '.._... ,.. ;h� ....: �. j7 r1 y � 1 `
TOGETHER WITH THAT PORTION OrVACATED - tti %AVE " '
STREET) LYING EASTERLY OF STATE ROAD NO.1 '(PACIF),C HIGHWAY S.)
AND 'ADJOINING ALL THE'. HEREINABOVE DESCRJBED.';PA iCELS OF LAND;
EXCEPT ANY MOBILE /MANUFACTURED HOME ? LOCATED `THEREON•
1. THE LEGAL DESCRIPTION SHOWN HEREON IS FROM A TITLE REPORT
BY CHICAGO TITLE INSURANCE COMPANY ORDER NUMBER 484265
DATED JUNE 17, 17, 1997.
2. THIS SURVEY WAS MADE WITH A SOKKIA TOTAL STATION USING THE
RANDOM TRAVERSE METHOD. THE BASIS OF BEARINGS IS FROM
KING COUNTY ENG. DEPT. DRAWING FOR 42nd AVE S. AND 40th AVE
S. SURVEY NUMBER 15-23-4-29, DRAWING DATED MAY 25, 1962.
OTHER REF. DATA:
PLAT — VAL —VUE ADDITION, VOL 40 PG 4
PLAT — ROBBINS VIEW TRACT ADDITION, VOL 17 PG 90
PLAT — JAMES CLARKS GARDEN ADDITION, VOL 13 PG 12
RECORD OF SURVEYS — 79080339002, 7810179002
3. TOTAL PARCEL AREA — 168,966.2 SQ.FT (3.88 ACRES) MORE OR LESS.
A PORTION OF SE 1/4 OF SW 1/4 OF SECTION 15, T23N, R4E, W.I
BOUNDARY SURVEY
FOR
SOUTH GATE -- ANDERSON LLC
DRAWN BYGTP DA I _ 9 JOB N0.227
CHECKED BY SCALE ( n = 1 00 , SHEET
OF
PART A; (To be con, • feted by applicant)
Site Address (Attach map and Legal Description showing
hydrant location and size of main):
11Whoin lifircirmatidmr . , •'•- - - , - • • . -' i•44'
latifleatittittP ttOntt- 4; •
.: ,
;-
Name: L API. 19 , A ili e_r 154 r)
Name:
Address: / 14 De_.E-, _ 4,4-2.0 / vc-7, e.. • 2
Address:
Phone: ./..)L-- 1 4`3(j -- )D5 - —
Phone:
This certificate Is for the purposes of:
0 Residential Building Permit 0 Preliminary Plat El Short Subdivision
El CommerciaVindustrial Building Permit El Rezone El Other
Estimated number of service connections and meter size(s): A b)
Vehicular distance from nearest hydrant to the closest point of structure ft.
Area is sen/ by (Water u lily d' trict): bti , el.,lac1 ) 7 `
Owner/ r :ig - tursr
,
Dat - •
4
Certificate of Water Availability
PROJECT #:
CITY OF UKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100, Tukwila, WA 98188
Telephone: (206) 431-3670
PART B: (To be completed by water utility district)
The proposed project is located within t tg_
(City/County)
H-11a
1 (Required only if outside City of Tukwila water utility district)
The improvements required to upgrade the water system to bring it to compliance with the utilities comprehensive
plan or to meet the minimum flow requirements of the project before connection:
(Use separate sheet if more room is needed) _
Based upon the improvements listed above, water can be provided and will be available at the site with a flow of
V Od gpm at 20 psi residual for a duration of 2 hours at a velocity of / 7-- fps as documented by the
attached calculations.
I hereby certify that the above information is true and correct.
A A )
Agen hone clO(0-4 a -154
By
3 /0 — 0/
Date
PART C: (To be completed by governing jurisdiction)
Water Availability: 0 Acceptable service can be provided to this project
Cl Acceptable service cannot be provided to this project unless the improvements in item C2 are met.
El System isn't capable of providing service to this project.
Minimum water system improvements: (At least equal to B2 above)
(Use separate sheet if more room is needed)
MAY 1 6 2001
Agency/Phone
By
Date
.„1Y,TRAVAII,DOC 6/5/96
Owner's Name ( Anc.r3 n
(Last. F•rst. M%cols (r la))
Property Tax I.D. Number I 5' 2 nDg}- f'-f4 -r - 45
Property Legal Address:
Subdivision Name7Arte aLMK p - 4Subdiv. #
Lot # 8 Block #
Building Name
(If aDOlicable)
Re .dential Sewer Use CertifiL. don
(To be completed for all new sewer connections, reconnections, or change of use of existing connections.
This form does not apply to repairs or replacements of existing sewer connections within five years of disconnect.)
Pursuant to King County Ordinance No. 11034, all sewer customers who establish a new service which uses metropolitan sewage facilities _
after February 1, 1990 shall be subject to a capacity charge. The amount of the charge is established annually by the King County Council
and is currently S10.50 per month per residential customer or residential customer equivalent for a period of fifteen years. The purpose of
the charge is to recover costs of providing sewage treatment capacity for new sewer customers. The charge is collected semi - annually. All
future billings can be prepaid at a discounted amount.
Questions regarding the capacity charge or this form should be referred to King County Wastewater Treatment Division at (206) 684 -1740.
(Please print or type)
i
Property •
Street Address Nbb.5 - 4
City, State, Zip TLf k ' L , LA- L(..) ' /L $
Owner's Mailing
'
Address /1D4 -'7a <7- cj # .1.)
(If different from
above)
Owner's Phone Number (u?d L ) 9 - IDS 5
Property Contact Phone Number ( ) i D
Party to be Billed
Of different from owner)
Party's Mailing Address
n.�
City or Sewer District J8 " : " 0/
Date of Connection
Side Sewer Permit #
Demolition of pre - existing building? .~ Yes No
Type of building demolished?
Sewer disconnect date?
Please check appropriate box:
E Single- family
E Duplex (0.8 RCE per unit)
3 -Plex (0.8 RCE per unit)
4-Plex (0.8 RCE per unit)
Li 5 or more (0.64 RCE per unit)
No. of Units
Mobile home space (1.0 RCE per space)
No. of Spaces
x 1.0 =
Residential Customer
Equivalent (RCE)
1.0
1.6
2.4
3.2
x 0.64 =
Print Name of Owner /Representative C/ A'L. R. x9' ri.,-)n
1057 (Rev. 7;0o) White — King County Yellow — Local Sewer Agency
For King County user
Account#
Monthly Rate
Six Month Due
For condominiums, please fill out Supplemental Form A in addition to this form.
I certify that the information given is correct. I understand that the capacity charge levied will be based on this information
and any deviation will require resubmissionpf corrected data for determination of a revised capacity charge. l
/
Signature of Owner /Representative �' 1i % : tilt l r• L - Date r
0
Pink — Sewer Customer
ontractor Registration
or. tractor Information in Sierra:
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