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HomeMy WebLinkAboutPermit 4303 - Red Robin - Tenant ImprovementCITY OF TUKWILA Building Division 6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 -1845 Work to be done Site Address Building Use Property Owner Address Contractor Address BUILDING PERMIT Tenant Improvement 16000 Christensen Rd Office R. A. Feichtmeir 16000 Christensen Rd PERMIT # (43O3 Control # 86 -112 Suite # 303 Tenant Red Robin Assessors Account # 352304 - 9601 -05 Phone # 241 -2110 Zip 98188 Phone # 241 -2110 Zip 98188 Tecton 6000 ristensen R at 'a arky FOR BUILDING PERMIT ONLY approved for iss Tukwila, WA Sq. Warehouse e Retail Other Occ. Load 1st F1. 2nd F1. 3rd F1. 871 109 R -2 17 Total Fire Protection: Zoning Sprinklers [I Detectors Type of Construction Special Conditions Fees sq. ft. @ 1st F1. $ sq. ft. @ 2nd F1. $ sq. ft. @ other $ sq. ft. @ other $ Total Valuation of Construction $ 10,000.00 Bldg. Permit Fee Plan Check Fee Demolition Surcharges Other Other TOTAL Receipt 04 50 $ 8f).00 Receipt #0651 $ 53.00 Receipt # $ Receipt #0651 $ 1.50 Receipt # $ Receipt # $ $ 135.50 FOR SIGN PERMIT ONLY Permanent [] Temporary [[ Single Face Building face E] Double Face [] Wall Mounted Setbacks: Front ['Free Standing [] Other Side Side Rear Square Footage of each sign face Total square footage of sign Special Conditions THIS PERMIT BECOMES NULL ANU VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FUR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT l HAVE READ AND GOVERNI IS TYPE OF WORK WI BE C VIOLAT ! ANCEL THE PR SIONS Signe KAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES IED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TU GIVE AUTHORITY TO F ANY OTHER STATE OR LOCAL LAW REGULATING CONST UCTIO(�„ qR THE PERFORMANCE OF CONSTRUCTION. Date 6 LICENSED CONTRACTORS DECLARATION Business and Professions Code, and my 11 nse is in ll force and effect. Date 1 hereby affirm that I am 1 Contractor (signature) sed under provis OWNER- BUILDER DECLARATION ( ) 1, as owner of the property, or my employees, with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ( ) I, as owner of the property, am exclusively contracting with licensed contractor's to construct the project. Owner (signature) Date ,CITY OF TUKWILA 4: Building Division 6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 -1845 Work to be done Site Address Building Use Property Owner Address Contractor Address BUILDING PERMIT Tenant Improvement 16000 Christensen Rd Office R. A. Feichtmeir 16000 Christensen Rd f�. PERMIT # 44303 Control # 86 -112 Teuton 16000 Christensen Rd Pat Malarky FOR BUILDING PERMIT ONLY approved for issuanc Suite # 303 Tenant Red Robin Assessors Account # 352304 - 9601 -05 Phone # 241 -2110 Tukwila, WA Zip 98188 Phone # 241 -2110 Tukwila, /' 1 \ Zip 98188 S p' Warehouse e Retail Other Occ. Load 1st F1. 2nd Fl. 3rd F1. 871 109 R -2 17 Total _ Fire Protection: Sprinklers E] Detectors Zoning Type of Construction Special Conditions Fees sq. ft. @ sq. ft. @ sq. ft. @ sq. ft. @ 1st F1. $ 2nd Fl. $ other $ other $ Total Valuation of Construction $ 10,000.00 Bldg. Permit Fee Plan Check Fee Demolition Surcharges Other Other TOTAL Receipt #()C150 $ C j.00 Receipt #0651 $ 53.00 Receipt # $ Receipt #0651 $ 1.50 Receipt # $ Receipt # $ $ 135.50 FOR SIGN PERMIT ONLY [[ Permanent Et Temporary J Single Face Building face 0 Double Face E] Wall Mounted Setbacks: Front 0 Free Standing 0 Other Side Side Rear Square Footage of each sign face Total square footage of sign Special Conditions THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED 1S NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK 15 COMMENCED. I HEREBY CERTIFY THAT l HAVE READ AND GOVERNIyyG —TtilS TYPE OF WORK WI 1, BE C VIOLATE / 0CANCEL THE PROVISIONS i Signed, XAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES 1ED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE AUTHORITY TO F ANY OTHER STATE OR LOCAL LAW REGULATING CONSTTRUCCT_IOx_ Q G R THE PERFORMANCE OF CONSTRUCTION. Date 1/ i'r1 /��-- 1 hereby affirm that I am 1 sed,undder/ provis iv�•c ''`Contractor (signature) ( ) 1, as owner of the offered for sale. ( ) 1, as owner of the property, am exclusively contracting with licensed contractor's to construct the project. property, LICENSED CONTRACTORS DECLARATION 64s of Business and Professions Code, and my 11 /�Sense is (in jell force and effect. Date (/ ` a/d f> OWNER- BUILDER DECLARATION or my employees, with wages as their sole compensation, will do the work, and the Owner (signature) Date structure is not intended or CITY OF TUKWILA BUILDING PERMIT INSPECTION RECORD POST AT OR NEAR FRONT OF BUILDING PROTECT FROM WEATHER City of Tukwila 'Wilding DiVision 433-1845 13.P. IA JOB ADDRESS /6000 f,AiLiMeAudifrU 4fre,Y. 3 Control f 810-11 Date Issued 1016 WORK TO,BE DONE OWNER A /1, Fek,i4)67,74,0y CONTRACTOR retenv DATE ISSUED TYPE OCCUPANCY SPECIAL CONDITIONS 'fX■e 4th,■ e.t, : Inspector :must sign all spaelei.;poHtilti ng to this job. TYPE - •::-. - . ' DATE ' i INSP. : NOTES Grading ".- -•,-.(81dg. 433.1845) '''''t . ,•• .. ' ''' , Setback - '."..-0'.(111dg: 433-1b45) •'• Rebar/Footing/Found L. '': ($)dg. a33-14141),. .''.%'','''',.:,-4•:-'2. 2.C;''':'.....,:•.% . ,..,..„ , . -, Slab • .. (lildi. 433-1845) .. •— .. , , ., .- ., , Grout . 1111dg. 433-1845) .., „,:. • -• - - ' - . , - •!•• . , ' ' Free •• ' (Bldg. 433-1845) ' ■ ,. . , . .. Roof 1 ng '- ' (B)dg. 433-1845) Insulation •(Bldg. 433-1845) ! : • ,, -• Mechanical (8)dg. 433-1845) I Wall Board – (81dg. 433-1845) Utilities . Water/Sewer/Drainage ' (Shops 433-1860) . Parking (Ping. 433-1845) ..., Landscape illing. 433-1845f ? Street Use Permits (PWD 433-1850) Fire (Fire 433-1859) FINAL • (B)dg. 433-1845) 5494 c...e • CITY OF TUK ILA Central Permit System Control No. '`'; t /, Permit No. f� FINAL APPROVAL FORM TO: ❑ Building ❑ Planning ❑ Public Works I Fire Dept. ❑ Police El Parks /Recreation I Project Name / 2( Address (, 00 0 Type of Permit(s) This project is nearing completion. Please investigate your area of responsibility and indicate below either your final approval or necessary corrections. If no response is received within one week, it will be assumed that the project is of no concern to your department and a certificate of occupancy may be issued. This project is NOT approved by this department; the following corrections are necessary: () () () () () () () () () () Authorized Signature Date / This project is approved by this department: Authorized Signature 5 Date CPS Form 3 'GENERAL NOTES G 14:242e't':; _GoN1 tGAom! ,1. 0/111110MINPV• INN • • • • 1. CONTRACTOR SHALL BE RESPONSIBLE FOR tROVIDING'ALL WORK AND MATERIALS IN ACCORDANCE WITH l.LL APPLICABLE CITY,)COUNTY, AND LOCAL BUILDING' AND FIRE CODES AS REQUIRED. 2. CONTR4CTOR SHALL BE GOVERNED BY ALL •CONDITIONS • AS. • INDICATED IN CONTRACT DRAWINGS & SPECIFICATIONS FOR BUILDING. 3. CONTRACTOR SHALL VISIT JOB SITE AND VERIFY All FIELD _•_ DIMENSIONS AND CONDITIONS AND NOTIFY MS & A OF. ANY DISCREPANCIES BEFORE PROCEEDING WITH WORK. 4. B/S INDICATES "BUILDING STANDARD" AS PROVIDED.•:BY -'.LANIPLORD•DRAWN AND/OR. SPECIFIED IN BUILDING CONTRACT • 5. BY L.L. ® T.E. INDICATES "BY LANDLORD AT .TENAIIT' S • EXPENSE". . 6. DIMENSIONS , TO .AND 'OF ELECTB ICAL & TELEPHONE OUTLETS INDICATES• MAXIMUM 0F. 6" . FROM OF ELECTRIC L OUTLE" • TO . i OF TELEPHONE OUTLET. 7. .F .F: INDICATES• "ABOVE•FINISH FLOOR ". 6. CONTRACTOR \TO OBTAIN ALL PERMITS & APPROVALS. e. CONSTRUCTION: LEGEND.: nit DOOR . SCHEDUL • 14+ t?Icl.1 I He+G+ • PATrrp4.l :. w/CSA rP, `iD +100° Ai`F Room .Number . :0 coAT got) l `Ceiiing :Ht::,� d 0611 UN LESS No-TE IS pc:R NUMeeR .VP. or pjpm N•'CE � v Wl:1 t7,CU!" p**-,. t22315 ' • Y:• 'i., ., FR , • • or 24?'St*. _.turf , E) 14'. , -� .. t 1 in • d,, wr :.l;vr.+cs51t` .: • S U I rte-- X303 AWN. ►I� ECKED tO Al E cALE..i;'E? .1I7 ' -. . DOOR . SCHEDUL • 14+ t?Icl.1 I He+G+ • PATrrp4.l :. w/CSA rP, `iD +100° Ai`F Room .Number . :0 coAT got) l `Ceiiing :Ht::,� d 0611 UN LESS No-TE IS pc:R NUMeeR .VP. or pjpm N•'CE � v Wl:1 t7,CU!" p**-,. t22315 ' • Y:• 'i., ., FR , • • or 24?'St*. _.turf , E) 14'. , -� .. t 1 in • d,, wr :.l;vr.+cs51t` .: • • 'GENERAL NOTES R SHALL BE RESPONSIBLE FOR PROVIDING 'ALL MATERIALS IN ACCORDANCE WITH ALL APPLICABLE LINTY, AND LOCAL BUILDING AND FIRE CODES AS OR SHALL BE GOVERNED 'BY ALL CONDITIONS. AS. • D IN CONTRACT DRAWINGS & SPECIFICATIONS ING. R SHALL VISIT JOB SITE AND VERIFY All FIELD NS AND CONDITIONS AND NOTIFY MS & A OF. ANY CIES BEFORE PROCEEDING WITH WORK. ' CATES "BUILDING STANDARD" AS PROVIDED. :BY DRAWN AND/OR. SPECIFIED IN BUILDING CONTRACT S'.'.:. T.E. INDICATES "BY LANDLORD AT .TENPJ T' S NS s TO .AND 'OR ELECTgICAL & TELEPHONE OUTLETS S' MAXIMUM. or. 6" FR N . OF ELECTRICAL OUTLET F TELEPHONE OUTLET. INDICATES "ABOVE PINISH FLOOR ". t. TORRTO OBTAIN ALL PERMITS & APPROVALS. tt. • k E 17 RoL r<VI W PLAZA TWO, marvin stein associates, inc. i�design Ywa 58101 1 understotitth f f1i6'+3I eck approvals are sub';,ct to errors and omis:liors:i and 'approval of plr.ns does not authorize t h e t viola tic.•J rf any ' ado tAC1.c_ efor '°'k*' n apf0 P MFiOA K cop!6f 1:5 n d p lays ac itlnw � ,d By Date Permit No r. qs,W3 ECEIVF -D•. OF 'iIJK1Ml. r; 7 1986 IL.OIN( DEM eAlTN1.0114 t • 1■1i% �Lit?S': y DOOR.. SCHEDULE E G 1 UNLESS N P :1 'POOR NUMeeR -=4': 0f ..rx om • 144 Ee-a 416.14/ P`tc64. 154, . '4) F1 ar 2{0' '6 . tom. X4.. . 15 • aosem, tit' :14 . ' t ' •• ti4M. 4. imrd •Legtcs5t- 11 LECTRICAL and T.ELEPH WAL. L.•. 't F?t.pC� =' f ,,i CA.L•t• 411 it6. bepARATEs: GIra2 Ut• • , ARA11G ' GAS • r -AOx - ft Rt4 t tr.p 'eat:. • s • 4. Su i1.- -- X303 ;AWN. .►I .1.. .}. -, . ECKE0 mil. A]E_ marvin stein associates, inc. i�design Ywa 58101 1 understotitth f f1i6'+3I eck approvals are sub';,ct to errors and omis:liors:i and 'approval of plr.ns does not authorize t h e t viola tic.•J rf any ' ado tAC1.c_ efor '°'k*' n apf0 P MFiOA K cop!6f 1:5 n d p lays ac itlnw � ,d By Date Permit No r. qs,W3 ECEIVF -D•. OF 'iIJK1Ml. r; 7 1986 IL.OIN( DEM eAlTN1.0114 t • 1■1i% �Lit?S': y DOOR.. SCHEDULE E G 1 UNLESS N P :1 'POOR NUMeeR -=4': 0f ..rx om • 144 Ee-a 416.14/ P`tc64. 154, . '4) F1 ar 2{0' '6 . tom. X4.. . 15 • aosem, tit' :14 . ' t ' •• ti4M. 4. imrd •Legtcs5t- 11 LECTRICAL and T.ELEPH WAL. L.•. 't F?t.pC� =' f ,,i CA.L•t• 411 it6. bepARATEs: GIra2 Ut• • , ARA11G ' GAS • r -AOx - ft Rt4 t tr.p 'eat:. • s • m V2° pcve44t, --m° 111,c ' 1 PGA M TAPE G' EOU1UP RA1 PART171O1.1 Q* ©' ,p, 111111 1 . i nuuuw.w uuunnnu imuge■uomome. 4'1 "rz1 IoM ¶r': C).natta r M TAlm INT. . rig GNI3 I?aTH SIPES FizOM I°1.100K TO 11KIDEK 510E cr HUNG CE. IL146 CA1 N b r TN i G N E5 Vv11 -1 SIt 3 + AGOtrerT1G 4-TT INsUL,. FfFOM picc IC u1J DEI[51 DE OF H1-11-4- NANT ! M ICI NG' p•TN i GNP eoTH KztvvTIG t4TT I N6I u,A�1oI-4 1=t � `1.0 111-421M. OF RUru6 C ILIt.r . 1}1-011 NUPE. ACq.IC*T1G 1?iArt 11-4 L. c4477 cv R Piu, ASCA/E. MIL! NG. -- AColY�T1A,t,11LE l.EIl- (4 . - z - r.lLJI rta \u f rb A WI Att. =CONT. L' /i�� 1'/4" 20GA. TQAC< W%2 NIA SCIZEYJS C 7.4 "o.G. PAI NET BLACK- n �•: CITY OF `T "UiQ. VILA . ).;nth 1986 U11.D1t4(( t1Eky' , -2'li t 25 GA. GALV. STL, ST11P Q 21- .- AL.BLAN14E7Q — 5t% mu RATED GYPSUM BOARD C auE N31W. CONMUCTIO N) 4n 174-46e,t$21 ,AIC r5t4e, e tart. 4'1416604 W/g a6e. c v.ta -GDNT, 25 GA. GALV, STL. RuNNE2 CUANNEt, - PTJCUoQ,Ep To Floo(Z I x t %e) A TAM A *DUk Al C' rA- 'TI-i1O J a+O.. SECTION Cc) BUILDING STD, PTN, marvin stein ('^ associates, inc. planning and design Taw aJANI:AW7 P�• i'T IT 100 Job Noe002 show No Job t2Ne -P, /I c\V RAzA 1 Dal. 1•6•S1- ' Re-V. 4.7.61LL • - . €t7. 4 ..rUL -lam 445I0I4T l.11� ......_. C a7'r' ALJM1 rAM-TAFZ L J -mac o61- U. - t70 Not ..i‹ / To 2u MCvkL #zV N MlL CI N(v p.T .141:35 OF owe) 141 IZvi wits • laXIGTNa, $. JMINUM MUD -1-bN marvin stein FP associates, Inc. planning and design T,II•I mc,),-1 //Auu for i 0:0N . Jo_ Nocf-021'4 Shcof No 2 Job Kve.Aminv FAza o.1.I"Zl• &1 t W1I-JCz7.4 11141.L. EsocK F -1 'TA4 1S 0-47 L "-METALEAEiE_ We GW15 ht ctlt it% h4%;PM • t;C1AL 1i' tat(trA AC C«1G, Cc,UH-114 marvin stain .FP associates, Inc. planning and design T�II�IH►�1 iG 1 / /lU��.. CCf•1N. Job p,NE /I r \V Fej\Z..Q Job No&YD21 '4 ShM.1 No •ZA 0.t. 121. &1 • +- • • -TYR .OAK. • Iku = IL-011 marvin stain CeP associates, Inc. planning and design T111•T ' 046 FtLATe.. Job N1.4 Stool No Job gIVF,VIG1V RA711 0.1. 1'8.01- • OAK 1P2,1/A OAll) LU VA. fi-Af6 K.P2 WV) Ur \V/ kIN.Go/Ar›. 1)44'6 (.464e-MT. • sr- ..,. • ........,.., -->'....... .....- 2 s/ rui-i tz.e marvin stein CP Taw Job Nce122ei•-4Shrel No 10 associates, inc. planning and design Job KIVMV(Mi RA-a, 0.1.1. e•- ON. aG1� (NJTH wl1 �fZE LJAMl3 Q OF WALL. ( p. Es c>. NIU) •'% N r OAK YR 10\ . • 1/4' tW GjA6 • .1• . I 'j�'r1c 4t- t7I 1AeI.151 O 146 (ALV-17 L,M22 Nu- Marvin stein .Fs` TM. Gl.l J4I/\ 7 Job NoaX121 - 4sh..1 No 1 associates, Inc. planning and design Job IIVvRVIEV FAZA o.,.I•b•61 We j1 12(-1-11t ItAn o; Trim 1/41 mArt r� t • ./ � / ///'../.// • II /IV-0V -- -r \\. \\` ,t • MALL 51Zt marvin stain associates, inc. planning and design T►11. t2 .L.ITI. kr-A9 Job No8Ga721.4•SMe1 No Job giV VIG \V FL&z4 oolo j•b,Ql .. • I2 / /1�i1/' LI1 OAK SAM & K LJA A marvin stein cP associates, inc. planning and design Title 2Z € CAL /364.:, t w) 1 v Job No865621 •4Sh..1 No Job f tVP. I GAY RAZA 0.1.1.0• bl . . Tr F. FVD K it y,o r -•A K 4 7� �a.. .pq pp. vtll OAK 19 -YWD, SHELF _ slIDE I'' oAK -to :IM ALL . - s �'- 4, 1 •SAT GI`1" marvin stein .Fr ? associates, inc. planning and design Tate Job KIVr%14NI W pL,,42A Job Noe Meet No Date 2.17• al " • • . • P..; W002 CX-06441 t.1 Lir • •■ 1, •.' • „, 660m woor? C.; I'Lz1G44,1 1.16i 4-'•-• 0 /1 P›.44' 191-41.-ne- f3A1?TI/\ L HE lerH T ..PAt?.71TION . ..-N&r. To, . marvin stein FP .Tolle rAt211AL. PT rA1Z111014J..,,„eca.?-1-41.0.,•„,,:..1. assoclatia, Inc. • planning and design -Job M 1 /...g.vi nv •,---tArz.A.1,-.A1A11...,.1..M Cam- f 'rlAL I4tvG11 -4'(' PziRT1T101 J marvin stain associates, Inc. planning and design Til t. CAP-FAA-II . le"Trr1DN' ,J•o woeat2("el v vlS\/1 51A ! 1 • 0 ■ .70 IL21 go 4A.6H ; 1z'•1l(1 IsbA eur. KI 14 i. i .GIC?71101 -1A L , 511... IA *1 .3"+rPS. NI %,'' PLAVVIZ. O CTIQN - o. H 8)1 . maMYMn shin S asaocla't s, Inc. . planning and design ti a' T.,4 vwr:r • pliwrA IL+ • r.ltIV5kV)W 12A -1 lip 2I "4 mi.. N■ w '1. • -MflG I,.�►.M, IM" 111aCNZ7 : , wiTcH ty 5 0 FL; 134eR t,y,41.1& • 2d Gle 1 • yTt. , S•1 Cg FTMVAIRE " A- - 2 x4 wv K 4G, ON p1.1^;.. • STL. IALgir 6M-1 3 (Jta2 MlFiL -1, 21/11 MTL. 144/ ' Gs. K!18• 2..42 Eel • 9Tt. -.61-1• 2 sat 144x' i E1,cr. 'G CI►r101-1AL rnarvin stain associates, inc. planning and design Till. C,411 P `C' ye-TAIL_ Job No0232 I- .,.No --1 c/ Job HIV' I W .RA2A-1 1II Lo.1. •.I P� I C'•iG t'LY t7 - r-11,1.1-0 1 OAK Y4II1zi1 ,W/ cA al u l:-r 1-11-15-K ..k ALT SIN. 5E TIOJf marvin stein svP associates, inc. planning and design TdI. CHILI We V AJL14IH $ Job.No I- 4siw.. No f� . JoidclYL=KvIYV MA24- tc.TA I Low. 5' I.01 "Ku ' OI C' `Y vw 7 b Required erberof:jarbing stalls_ a. CC .. — h ,•w r i ',) dlitot a RI City of Tukwila Fire Department Building Official City of Tukwila Control *86 -112 Gary Vandusen Mayor Hubert H. Crawley Fire Chief April 9, 1986 Re: Red Robbin - 16000 Christensen Road, *303 Dear Sir: The attached set of building plans have been reviewed by The Fire Prevention Bureau and are acceptable with the following concerns: 1. Exit hardware and marking must meet the requirements of Uniform Fire Code Sections 12.104 & 12.114. Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort. (UFC 12.104b) 2. Maintain sprinkler protection for all enclosed areas. (NFPA 13, 4- 1.1.1) All modifications to sprinkler systems shall have the written approval of the Washington Surveying & Rating Bureau, Factory Mutual Engineering or Industrial Risk Insurers, then by the Tukwila Fire Department. No sprinkler work shall commence without approved drawings. (City Ordinance *1141 & NFPA 13, 1 -9.1) 3. All electrical wiring is to be inspected by the State Electrical Inspector, Washington State Department of Labor & Industries. 4. In order to provide you with the fastest police and fire protection under emergency conditions, please post your suite, room or apartment number in a conspicuous place near the main entry door. Numbers shall contrast with their background. (UFC 10.208) Yours truly, The Tukwila Fire Prevention Bureau cc: T.F.U. File slj City oI Tukwila Fire Department, 444 Andover Park East, Tukwila, Washington 98188 (208) 575 -4404 Describe CITY OF TUKWILA Building Division 6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 -1845 kiLADM1. BUILDING PERMIT APPLICATION (Please Print) ;::a'9 Y OF T4 KAA.11 work to be done /-2-, Site Address Control # // 2 Valuation r/o�x?___..� Plan Check F.ee- 3.-- ~ Receipt # Q66s-/ /. SO /99O (Jr,s cnseN Pct) Suite # 30:3 Tenant R -Ro6,iJ Assessors Account # 35 )y- /10O /'t6 Valuation of Construction Building Use (&( fl1'KQ. Type of Construction Grading: Fill /1 cubic yards Cut /I'" cubic yards /O oc,o Occ. Group Property Owner A10!VJ 1 /tee /CGS r/ee /< �y ( Address /�000 Gtvs Se/J /( c.f Phone # 2V/ Applicant "e Gov Address /6000 Architect /Engineer M '1/00 IN Cor feed Address 1106 bI i'u� t ay Seatte , cat qis/b/ Contractor jec.- tatiuc(o ,o)eoT GoRp License # Phone # at/f -c�l(v Address 6coo C_ %'( 1e1 G)8 Zip q/c--r� Phone # Phone # Zip 9 &' - ay/ /r0 Zip 4,,;13 -AS- i 3 Zip q%-/c)/ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. Applicant /Authorized Agent (signature) (print name) Contact Person (please Print) (8/85) Date 1//7/c�f6 Phone #