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Home My WebLink AboutPermit 5272 - Nielson Residence - Fill• CITY OF TUKWILA Building Division 6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 - IPP9 BUILDING PERMIT Work to be done Site Address Building Use Property Owner Address Contractor Address F.11 1 .Y. 14428 57 Av S Residence dim Nielson 14428 57 Av S., Tukwila. WA Owner PERMIT 0 .6L'77J Control 0 88 -154 uite enant Nielsen, Jim Assessors Account # N/A Phone # 433 -1748 Zip 98188 Phone # Satrap as ahnve FOR BUILDING PERMIT ONLY Approved for issuance by: Sq. Ft. sstt Fi Office Storage/ Warehouse Retail Other Occ. Load 2nd F1. 3rd Fl. Total Fire Protection: [] Sprinklers ❑ Detectors Zoning Type of Construction Special Conditions Date: sq. ft. @ sq. ft. @ sq. ft. @ sq. ft. @ 1st F1. $ 2nd Fl. S other S other S Total Valuation of Construction $ 350.00 Bldg. Permit Fee Receipt #4.27 $ 15.00 Plan Check Fee Receipt # E Demolition Receipt # $ Surcharges Receipt N $ Other Receipt 0 $ Other Receipt 0 S TOTAL S 15.00 FOR SIGN PERMIT ONLY ❑ Permanent ❑ Temporary ❑ Single Face ❑ Double Face [] Wall Mounted ❑ Free Standing ❑ Other Building face Setbacks: Front Side Side Rear Square Footage of each sign face Total square footage of sign Special Conditions THIS PERMIT BECOMES NULL ANO VOID IF WORK ON CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR wURK IS '..:S .'ENDED OR ABANDONLU FuR A PERIOD Of 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY, /CERTIFY THAT I SAVE RE AND\ )(AMINEO THIS APPLICATION AND KNOW THE SAME TO SE TRUE AND CORRECT. ALL PROVISIONS OF LAYS ANU ]ROINANCES GOVERNING THIS TY OF MgIK MIL BE C LIED'11ITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PE IT DUES NOT PRESUME TO GIYE AuTMORITY 10 ' y{OLATE' CANCEL I T.HEj RN0 JS10NS O.I I$Y OTHER STATE OR LOCAL LAW REGULATING /OMSj�I %OII PERFORMANCE OF CONSTRUCTION. g I / 1, ei f' Date Signed �r LICENSED CONTRACTORS DECLARATION I hereby affirm that I at licensed under provisions of the Business and Professions Code. and my license Is in full force and effect. Date Contractor (signature) OWNER - BUILDER DECLARATION ( ) I, as owner of the property. or my employees. with wages as their soli compensation. will do the work, and the structure Is not +noes offered for sale. ( ) I, as owner of the property, Owner (signature) am exclusively contracting with licensed contractor's to construct the project. Date Or CITY OF TUKWILA ,a'"`' Building Division( 6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 - IS49 BUILDING PERMIT Work to be done 11 Site Address 14428 57 Av S uite enant Nielsen, Jim Building Use Residence Assessors Account # N/A Property Owner Jim Nielson Phone 0 433 -1748 Address L4428 57 Av S._ Tukwila. WA Zip 98188 Contractor Owner Phone # Address Sams ac ahnv PERMIT 0 Control 0 88 -154 FOR BUILDING PERMIT ONLY Approved for issuance by: S Ft. Sq. • ss t FT. Office Storage/ Warehouse Retail Other Occ. Load 2nd Fl. 3rd F1. T Total Fire Protection: [] Sprinklers [] Detectors Zoning Type of Construction Special Conditions Fee Zip Date: 5) sq. ft. is sq. ft. 9 sq. ft. is sq. ft. @ 1st F1. $ 2nd F1. $ other S other S Total Valuation of Construction S 350.00 Bldg. Permit Fee Receipt #1;j./,27 S 15.00 Plan Check Fee Receipt 0 S Demolition Receipt 0 S Surcharges Receipt 0 S Other Receipt 0 S Other Receipt N S TOTAL S 100 FOR SIGN PERMIT ONLY (] Permanent Temporary [] Single Face Building face [] Double Face C1 Wall Mounted ['Free Standing Other Setbacks: Front Side Side Rear Square Footage of each sign face Special Conditions Total square footage of sign THIS PERMIT BECOMES NULL AND V010 IF Wall ON CONSTRUCTION AUTHORIZED IS NOT COiMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION UR wURK IS •,80(400 UR ABANOONCU FuR A PERIOD OF 180 CMS AT ARV TIME AFTER WORK l5 COMMENCED. I HERESY/CERTIFY THAT I V( R ANO KAMINEO THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANU )0014ANCES GOVERNING THIS Tr OF MIL BE C IE0'1MtTH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PE IT DUES NOT PRESUME TU GIVE AU1 0O ITV TO CRATE/ OS CANC _MIL. SIONS OFF ARY OTHER STATE ON LOCAL LAW REGULATING Si PERFORMANCE OF CONSTRUCTION. t �'.� ) Bate / Sfgnedi � ;,...._____1,_ i LICENSED CONTRACTORS DECLARATION hereby'a /lira that i ea licensed under provision of the Business and Professions Co, de and ay license is in full force and effect. Date Contractor (signature) OWNER - BUILDER DECLARATION ( ) 1, as owner of the property. or ay eaployees, with wages es their We cORpeltsation. will do the work, and the structure is not ^aea or offered for sale. ( ) 1, as owner of the property, M exclusively contracting with licensed contractor's to construct the project. Owner (signature) Date '' it(,.r �\G ,' Site Project Valuation Property Address Applicant Address Architect Address Contractor Address Hauling Address Describe Build1n TD1v1saon 6200 Southcenter Boulevard Tukwila, Washington (206)- 433 -1849 Address /-711,421 ; RADING /FILL /EXCAVATIOr. 98188 PERMIT APPLICATION CONTROL# $8-15-7-/ ./ ,(%. C) Suite# Floor# Name /Tenant of Grading Owner `27 '2' 41/21(-:-- —CC.,./' 3.504? Assessors Account# f4- z/)'3 Phone Zip C;i4/ 7-21 Phone /1/7)(2_3— Zip /Engineer_ Phone Zip = .:.. ), f License# Phone Zip Co. ;' ' ‹ Phone Zip the purpose and extent of fill, excavation or grading Cut (c.u.)_/).% Fill (c.u.) I CORRECT Applicant Contact Two (2) sets of grading /fill /excavation plans must be submitted which meet the application requirements engineering An ment A Hauling of Section 7006(d), 1985 Uniform Building Code. A soils engineering report and geology report may also be required. Environmental Checklist is required to be submitted ($100.00 Fee) to the Planning Depart- for any permit grading /fill /excavation 500 cubic yards or more. is required for any grading /fill /excavation of cubic yards or more. certificate of insurance, route map, and permit fee of $25.00 are required. A $2,000 bond, HEREBY CERTIFY THAT I AND THAT I HAVE /Authorized Agent Person (please print) HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND THE PROPERTY OWNE 'S AUTHOR ZATION TO DO THIS WORK. (signature) / 7 )J2 Date '..� 4(4 (print name) /- 7 e---/1'�y -c's 1/ -/ ,)f") L .0/ .d �� Phone 'Y'3?-7x7</ 5 FEES: Grading Permit Fee Plan Check Fee Other OFFICE USE ONLY (000/322.100) $ /(5:t7 Receipt# Date Paid Excavation :» KIN (000/345.830) Receipt# Date Paid ( ) Receipt# Date Paid Ordinance #1341: ' An TOTAL /S 0 (OWES: $ ) [] Bond Required: $ Cert. of Ins. Amount $ . 1, I I, 1 1.. BLDG 7 5 -2s-g? 5 Approved for Issuance PLNG Approved (Initials) SEPA Checklist required: j] Yes (] No SEPA Determination SEPA File# PWD Approved (Initials) Hauling Permit Required: J Yes j No dir 0 5x72. Y .V 4/12e z� �y1 �1 ter: 6tC/77 o :." e ylO' gOrt-7 / cr-z Za,(A-7//// /W25' 57*' -tV61 •