HomeMy WebLinkAboutPermit M04-217 - NG RESIDENCEParcel No.: 0179001048
Address: 12225 47 AV S TUKW
Suite No:
City GA Tukwila
Tenant:
Name: NG RESIDENCE
Address: 12225 47 AV S, TUKWILA WA
Owner:
Name: NG, RAYMOND
Address: P.O. BOX 4084, RENTON WA
Contact Person:
Name: RAYMOND NG
Address: P.O. BOX 4084, RENTON WA
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
Contractor:
Name: SKYWAY HOME IMPROVEMENT INC
Address: P.O. BOX 4084, RENTON, WA
Contractor License No: SKYWAHI00203
Value of Mechanical: $4,000.00
Type of Fire Protection:
Furnace: <100K BTU 1
>100K BTU 0
Floor Furnace 0
Suspended /Wall /Floor Mounted Heater 0
Appliance Vent 1
Repair or Addition to Heat /Refrig /Cooling System
Air Handling Unit <10,000 CFM 0
>10,000 CFM 0
Evaporator Cooler 0
Ventilation Fan connected to single duct 0
Ventilation System 1
Hood and Duct 0
Incinerator: Domestic 0
Commercial /Industrial 0
doe: IMC- Permit
MECHANICAL PERMIT
* *continued on next page **
M04 -217
Permit Number:
Issue Date:
Permit Expires On:
Phone:
Phone: 206 356 -1628
Phone: 206 772 -1886
Expiration Date:09 /18/2005
DESCRIPTION OF WORK:
INSTALLING NEW HVAC SYSTEM INTO NEW SINGLE FAMILY RESIDENCE TO INCLUDE GAS
FURNACE AND ASSOCIATED DUCT WORK.
Steven M. Mullet, Mayor
Steve Lancaster, Director
M04 -217
05/02/2005
10/29/2005
Fees Collected: $231.56
International Mechanical Code Edition: 2003
EQUIPMENT TYPE AND QUANTITY
Boiler Compressor:
0 -3 HP /100,000 BTU 0
3 -15 HP /500,000 BTU 0
15 -30 HP /1,000,000 BTU.. 0
30 -50 HP/1,750,000 BTU.. 0
50+ HP/1,750,000 BTU 0
Fire Damper 0
Diffuser 0
Thermostat 1
Wood /Gas Stove 0
Water Heater 1
Emergency Generator 0
Other Mechanical Equipment
Printed: 05 -02 -2005
Permit Center Authorized Signature:
doc: !MC-Permit
City GA 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
M04 -217
(
Steven M Mullet, Mayor
Steve Lancaster, Director
Permit Number: M04 -217
Issue Date: 05/02/2005
Permit Expires On: 10/29/2005
Date: e VS
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.
Date: `( 0 S
Signature:
Print Name: kyilPitof l�U�
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: 05 -02 -2005
Parcel No.: 0179001045
Address: 12225 47 AV S TUKW
Suite No:
Tenant: NG RESIDENCE
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
1: ** *BUILDING DEPARTMENT CONDITIONS * **
PERMIT CONDITIONS
Permit Number: M04 -217
Status: ISSUED
Applied Date: 12/13/2004
Issue Date: 05/02/2005
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: Insulating materials, where exposed as installed in buildings of any type of construction, shall have a flame spread
index of not more than 25 and a smoke development index of not more than 450. Where facings are installed in concealed
spaces in buildings of Type III, IV, or V construction, the flame spread and smoke - developed limitations do not apply
to facings, that are installed behind and in substantial contact with the unexposed surface of the ceiling, wall or
floor finish.
5: 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.
6: Manufacturers installation instructions shall be available on the job site at the time of inspection.
7: Ventilation is required for all new rooms and spaces of new or existing buildings and shall be in conformance with the
International Building Code and the Washington State Ventilation and Indoor Air Quality Code.
8: Except for direct -vent appliances that obtain all combustion air directly from the outdoors; fuel -fired appliances
shall not be located in, or obtain combustion air from, any of the following rooms or spaces: Sleeping rooms,
bathrooms, toilet rooms, storage closets, surgical rooms.
9: Equipment and appliances having an ignition source and located in hazardous locations and public garages, PRIVATE
GARAGES, repair garages, automotive motor -fuel dispensing facilities and parking garages shall be elevated such that
the source of ignition is not Tess than 18 inches above the floor surface on which the equipment or appliance rests.
10: Water heaters shall be anchored or strapped to resist horizontal displacement due to earthquake motion. Strapping shall
be at points within the upper one -third and lower one -third of the water heater's vertical dimension. A minimum
distance of 4- inches shall be maintained above the controls with the strapping.
11: 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).
12: 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).
13: 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
doc: Conditions
M04 -217
Printed: 05 -02 -2005
doc: Conditions
City of Tukwila
* *continued on next page **
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
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.
M04 -217 Printed: 05 -02 -2005
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 of law and
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 work
regulating construction or the performance of work.
Signature: 7 Date: S 1
Print Name:
doc: Conditions
A t g,„d J.
ordinances
or local laws
M04 -217 Printed: 05 -02 -2005
CITY OF TUKWILA
Community Development ... epartment
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
Building Perma. c�
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: I a.2.)-S it-7 t4 Ae
Tenant Name:
Property Owners Name: R& r' O tL Nil
Mailing Address: P. 0 F o) .
n 1,
Name: tga�►�noo _
Mailing Address: Pa L . / �f
E -Mail Address: Z) /Y!11d /b [1) Covet. 474-
Company Name: �k� l,U 0.y golvv .
Mailing Address: P. 0 B (3)( 4024
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
Company Name:
Mailing Address:
des; n51 d
\permits plus \ia changeslpermil application (7.2004)
Roiptom
]sr t, r t tl /Jot/ dal
ly Al" / S ih.
d id Al ykiiwt
As to 1;0001 r [.vn.
1160 8(r' Au.e 1;a1-4
.
Contact Person: bf165' R . Tem . e/
E -Mail Address:
Pagc
King Co Assessor's Tax No.:
5 0L1 -111 . Suite Number: Floor:
New Tenant: ❑ .... Yes ❑ ..No
City
State
Day Telephone: (2 ) SL "/C2 6/1404 7
City y State Zip
Fax Number: ( o6) 771 — 6c77
GENERAL: CONTRACTOR. INFORMATION (Mecbanical:Contractor information . on back page)
kotiellt.4'r1 t 14 ( .
LA/4 9 ?OS 7
17 yoo /o'k
WS 7
Zip
City
p
Contact Person: tlkyfkci^a /!Js Day Telephone: / o6)
E -Mail Address: Fax Number: (O6) 772- - b072
Contractor Registration Number: Sgl.1/J. /41002 at Expiration Date: 9
* *An original or notarized copy of current Washington State Contractor License must be presented at the ance **
State Zip
77 !I'e
I
'(j /D&
time of permit issu
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
Pm Wei f1032-
City `` State Zip
Day Telephone: (2S' 3) 872 - 2-S7U
Fax Number: i1j-3) 872 — 3i511
City
A4- ong .
State Zip
Day Telephone: W3) t772. - 14TO
Fax Number: 1.2 1) 872- i�7 .
•
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Compressor:
0 -3 HP /100,000 BTU
Qty
.
Furnace <100K BTU
(
Air Handling Unit >10,000
CFM
Fire Damper
Fumace>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
Heat/Refrig/Cooling
System
Incinerator - Domestic
Emergency
Generator
Air Handling Unit
<10,000 CFM
Incinerator — Comm/Ind
Other Mechanical
Equipment
MECHANICAL PERMIT INFOI_ ,CATION — 206 -431 -3670
MECHANICAL CONTRACTOR INFORMATION
Company Name: ■ita I' '*
Mailing Address: 110 F. 3s-4 cf Ta COMQ (14 , S l { w
Cad /�,� , J _ / t.y r City. State �+ Zip
L
Contact Person: ai'( /NtCCYkG Day Telephone: / 2s'i) � [� - .Z
E -Mail Address: / Fax Number: (250 X72- coo 2_
Contractor Registration Number: CARMAN* 000(16 Expiration Date: ' t / 247ot
"An original or notarized copy of current Washington State Contractor License must be presented at the time of permit issuance **
V
Valuation of Project (contractor's bid price): $ 4, 000
Scope of Work (please provide detailed information): mu' - cideitet(i
Use: Residential: New ....�
Commercial: New .... ❑
Fuel Type: Electric
Print Name:
Mailing Address:
\permits plus\icc changes \permit application (7.2004)
Ra /,t41I �
p. 0 Box koel-
Replacement
Replacement
❑ Gas ....fg Other:
Indicate type of mechanical work being installed and the quantity below:
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 PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER OR AUT RIZED AGENT:
Signature: Date: 121131
Page 4
Day Telephone: (2o6) 3(6 -/AF
City
(i itos7
State Zip
Date Application Accepted:
Date Application Expires:
Staff Initials:
1
RECEIPT 1
Parcel No.: 0179001048 Permit Number: M04-217 i vj
Address: 12225 47 AV S TUKW Status: PENDING s N o
Suite No: Applied Date: 12/13/2004 N W
Applicant: NG RESIDENCE Issue Date:
co wi
Receipt No.: R04 -01667 Payment Amount: 201.56 IL a
N 3
Initials: SKS Payment Date: 12/13/2004 03:41 PM w
User ID: 1165 Balance: $0.00 z
0
Payee:
City of Tukwila
TRANSACTION LIST:
Type Method Description Amount H-
O
201.56 t lu N; .
Payment Check 5082
ACCOUNT ITEM LIST:
Description
doc: Receipt
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
LINCOLN ALAN LOUIE /RAYMOND NG PROPERTY ACCOUNT
MECHANICAL - RES
PLAN CHECK - RES
Account Code Current Pmts
000/322.100 167.25
000/345.830 34.31
Total: 201.56
71300 2/14 Th.6 TOTAL. rAL. 1.41 4
Printed: 12 -13 -2004
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.
PER IT N
(206)431 -3670
Type of Inspec _ �}
Pro a t
A ,. s.
Special Instructions:
Date Called: \2..., 0 '�
(L ((�� m.
Date Wanted. D
Req � r:
Phn eon _33 -
Corrections required prior to approval.
COMMENTS:
P i wt ice.. \ +t� �'t
tit L
p•id a
J RecelpfN.:
Gk.A ) r►
REINSPECTION FEE R QUIRED. Prior tglinspection, fee must be
6300 Southcenter Blvd., Suite 100. Cal to sechedule reinspection.
(Date:
Date:
1Z LI .04
Pro a t: Ai-4'f
Type of I spection: (��
'
Addr s:
I 2,2Se"
save 50.
Date C�Iled
7 tec
Special Ins ructions:
Date Wanted:
7 / `f DC
m.
p.m.
Requester: j
P ryirne 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
(206)431 -3670
Corrections required prior to approval.
COMMENTS:
�! Lt -S pp r
r
'Inspector:
'Date:
/ /0
El S58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
'Receipt No.:
'Date:
iY W
� c
U
to 0
co W
J
Nu_
W O,
2
g
Q
FW
Z� .
I-6
W H:.
W
• 0
O —
• 0 I—
1 -
H
LL' O
ll •
U N ..
O :
COMMENTS: `
Type nspection:
Ad r
�5 �7
6- Al C L �4 P ,/ae -- C f! RA-
Date alled:
ild //7 OS
E�// io7 i / / >10
p c Sys -/.•i
Date Wanted:
1 05 p.m.
a 6 u(7 /gin -1 6,G
Phone No:
� 3 — /O�/
f
,AkdA�K7 d C/-� bNNP1.)J)yy / 4-'7)
3
Le. "itee.
a - 1/F J e 4,12
c
v . / = /oCV
/
AJ WI. . ,•
I f F
f
Pro cc : 44
Type nspection:
Ad r
�5 �7
five.
Date alled:
ild //7 OS
Special Instructions:
Date Wanted:
1 05 p.m.
Requester:
4/ 5 •
Phone No:
� 3 — /O�/
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
(20 • )431 -3670
Corrections required prior to approval.
Inspec . Date•
$ .00 REINSPECTION EE REQUIRE P rior to ipspection, fee must be
id at 6300 Southcenter Blvd., Suite 100,.Call to sechedule reinspection.
Receipt No.:
'Date:
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
nre *gin f fir^
RESIDENTIAL HEATING AND VENTILATION COMPLIANCE FORM
(Complete Sections I and II for Group R Occupancies 4 Stories or Less)
MECHANICAL PERMIT APPLICATION NO.: MO P Zi T
Project Name: f( V3 ►R ia (
Site Address: / Pais 47 AA)
sti4 f i'! - afK(L,a lC i/1
I. WASHINGTON STATE ENERGY CODE HEATING DESIGN METHOD (select A, B or C below):
A. ❑ System Analysis — W.S.E.C. Chapter 4 (submit documentation)
B. 0 Component Performance Approach — W.S.E.C. Chapter 5 (submit documentation)
C. gl Prescriptive Option — W.S.E.C. Chapter 6 (for prescriptive, complete the following calculation):
House Square Footage (heated space): ' 2 5
X 20 BTU /h:. -, \ i .: \ �'
C ,E
x C Ma ,ximum BT of Heating System Output
❑ Heating System Installed, (check system type elow):"�
1. ❑ Electric Resistance
2. ❑ Electric (forced air)
3. X Other Fuels (gas, heat pump)
I1. WASHINGTON STATE VENTILATION AND INDOOR AI QVALffirCODE (select A or B below):
A. ❑ Ventilation by Performance or Design Method - W.S.V.I.A.Q. Section 302 (submit documentation).
B. ❑ Prescriptive Ventilation Options - W.S.V.I.A.Q. Section 303 (select one of the following):
1. ❑ Ventilation using Exhaust Fans (Section 303.4.1.)
❑ Exception for outdoor air inlets — Forced air heating system w /interior doors undercut 1/2"
2. ❑ Ventilation integrated with Forced Air System (Section 303.4.2.)
3. ❑ Ventilation using Supply Fan (Section 303.4.3.)
4. ❑ Ventilation using Heat Recovery System (Section 303.4.4.)
Prescriptive Minimum /Maximum Outdoor Air Calculation specified in Table 3 -2 (see reverse side of form).
1. House Square Footage: / 2S y-
2. House Number of Bedrooms:
3. Required Outdoor Air Table 3 -2: Minimum - cfm
Effective: 7/1/02
tapplicationstheating and ventilation system — form h-6 (7.2002)
r'!L! COPY
BUILDING PERMIT APPLICATION NO.: Wel41/0
3
0
Maximum -
IEC 1 3 2004
.tis \
11
Permit Center /Building Division:
206 - 431 -3670
Public Works Department:
206 - 433 -0179
Planning Division:
206 -431 -3670
cfm
/441002/7
Floor
Area, ft2
Bedrooms
•
Minimum Smooth
Diameter
less
3
4
5
6
7
8
T t . " , Min
•"�` `�
y' x ,• f `- '>M: ,7;t1W,
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ax
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Max
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65
80
5 inch
15
5 inch
100
110
165
125
188
140
210
.1 - 00 `
100
83 ,,1
> 70 , _
;.,19085i,,
:ii.85 '?;
".;:1 28 ::`
;:;:195 00;
;,15143 0 :;
;;1,15,..:11.735
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:��1`73
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^' ; '•_rt t >. 3'c. k,
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= 1.45 <
-218
1001 -1500
60
90
75
113
90
135
105
158
120
180
135
203
150
225
'?;?:.1501;- 2000 >•- r''65'`::
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;155
X233 :::
2001 -2500
70
105
85
128
100
150
115
173
130
195
145
218
160
240
wti'2501 := 3000:x:'?
c;75 .1;i
' ?113-
y;. 90`:- ;
':(:1
":105`
"-158'
is 120 : ::
;1':135':
i!):' 3;';'1;.,1150:
;:::.22.5
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3001 -3500
80
120
95
143
110
165
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188
140
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155
233
170
255
t1 :=400:0:'
' s85,-
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' 145?.
: i21'8.
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;'.1'1.5:i
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4001 -5000
95
143
110
165
125
188
140
210
155
233
170
255
185
278
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.` 225 '
.165
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e;180:
X
x.195.
5 293'i
6001 -7000
115
173
130
195
145 .•218
160
240
175
263
190
285
205
308
7.001-800cg
4'25 °.
Xi188-:'
1 :40'Ri
b210:0
.',:155.
:t2
::170.;
:'2554
;1:85 =•
;127.8 ?i
t;206
'1=300 _
.'21
23:
8001 - 9000
135
203
150
225
165
248
180
270
195
293
210
315
225
338
' }':61.T=59000:i:itai
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X218':ri.s160V,.240
';175"
;263:
`.:1:90 ":'
71
;205`4008,
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.'235s:}353iPi
Fan Tested CFM
0.25" W.G.
Minimum Flex •
Diameter
Maximum Length
Feet
Minimum Smooth
Diameter
Maximum Length
Feet
Maximum
Elbows'
50
4 inch
25
4 itich
70
3
•"�` `�
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r" :'v t AI 2'
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12 -05 -2005
RAYMOND NG
P.O. BOX 4084
RENTON WA 98057
RE: Permit No. M04 -217
12225 47 AV S TUKW
Dear Permit Holder:
Thank you for your cooperation in this matter.
Sincerely,
MaA5PQ
nnifer Marshall,
Permit Technician
xc: Permit File No. M04 -217
City of Tukwila
Steven M. Mullet, Mayor
Department of Community Development Steve Lancaster, Director
In reviewing our current records the above noted permit has not received a fmal 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 01/11/2006, 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
PERMIT COORD COP\
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: M04 -217
PROJECT NAME: NG RESIDENCE
SITE ADDRESS: 12225 47 AVENUE SOUTH
X Original Plan Submittal
DATE: 12 -13 -04
Response to Incomplete Letter #
Response to Correction Letter # Revision # after /before permit is issued
DEPARTMENT
Buildi
Works
Documents /routing slip.doc
2-28-02
1 l 1 5.
Fire Prevention
Structural
DETERMINA ON OF COMPLETENESS: (Tues., Thurs.)
Complete [ Incomplete ❑
p P
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS Ft TING:
Please Route ,LYiJ{ Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions Not Approved (attach comments) ❑
Notation:
REVIEWER'S INITIALS:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
PERMIT COORD COPY
Planning Division
Permit Coordinator
DUE DATE: 12 -14 -04
Not Applicable ❑
DUE DATE: 01 -11 -05
DATE: