HomeMy WebLinkAboutPermit M04-046 - GRIFFITH RESIDENCEGRIFFITH RESIDENCE
12248 43RD AVENUE
SOUTH
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City of Tukwila
Department of Community Developmehc / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 0179000290
Address: 12248 43 AV S TUKW
Suite No:
Tenant:
Name: GRIFFITH RESIDENCE
Address: 12248 43 AV S, TUKWILA WA
Owner:
Name: GRIFFITH ALFRED
Address: 12248 43 AV S, TUKWILA WA
Contact Person:
Name: ALFRED GRIFFITH
Address: 12248 43 AV S, TUKWILA WA
Contractor:
Name: KING'S HEATING INC
Address: 2317 N 179, SEATTLE WA
Contractor License No: KINGSHI044JA
MECHANICAL PERMIT
DESCRIPTION OF WORK:
INSTALLING 1 80% YORK DIAMOND FURNACE WITH 10 SUPPLY AIRS AND 1 RETURN AIR.
INSTALLING ALL REGISTERS, GRILLS AND THERMOSTAT FOR COMPLETE SYSTEM.
Value of Construction: $3,856.00 Fees Collected: $70.25
Type of Fire Protection: N/A Uniform Mechnical Code Edition: 1997
Permit Center Authorized Signature:
Permit Number: M04 -046
Issue Date: 05/10/2004
Permit Expires On: 11/06/2004
Phone: 206 767 -7120
Phone: 206 767 -7120
Phone: 206 361 -1380
Expiration Date:03 /07/2006
Date:
6 - V
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and
ordinances governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws
regulating construction or the performance of work. I am authorized to sign and obtain this mechanical permit.
Signature: 0
Print Name:
This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is
suspended or abandoned for a period of 180 days from the last inspection.
doc: Mech
(v2(ric/
M04 -046
Date: / / 6
Printed: 05 -10 -2004
doc: Conditions
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
PERMIT CONDITIONS
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Parcel No.: 0179000290 Permit Number: M04 -046 $-
Address: 12248 43 AV S TUKW Status: ISSUED 6 Suite No: Applied Date: 03/25/2004 J v
Tenant: GRIFFITH RESIDENCE Issue Date: 05/10/2004 c) o
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5: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any o o
o
construction. These documents are to be maintained and available until final inspection approval is granted. p N
of
6: Any exposed insulations backing material shall have a Flame Spread Rating of 25 or less, and material shall bear = w
identification showing the fire performance rating thereof. I—
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7: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997 iii N
Edition) as amended, Uniform Mechanical Code (1997 Edition), and Washington State Energy Code (1997 Edition). F= _
O H
8: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations shall not be Z
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 ordinance of the jurisdiction. No permit presuming to give authority to violate or cancel the provisions of this
code shall be valid.
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: Plumbing permits shall be obtained through the Seattle -King County Department of Public Health. Plumbing will be
inspected by that agency, including all gas piping (296- 4722).
4: Electrical permits shall be obtained through the Washington State Division of Labor and Industries and all electrical
work will be inspected by that agency (206 -835- 1111).
9: Manufacturers installation instructions required on site for the building inspectors review.
10: Ventilation is required for all new rooms and spaces of new or existing buildings in conformance with the Uniform
Building Code and the Washington State Ventilation and Indoor Quality Code, Chapter 51 -13 WAC.
11: Fuel burning appliances may not be installed in sleeping rooms, U.M.C. 304.5.
12: Appliances which generate flame, spark or glowing ignition, shall be elevated 18 inches above the floor (U.M.C.
303.1.3.).
13: Water heater shall be anchored to resist earthquake (U.P.C. 510.5).
* *continued on next page **
M04 -046
Printed: 05 -10 -2004
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 work.
Signature:
doc: Conditions
Print Name:
M04 -046
of law and ordinances
other work or local laws
Date: 5/�U/
Printed: 05 -10 -2004
CITY OF TUKWIL n
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
Building Permit To
Mechanical Permit. No
Public Works' Permit No.
Project No.
(For: office use only,
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: / 22 T q5 /4 VE
King Co Assessor's Tax No.:
Suite Number: Floor:
New Tenant: .... Yes ❑ ..No
Tenant Name: AL ,c/ t%;
Property Owners Name: c L. F/eco / /, �j
Mailing Address: /2- 2 UJ a 4 3 41 "- 41../F. S. ruk-fr ! /L�} WA - IS- O
Cit State Zip
Name:
/ e c-/2 )r /7?-/
Mailing Address: ' A'm E
E -Mail Address:
GENERAL CONTRACTOR INFORMATION=
Contact Person:
E -Mail Address:
Contact Person:
E -Mail Address:
Contact Person:
E -Mail Address:
\applications\pennit application (3.2003)
3/2003
Page I
Day Telephone: WO
City
Fax Number:
Company Name: k/ A) S H AJ C� 1 A/C,
Mailing Address: 2 3 /"7 �Y ' / 79' I " 2 /"/ F W4, 9S(/ 33
City State Zip
Day Telephone: / — 11 5
Fax Number:
Contractor Registration Number: t 2A/ I L e Expiration Date:
* *An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
ARCHITECT..;OF RECORD , All plans mustbe wet stamped by Architect , of Recor
Company Name:
Mailing Address:
City
Day Telephone:
Fax Number:
State
State
State
Zip
Zip
;ENGINEER "OF RECORD All plans'must be w stamped .by Engineer of Record
Company Name:
Mailing Address:
Zip
City
Day Telephone:
Fax Number:
a+ul:i +4.:.:..L'w.wl:fw • "i4n�G n .a�L+a.Y.�s.1:.t1 — •' = v
Valuation of Project (contractor's bid price): $
Existing Building Valuation: $
Scope of Work (please provide detailed information):
Will there be new rack storage? ❑ ..Yes El .. No If "yes ", see Handout No. for requirements.
Provide All Building Areas. in Square Footage Below
Floor.
Floors • thru
Basement .'
Accessory Structure
::Attatlied.Garagell
;Detached: Garage
Attached Carport;.:
Detached Carport e
Covered Deck
Uncovered Deck.. ": .
Interior
Remodel
Type of
Construction
per UBC
to
Existing
Structure
Type 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: Handicap:
Will there be a change in use? ❑ ....Yes ❑ ..No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0.. Sprinklers 0..Automatic Fire Alarm ❑..None ❑ . Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes ❑ ..No
If "yes", attach list of materials and storage locations on a separate 8-1/2 x 11 paper indicating quantities and Material Safety Data Sheets.
\applications \permit application (3 -2003)
3/2003
Page 2
Scope of Work (please provide detailed information):
Please refer to Public 'Works Bulletin #1 for fees and estimate sheet.
Water District
❑ ...Tukwila ❑ ...Water District #125
❑ ...Water Availability Provided
Sewer District
❑ ...Tukwila ❑... 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 (murk 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
❑ . ..Constrtiction/Excavation/Fill - Right -of -way
Non Right -of -way
❑ ...Total Cut
❑ ...Total Fill
\applications \permit application (3.2003)
3/2003
cubic yards
cubic yards
❑ ...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 _
„
❑ .. Abandon Septic Tank
❑ .. Curb Cut
❑ .. Pavement Cut
❑ .. Looped Fire Line
„
Call before you Dig: 1- 800 - 424 -5555
„
WO#
WO#
WO#
Private
Private
❑ .. 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 Slate Zip
Page 3
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
❑...Deduct Water Meter Size
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty :
Boiler /Compressor:
Qty
Furnace <100K BTU
I
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 /1,000,000 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
r F�
CHANICAL TERMIT INFO;<..�IATION 206 = 43113670
MECHANICAL CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
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 **
/
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Valuation of Project (contractor's bid price): $' � g J (Q /
0 1 Scope of Work (please provide detailed information): //(/ L / -g ' *,64- 1)1 am O.ti Ll Fc4 /2ND
W i7-Il / 0 su ppl/ A-i/25 and 1 '1p e 4- ,u /.-,2. • /'Ns 4=
,� ec, /S7 -� / 9 t„, ./f - therm 0 ' r ' v nrl pI -e e Sy $ ff, •
Use: Residential: New ....0 Replacement ....DI
Commercial: New .... Replacement ....
Fuel Type: Electric Gas .... Other:
Indicate type of mechanical work being installed and the quantity below:
ICATIONNOT
pplicable 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 PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER Og AUTHORIZE AGF�NT:
Signature:
tapplicationslpermit application (3.2003)
3/2003
Date: 3 -.2 `- 64 1
Print Name: / L i/ / / Day Telephone:
Mailing Address: 1.2244 g' ! 3 dp D , 4 v 1 3, - 7 - 1A k IA) /L 1'V 4- R
State Zip
Date Application Accepted:
3.-
Date Application Expires:
Staff Initials:
vezTeE
i
Page 4
City
Receipt No.: R04 -00560
SKS
1165 ..
Initials:
User ID:
ACCOUNT ITEM LIST:
Description
doc: Receipt
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 0179000290
Address: 12248 43 AV S TUKW
Suite No:
Applicant: GRIFFITH RESIDENCE
Payee: ALFRED GRIFFITH
TRANSACTION LIST:
Type Method Description
MECHANICAL - RES
PLAN CHECK - RES
RECEIPT
Payment Check 5100 70.25
Account Code Current Pmts
000/322.100 56.20
000/345.830 14.05
Permit Number: M04 -046
Status: APPROVED
Applied Date: 03/25/2004
Issue Date:
Payment Amount: 70.25
Payment Date: 05/10/2004 02:42 PM
Balance: $0.00
Amount
Total: 70.25
,.0757 05/1.1. 971.6 TOTAL 70.25
Printed: 05 -10 -2004
Project: V Vy`T }.
57' / /TN /06: - /v {e
Type of Inspection
"f ,-
Address:
7 ` /3 4'° / S.
Date Called:
,. `7-‘2 5
_
_L
Special Instructions:
Date Wanted:
=3 - 7/- D ::
7 a.m.
P.m.
Requester:
Phone No:
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter,alvd., #100, Tukwila, WA 98188
74 Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
R+ CO letA 4
1 lnspecto jr
Receipt No.:
(206)431 -3670
Date:
3 -11- 0s
E $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
Date:
77
1
yype of
nsp ction:
AdcJ r s ife ���
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//
Date Celled: 7 /6vi
Special Instructions:
`
Date Wanted: �y ,(
U4
p.m.
RA / tec: 2
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Phone No: �j
2 7L7 — / /2-o
INSPECTION RECORD
Retain a copy with per
INSPECTI • N
CITY OF TUKWILA BUILDING DIV S
6300 Southcenter Blvd., #100, Tukwila, WA 98188
mD 0vv
0 S47. INSPECT' • FEE REQUIRE r. Prior to inspection, fee ust be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
COM TS:
Approved per applicable codes. I .. I Corrections required prior to approval.
Receipt No.:
'Date:
COMMENTS:
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E' Pnr� Z I'1 ?uu1
Address:
13-,..gQ, 4-1 -
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Special Instructions:
n
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a.m.
p.m.
1
Phone No:
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Address:
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Date Called:
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Special Instructions:
Date Wanted:
1p 'JCi 041
a.m.
p.m.
Requester:
Phone No:
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
['Approved per applicable codes.
INSPECTION RECORD
Retain a copy with permit
forrections required prior to approval.
Inspectorr e n ()^ 'l��ofn� - x-►� �L.. 1Date: 2-
y JCJ( C 0'�z9-G l
$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: 1 ) 9 ,,,,,4,A;,.., 1 c 4 itG0c i
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Address:
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Date Called:
Spte al Instructions:
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Date Wanted : a.m.
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P.m.
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Requester:
Phone No:
2 0 Ce — 70
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Approved per applicable codes.
INSPECTION RECORD
Retain a copy with permit
/f
(206)431 -3670
121 Corrections required prior to approval.
Date: 1 Co- 0
$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:
Project:
Gr-k-k
Type of Inspection:
Address:
1 • AU-
Date Called:
Special Instructions:
Date Wanted:
a.m.
P.m.
Requester:
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Approved per applicable codes. Corrections required
prior to approval.
COMMENTS: - ) ,--
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INSPECTION RECORD
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
' 6300 Southcenter Blvd., #100, Tukwila, WA 98188
2
Inspector:
Retain a copy with permit
(206)431-3670
'Date: ( to, cyl
El $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:
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Special Instructions: ,
Date Wanted: t �
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Requester: �,
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Phone No: -1 / 7 r7 /DO
COMMENTS:
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Date;
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INSPECTION NO.
Receipt No.:
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INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
PER —
(206)431 -3670
Approved per applicable codes. Corrections required prior to approval.
$47 I I REINSPECTIONIFEE REQUIRE I1 Prior to inspection, fee must be
d at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
'Date:
By
Date
Permit No.
FILE CO
EPARATE PERM
REQUIRED FOR:
0 MECHANICAL
UIELECTPJCAL
PLUMBING
1/ GAS PIPING
CITY OF TUKWI
BUILDING DIVISIO
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-
tractor's copy of approved plans acknowledged.
1
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A M - 01.5 1 t Orr
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' REMMONS
ellAKSIES S1.IALL E MPE TO
ST,'OPE OF WORK WM40UT PFICOR
OF 717T,,,,19L4ea BUILDIN DIVISCN.
f..7-'!1!-J,:..413 WILL PEOUIRE A NEW P SUBMITTAL
tat) tk,t.AY 1L.UDE ADDITIOM PLAN PM W PEr-...S.
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RECENEO
CITY OF TUKWILA
MAR 2 5 2004
PERMIT CENT&
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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.
3
11 -02 -2004
ALFRED GRIFFITH
12248 43 AV S
TUKWILA WA 98178
RE: Permit No. M04 -046
12248 43 AV S 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 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 12/29/2004, 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
}c
xc: Permit File No. M04 -046
Bob Benedicto, Building Official
City of Tukwila
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206- 431 -3665
ACTIVITY NUMBER: M04 -046
PROJECT NAME: GRIFFITH RESIDENCE
SITE ADDRESS: 12248 43 AVENUE SOUTH
DATE: 03 -25 -04
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision # aftertbefore permit is issued
DEPARTMENT :
v
Building ivisio 32o -ot
Public Works ❑
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
510 A/tL R,„
Fire Prevention Ln
Structural ❑
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 03 -30 -04
Complete Nd
Comments:
Incomplete ❑
Not Applicable ❑
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS ROUTING:
Please Route [ � Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
DUE DATE: 04 -27 -04
Approved ❑ Approved with Conditions Not Approved (attach comments) ❑
Notation:
APPROVALS OR CORRECTIONS:
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 :
. ,:.
KINGSHI044JA.03 07 /200
EFFECTIVE DATE.- X 9 9 6
KING HEATING INC
231.7.. N-- 179TH:.
SETTLE: WA 98I33 -5151
Signature
. I se Issued by
d _ Y DEPARTMENT OF LABOR
... �::. "- -- ------ _- _.._:�,.� AND INDUSTRIES
: NOTICE IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT.