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HomeMy WebLinkAboutPermit D06-028 - Nguyen Residence - AdditionNGUYEN RESIDENCE 4220 S 122 ST SIRED 08 -26 -06 D06 -028 Parcel No.: 3347400380 Address: 4220 S 122 ST TUKW Suite No: Tenant: Name: Address: Owner: Name: Address: Contact Person: Name: Address: City the Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 - 431 -3665 Web site: ct.tukwila.wa.us NGUYEN RESIDENCE 4220 S 122 ST, TUKWILA WA NGUYEN THU 4220 S 122ND ST, TUKWILA WA DANTE PALMAFFY 12925 47 DR SE, EVERETT WA Contractor: Name: P G CUSTOM BUILDER LLC Address: 12979 M L K WAY S #16, SEATTLE WA Contractor License No: PGCUSGC978PU DESCRIPTION OF WORK: 2 -STORY ADDITION TO REAR OF EXISTING RESIDENCE (1ST FLOOR: 600 SF, 2ND FLOOR: 550 SF, COVERED DECK: 52 SF, & UNCOVERED DECK 38 SF) PUBLIC WORKS ACTIVITIES INCLUDE: LAND ALTERING, AND STORM DRAINAGE. Value of Construction: $102,368.40 Type of Fire Protection: SMOKE DETECTORS Type of Construction: V -B Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / as. N Fire Loop Hydrant: Flood Control Zone: Hauling: Land Altering: Landscape Irrigation: Moving Oversize Load: Sanitary Side Sewer: Sewer Main Extension: Storm Drainage: Street Use: N N N Y N N N N Y N Water Main Extension: N doc: IBC - Permit DEVELOPMENT PERMIT Number: 0 Start lime: Volumes: Cut Start lime: Private: Profit: N Private: Permit Number: Issue Date: Permit Expires On: Phone: Phone: 425 345 -2530 Phone: Expiration Date:02 /01/2008 Fees Collected: $3,397.92 International Building Code Edition: 2003 Occupancy per IBC: 22 Size (Inches): 0 End Time: 10 c.y. Fill 10 c.y. End Time: Public: Non - Profit: N Public: Steven M. Mullet, Mayor Steve Lancaster, Director D06 -028 02/22/2006 08/21/2006 D06-028 Printed: 02 -22 -2006 Water Meter: N doc: IBC - Penult City o r'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 * *continued on next page ** Steven M. Mullet, Mayor Steve Lancaster, Director 006 -028 Printed: 02 -22 -2006 Permit Center Authorized Signature: doc: IBC - Permit City Or'Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: ei.tukwila.wa.us iv-) Armtek Da0 Steven M. Mullet, Mayor Steve Lancaster, Director Permit Number: D06-028 Issue Date: 02/22/2006 Permit Expires On: 08/21/2006 Date: 0424 bL I hereby certify that I have read and bx mine is 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 development permit. Signature: � /��/� Date: 21 °� Print Name: TLC( - gin) ICA 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. D06 -028 Printed: 02 -22 -2006 City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 3347400380 Address: 4220 S 122 ST TUKW Suite No: Tenant: NGUYEN RESIDENCE 1: ** *BUILDING DEPARTMENT CONDITIONS * ** PERMIT CONDITIONS Permit Number: D06 -028 Status: ISSUED Applied Date: 01/30/2006 Issue Date: 02/22/2006 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 mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center (206/431 3670). 4: 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. 5: Truss shop drawings shall be provided with the shipment of trusses delivered to the job site. Truss shop drawings shall bear the seal and signature of a Washington State Professional Engineer. Shop drawings shall be maintained on the site and available to the building Inspector for Inspection purposes. 6: 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. 7: Notify the City of Tukwila Building Division prior to placing any concrete. This procedure is in addition to any requirements for special inspection. 8: All wood to remain in placed concrete shall be treated wood. 9: There shall be no occupancy of a building until final Inspection has been completed and approved by Tukwila building inspector. No exception. 10: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final Inspection approval will be determined by the building Inspector based on satisfactory completion of this requirement. 11: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy can be obtained at City Hall in the office of the City Clerk. 12: 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. 13: 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. 14: 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 doc: Conditions D06 -028 Printed: 02 -22 -2006 City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 the source of ignition is not less than 18 inches above the floor surface on which the equipment or appliance rests. 15: 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. 16: 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). 17: 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). 18: 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 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. 19: ** *FIRE DEPARTMENT CONDITIONS * ** 20: The attached set of building plans have been reviewed by the Fire Prevention Bureau and are acceptable with the following concerns: 21: Adequate ground ladder access to rescue windows shall be provided. 22: Any overlooked hazardous condition and /or violation of the adopted Fire or Building Codes does not imply approval of such condition or violation. 23: These plans were reviewed by Inspector 511. If you have any questions, please call Tukwila Fire Prevention Bureau at (206)575 -4407. 24: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * ** 25: Contractor shall notify Public Works Utility Inspector Mr. Greg Villanueva at (206)433 -0179 of commencement and completion of work at least 24 hours in advance. 26: Any material spilled onto any street shall be cleaned up immediately. 27: The Land Altering Permit Fee is based upon an estimated 10 cubic yards of cut and 10 cubic yards of till. If the final quantity exceeds this amount, the developer shall be required to recalculate the final quantity and pay the difference in permit fee prior to the Final Inspection. * *continued on next page ** doc: Conditions 006 -028 Printed: 02 -22 -2006 City of Tukwila Signature: " l, ° —J Print Name: T: - 1 A - Af-4 'L tfil) 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 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 work or local laws regulating construction or the performance of work. Date: 1 ? . 4 2- a doc: Conditions D06 -028 Printed: 02 -22 -2006 Company Name: Mailing Address: Company Name: Mailing Address: Contact Person: E -Mail Address: CITY OF TUKWILA Community DevelopmeAsepartment Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 6:tVet nit. plus tice dAajeetparmit application ( Revised: 64-05 bb Building Pe Mechanical Penpi Public Works Pertiiit Project I o zee u$t 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: 4 no s t 7 -2 KO ST Tenant Name: T7 Property Owners Name: t Lt'i ft M3-0 teb -K1, Mailing Address: 4270 S. 1 22 Ain sr- Contact Person: ty ^ re- Pp cam 4 E -Mail Address: bPACLAA 4-Fri Q.-- Alb U t ' tA_ King Co Assessor's Tax No.: 33414 33 0 TuK -cot City Suite Number: New Tenant: Name: 1.. b11 7 e Pte( -NA \ Day Telephone:A- S) S4s 2S'30 Mailing Address: 17-TZ5 v Ajel b Q- Se" g7/& eT 10/_ 20Q City State Zip E -Mail Address: 1) - G4/{ A 4.0 4- t CO7?/\ Fax Numbe 4-LZ /65 10 ENGINEER OF RECORD -Ail plans must be wet stamped by Engineer of Record W4 State Floor: ❑ ....Yes ❑ ..No GENERAL CONTRACTOR INFORMATION - (Mechanical Contractor infocmation back page) , Company Name: Mailing Address: City 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 State ReCe Zip Zip ARCHITECT OF RECORD — All plans must be we stamped by Architect of Record 1.24 -C 4-tt' be, SE evt e-err / thiti - 9,s rang City Day Telephone: 4- 7 - 1 3 4C 2S3O Fax Number: 2C; -33e laso City State Zp Day Telephone: x Number: Page l .$1.71LDING,T Valuation of Project (contractor's bid price): $ �Jj / Existing Building Valuation: $ Scope of Work (please provide detailed information): AbD 2 5'IZ�Z'( AteQ cm Ai ID t t+& Will there be new rack storage? ❑ ..Yes b.. No If "yes ", see Handout No. for requirements. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single- family building footprint (area of the foundation of all structures, plus any decks ova 18 inches and overhangs greater than 18 inches) X1'9 G 15 For an Accessory dwelling, provide the following: Lot Area (sq fl): 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: 7 Compact: Handicap: Will there be a change in use? ❑ ....Yes ,$.No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑.. Sprinklers ❑..Automatic Fire Alarm q:Vpnmia plus \icc clungn \pennit application (7 -2004) Revised' 61-05 nn Page 2 ❑..None RI. Other (specify) ;SYMO(r -- l Tb-c_t C Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑..Yes o If "yes", attach list ofmaterials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Material afety Data Sheets. ' Existing Interior Remodel ; Addition to Existing Structure : New . Type of Construction :: per IBC , Type of Occupancy per IBC I" Floor - - - . , 7' CP-0 V t 'a -3 r Floor . 4D S Y •i C3 e_3 3 Floor. Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport -- Detached Carport Covered Deck _ SZ Uncovered Deck - at? .$1.71LDING,T Valuation of Project (contractor's bid price): $ �Jj / Existing Building Valuation: $ Scope of Work (please provide detailed information): AbD 2 5'IZ�Z'( AteQ cm Ai ID t t+& Will there be new rack storage? ❑ ..Yes b.. No If "yes ", see Handout No. for requirements. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single- family building footprint (area of the foundation of all structures, plus any decks ova 18 inches and overhangs greater than 18 inches) X1'9 G 15 For an Accessory dwelling, provide the following: Lot Area (sq fl): 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: 7 Compact: Handicap: Will there be a change in use? ❑ ....Yes ,$.No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑.. Sprinklers ❑..Automatic Fire Alarm q:Vpnmia plus \icc clungn \pennit application (7 -2004) Revised' 61-05 nn Page 2 ❑..None RI. Other (specify) ;SYMO(r -- l Tb-c_t C Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑..Yes o If "yes", attach list ofmaterials and storage locations on a separate 8 -1/2 x 11 paper indicating quantities and Material afety Data Sheets. PUBLIC W ORKS PERMIT INF RMA'CION =206- 433-01 Scope of Work (please provide detailed information): / - i 7 > 2— 67Z:ieI A-i>D CZvttl 7a Td*' tee» o f G S I & 0-e'S c Please refer to Public Works Bulletin 81 for fees and estimate sheet. r District ..Tukwila ❑...Water District #125 ❑ .. Highline 0... Water Availability Provided S err District ...Tukwila 0... VaIVue ❑ .. 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. t u ... ttted with Application (mark boxes which apply): Civil Plans (Maximum Paper Size -22" z 34 ") Technical Information Report (Storm Drainage) ❑ ...Bond ❑ .. Insurance ❑ .. Easement(s) Proposed Activities (mark boxes that apply): ❑ ...Right -of -way Use - Nonprofit for Tess than 72 hours ❑...Rightof -way Use • No Disturbance ❑,i( - Right-of-way •O Non Right -of -way 1 0 Total Cut cubic yards .Total Fill fp1 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 _ o ...Sewer Main Extension Public ❑ ...Water Main Extension Public tRpermiu *ACC elu^amtpnit applicatue ( 7 - 2004 ) Revised: 64.05 CaII before you Dig: 1- 800 - 424 -5555 .. Abandon Septic Tank .. Curb Cut .. Pavement Cut .. Looped Fire Line WO# Wo# WON Private Private Page 3 ❑.. Geotechnical Report ❑...Traffic Impact Analysis ❑...Hold Harmless ❑ .. Maintenance Agreement(s) ❑ ...Renton ❑ .. Right-of-way Use - Profit for less than 72 hours ❑ .. Right-of-way Use — Potential Disturbance ❑ .. Work in Flood Zone g. Storm Drainage ❑ .. Grease Interceptor ❑ .. Channelization ❑ .. Trench Excavation ❑.. Utility Undergrounding ❑ ...Deduct Water Meter Size FINANCE INFORMATION Fire Line Size at Property Line ❑...Water ❑...Sewer )vtonthly Service Billing to: Number of Public Fire Hydrant(s) ❑...Sewage Treatment Name: Water Meter Refund/Billing: Name: Mailing Address: Day Telephone: Mailing Address: State z City Day Telephone: City State Zip Unit Type: - Qty Unit Type: - -- Qty - Unit Type: - - - Qty Boiler /Compressor: Furnace<IOOKBTU 1 I Air Handling Unit >10,000 CFM Fire Damper 0 -3 HP /100,000 BTU Furnace >100K BTU Evaporator Cooler Diffuser 3 -15 HP /500,000 BTU Floor Furnace Ventilation Fan Connected to Single Duct v Thermostat •- 15 -30 HP /I,000,.9 0 BTU ,. Suspended/Wall/Floor Mounted Heater'' Ventilation System Wood/Gas Stove 30 -50 HP /I,750,OD0 BTU Appliance Vent Hood and Duct Water Heater 1 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 1l EC IANICAL`PERMIT.INFf \IATION T 20G 431 -3676 MECHANICAL CONTRACTOR INFORMATION Company Name: I • . - ' 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 ** Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): 1 ni S TWO__ &Jez&) F 4c r l �( 1?%(STh -k' 2e6 (Do-tau' /wit kWflc A Use: Residential: New ...%) Replacement ❑ Commercial: New .... ❑ Replacement ❑ Fuel Type. Electric ❑ Gas ....0 Other: Indicate type of mechanical work being installed and the quantity below: • PERMIT APPI,.LCATION NOTE - Applicabto le s (permits in this` p pl i cation . 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 grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). I HEREBY CERTI AT I AD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PE' d ' ' B AWS c F THE STA! OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. q:\lpvmils *slice changes \permit application (7-2004) Revised. 6.1.05 bh IZED NT: BUILDING 0 Signature: Print Name: &Si re P Mailing Address: 12- 4 I Date Application Accepted: © 1 , 'v• bito (02- SEr Page 4 Date: \kJ 30, *' Day Telephone: 42-S 34-5- X34'5- Z��3O Q c p City State Lp Date Application Expires: cip Parcel No.: Address: Suite No: Applicant: Receipt No.: R06 -00244 Initials: ]EM User ID: 1165 Payee: ACCOUNT ITEM LIST: Description doe: Receipt City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 3347400380 4220 S 122 ST TUKW NGUYEN RESIDENCE THI THU NGUYEN TRANSACTION LIST: Type Method Description Payment Check 2103 BUILDING - RES PW LAND ALT PERMIT FEE PW PERMIT /INSPECTION FEE PW PLAN REVIEW . STATE BUILDING SURCHARGE RECEIPT Permit Number: Status: Applied Date: Issue Date: Payment Amount: Payment Date: Balance: Amount 2,583.60 Account Code Current Pmts 000/322.100 000/342.400 000/342.400 000/345.830 000/386.904 2,505.60 23.50 25.00 25.00 4.50 Total: 2,583.60 D06 -028 APPROVED 01/30/2006 2753 02/22 9716 TOTAL 2583.60 2,583.60 02/22/2006 11:07 AM $0.00 Printed: 02 -22 -2006 Parcel No.: Address: Suite No: Applicant: Receipt No.: R06 -00127 Initials: User ID: Payee: TRANSACTION LIST: Type Method ACCOUNT ITEM LIST: Description doc: Receipt City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 3347400380 4220 S 122 ST TUKW NGUYEN RESIDENCE 3EM 1165 DANTE PALMAFFY Payment Check PLAN CHECK - RES Description 3431 RECEIPT Account Code 000/345.830 Permit Number: Status: Applied Date: Issue Date: Payment Amount: 814.32 Payment Date: 01/30/2006 12:39 PM Balance: $1,257.30 Amount 814.32 Current Pmts 814.32 Total: 814.32 DO6 -028 PENDING 01/30/2006 1780 01/31 9710 TOTAL 814.32 Printed: 01 -30 -2008 Pr�ojey t� m /V Type of Inspection: Pei/VV£ STOPWo As O C ' /- s Date Called: Special Instructions: Date Wanted: am 2 — 27 -0 4 Requester: Phone No: INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 El Approved per applicable codes. C COMMENTS: ,?Pnn ae .57 afV f r._ rZ se +?rn4 i±\64 -67g nspecof: I I� x t.t Date :z z 7 S 8.00 REINSPECTION FEE REQUIRED. p'or to inspection, fee must be id at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspectlon. 'Receipt No.: 'Date: INSPECTION RECORD Retain a copy with permit PER (206)431 -367 El Corrections required prior to approval. 07 -03 -2006 DANTE PALMAFFY 12925 47 DR SE EVERETT WA 98208 RE: Permit No. D06 -028 4220 S'122 ST TUKW Dear Permit Holder: 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 Inspection Request Line at 206 -431 -2451 to schedule 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 one or more extensions of time for additional periods not exceeding 90 days each. 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 08/26/2006, 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. xc: Permit File No. D06 -028 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 i- _., HT COOT:i JPY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D06 -028 PROJECT NAME: NGUYEN RESIDENCE SITE ADDRESS: 4220 S 122 ST X Original Plan Submittal Response to Correction Letter # DATE: 01 -30 -06 Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: Bui ing Divi n PLtb oWorkb L 2.00 511 MVO 14 Fire Prevention Structural DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete ❑ Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: Departments determined incomplete: Bldg ❑ LETTER OF COMPLETENESS MAILED: Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS ROUTING: Please Route Structural Review Required REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Approved ❑ Approved with Conditions Notation: REVIEWER'S INITIALS: Documents/rouling slip.doc 2-28-02 DUE DATE: 01-31-06 No further Review Required DATE: DATE: 1-4 PfannTng Division LEI Permit Coordinator ❑ Not Applicable n DUE DATE: 02 -28-06 Not Approved (attach comments) ❑ Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: License Informatlon License POCUSGC978PU Licensee Name P G CUSTOM BUILDER LLC Licensee Type CONSTRUCTION CONTRACTOR UBI 602326292 Ind. Ins. Account 3d #1 Business Type LIMITED LIABILITY COMPANY Address 1 2739 4TH AVE S Address 2 City SEATTLE County KING State WA Zip 98134 Phone 2063539699 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 10/31/2003 Expiration Date 2/1 /2008 Suspend Date Separation Date Parent Company Previous License Next License Associated License Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date #1 ACCREDITED SURETY & CAS CO 8569 10/14/2003 Until Cancelled 512,000.00 10/31/2003 Business Owner Information Name Role Effective Date Expiration Date PHAM, PHUONG PARTNER/MEMBER 10/31/2003 Look Up a Contractor, Electri' "n or Plumber License Detail Page 1 of 2 � Washington State Department of Labor and Industries General/Specialty Contractor A business registered as a construction contractor with L &I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assigmnent of account and carry general liability insurance. https: // fortress. wa. gov /Ini/bbip /printer.aspx ?License= PGCUSGC978PU 02/22/2006 x x x x x x