Loading...
HomeMy WebLinkAboutPermit B93-0472 - STEPHENSON RESIDENCE - REMODELrr- z If 4,0 P'4 1 I] 1] b 1 -I CT' 41 '4•..",%;41'••,44. ;•4'; -tp:44 City of 7ikwid� (206) 4313670 Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 Permit No: 893 -0472 Type: B -BUILD Category: ASFR Address: 13004 56 AV S Location: Parcel #: 217200 -0296 Zoning: R1.72 Type Const: V -N Gas /Elec: Wetlands: Water: TUKWILA Contractor License No.: TENANT OWNER CONTACT BUILDING PERMIT Status: ISSUED Issued: 01/10/1994 Expires: 07/09/1994 Suite: Type of Occupancy: DWELLING Slopes: N Sewer: TUKWILA STEPHENSON JEFF. 13004 56 AV S, TUKWILA, WA 98168 STEPHENSON JEFF & WOODWARD PAM 13705 56 AV S #A -311, TUKWILA, WA 98168 JEFF STEPHENSON 13705 56 AV S, TUKWILA, WA 98168 Phone: 206 242 -4361 Phone: 206 242 -4361 Phone: 206 242 -4361 ******************************************** * * * * * ** * * * * * * * * * * * * ** * * * * * * * * ** Permit Description: NEW INSULATION AND SHEETROCK ENTIRE HOUSE, REMOVE ONE BEARING WALL AND REPLACE BEAM. Units: 001 Front: Buildings: 001 Left: Fire Protection: N/A SETBACKS . 0 Back: . 0 Right: .0 .0 UBC Edition: 1991 Valuation: 3,000.00 Total Permit Fee: 147.60 *************************,***************** * * * * * * * * * * * * * * * * * * ** * * * * * * * * * ** Permit Center Authorized Signature Date 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 for and obtain this bui ling per t. Signature:_ Date: /- /U'94/ Print Name: Title:...avgeLL 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. All PERMITS ISSUED FOR NEW CONSTRUCTION, REMODELING, OR DEMOLITION PROJECTS REQUIRE CONSTRUCTION, DEMOLITION AND LANDCLEARING WASTE MATERIAL FROM THESE PROJECTS TO BE RECYCLED AT A KING COUNTY LICENSED OR APPROVED FACILITY, OR TAKEN TO REGIONAL DISPOSAL FACILITIES. CITY OF TUKWILt Department of Community Development - Permit Center 6300 Southcenter Boulevard - #100, Tukwila, WA 98188 (206) 431 -3670 Building Permit Application Tracking PLAN CHECK NUMBER 3' O4-g-- PROJ CT AME F3SO0 , i EF'F SITE ADD ESS rD SUITE NO. INSTRUCTIONS TO STAFF • Contacts with applicants or requests for information should be summarized in writing by staff so that the status of the project may be ascertained at any time. • Plan corrections shall be completed and approved prior to sending to the next department. • Any conditions or requirements for the permit shall be noted in the Sierra system or summarized concisely in the form of a formal letter or memo, which will be attached to the permit. • Please fill out your section of the tracking chart completely. Where information requested is not applicable, so note by using "N /A ", date and initial. DEPARTMENTAL REVIEW "X" in box indicates which departments need to review the project. DEPARTMENT DATE 1N. E APPRDATOVED REQUIREMENTS / :;COMMENTS BUILDING - initial review I4- 61-'13 (ROUTED CONSULTANT: Date Sent - Date Approved - 0 FIRE FIRE PROTECTION: Sprinklers a Detectors II N/A FIRE DEPT. LETTER DATED: INSPECTOR: INIT: 0 PLANNING 1 ,/� '�[�-j tz %c ZONING: BAR/LAND USE CONDITIONS? •Y • No REFERENCE FILE NOS.: INIT: �� - MINIMUM SETBACKS: N S E W PUBLIC WORKS � w (d [� 0-4 ,Ij %71 ` UTILITY PERMITS REQUIRED? 7'Yes (i -I�o PUBLIC WORKS LETTER DATED: r INIT: (-3V -3 OTHER INIT: BUILDING - final review 62.34Na At TYPE' OF CONSTRUCTION: v CERT.OFOCCUPANCY? QYes ISZIo UBC EDITION (year): 1991 INIT: ,.�,,r` TBUILDING OFFICIAL /0, IINIT: y REVIEW COMPLETED AMOUNT OWING: CONTACTED DATE NOTIFIED 2nd NOTIFICATION 3RD NOTIFICATION BY: (init.) BY: (init.) BY: (init.) 01/08/03 CITY OF TUKWILA Department of Community Development - Building Division 6300 Southcenter Boulevard, Tukwila WA 98188 (206) 431 -3670 BUIL1IK. PERMIT APPUCATON P(3- Ol DESCRIPTION !PLAN CHECK NUMBER 110 doP -- BUILDING PERMIT FEE PLAN CHECK FEE.: BUILDING SURCHARGE OTHER: TOTAL - AMOUNT ( ') X11,00 ID RCPT # DATE /' 0 SITE ADDRESS SUITE # 13 -) SG - Avg- S. VALUE OF CONSTRUCTION - $ _. Gd 0 PROJECT NAME/TENANT TEFF 5r EPI+cr2SoA1 'X ASSESSOR ACCOUNT # (%. 1 1 a 00 - og9 6 —01 (commercial) L) Demolition (building) 0 Other: TYPE OF O New Building Li Addition Li Tenant Improvement WORK: 0 Rack Storage 0 Reroof Remodel (residentia&L DESCRIBE WORK TO BE DONE: iVE4 1N5oL;d1-(aA) AN) S NEETinte- fellTieE 141705r. Pgerlbvi. Wt tia_NWr' W ;'Lt 9 12EP,Oc (J 13'1E9044 BUILDING USE (office, warehouse, etc.) HOME sue, tJ EzL);1 Co NATURE OF BUSINESS: WILL THERE BE A CHANGE IN USE? 0 No O Yes If Yes, new building requirements may need to be met. Please explain: SQUARE FOOTAGE - Building: /25.0 Tenant Space: Area of Construction: 3-e WILL THERE BE STORAGE OR USE OF FLAMMABLE, COMBUSTIBLE i No 0 Yes IF YES, EXPLAIN: FIRE PROTECTION FEATURES: 0 Sprinklers ❑ Automatic Fire Alarm OR HAZARDOUS MATERIALS IN THE BUILDING? System PROPERTY OWNER OFF- St-E.p14 9A►'N IjOt ul44, PHONE I a� PHONE ZIP ��� 98/ 44?_____ 1ZIP ADDRESS 13705 SG �`' Aver "1-3// CONTRACTOR SELF ADDRESS WA. ST. CONTRACTOR'S LICENSE # EXP. DATE ARCHITECT SF�I` PHONE (ZIP ADDRESS I HEREBY. CERTIFY;:; THAT; 1: HAVE READ,' AND EXAMINED TI-HS: APPl iCAfl0N. AND KNOW THE: SAME 1.0 BE TRUE.AND ;CORRECT; ,AND:1 AM <AUTHORIZED TO APPLY FOR`THIS PERMIT. ;.: BUILDING OWNER OR AUTHORIZED AGENT SIGNATURE .4.% DATE . PHONE Z Ci Y21P,1.V 21-4 11,8 PHONE ,J42 -130 f PRINT NAf .Ff Rr V IP', "VPh+5vS�4 ADDRESS 13705 .5646.4 'I $ /4-3// Alu f: CONTACT PERSON APPLICATION SUBMITTAL In order to ensure that your application is accepted for plan review, please make sure to fill out the application completely and follow the plan submittal checklist on the reverse side of this form. Handouts are available at the Building counter which provide more detailed information on application and plan submittal requirements. Application and plans must be complete in order to be accepted for plan review. VALUATION OF CONSTRUCTION Valuation for new construction and additions are calculated by the Department of Community Development prior to application submittal. Contact the Permit Coordinator at 431 -3670 prior to submitting application. In all cases, a valuation amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Building Division to comply with current fee schedules. EUILDING OWNER / AUTHORIZED AGENT If the applicant is other than the owner, registered architect/engineer, or contractor licensed by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and obtain the permit will be required as part of this submittal. EXPIRATION OF PLAN REVIEW Applications for which no permit is issued within 180 days following the date of application shall expire by limitations. 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 304(d) of the Uniform Building Code (current edition). No application shall be extended more than once. 11 you have any questions about cur process or plan submittal requirements, please contact the DeparttReoElornrnunity Development Building Division at 431 -3670. CITY OF TUKWILA DATE APPLICATION ACCEPTED .,n 1 DATE APPLICATION EXPIRES 0-61-13 EC 91993 PERMIT CENTER COMMERCIAL SUBMITTAL CHECKLIST NEW COMMERCIAL BIJILDINGS /ADDITIONS Complotod building permit application (ono for each. structure LiAssessor Account Number •Two sots (2) of the following Specifications: LJStructural calculations stamped by .a Washington State licensed engineer. 11 Soils roport stampod by a Washington State licensed engineer Li Topographical survey Li Energy calculations stamped by a Washington State licensed engineer or architect 1 Legal description riWorking drawings stamped by a Washington State license architact,.which include:;: • Sit() plan : • Architectural drawings ••Structural drawings Mochanical.drawings • Elevations Civil drawings • Landscape plan • [11 Go. tplotod utility permit application :''x (6) sets of civil drawings onk for entire project NOTE: .See utility :permit application and checkIist, for.,specific`utili submittal requirements RACK. STORAGE J Completed building permit application 1:!1 sossor Account 'Dumber :Two (2) sots of plan, which include::. Li Building floor plan showing • Entire space whore racks will bo tocatod • Exit doors • Dimensions of all aisles Trmant space door plan showing rack storage ikyout, aisles an NOTE lrcluda dimensions. e! racks .(herght,,width and length); aisles'; anri exit •ways nn plan:. Ltructural coicuiatione stamped by a Washington Statolicansed • ..;onginoer (rack stornge E3':and over) RESEDENT?AL NEW SINGLE- FAMILY DWELLINGS /ADDITIONS EComplotod buliding pormit application one for oath structure COMMERCIAL. TENANT:IMPROVEMCNTS Completed buliding permit application (one for each structura,or • tenant) Assessor Account Number; Two (2) sets of constructf on plans which.include •- Site plan �:LocaUon of tenant space; :Existing and proposed parking' :Landscape Plan (if applicable, t o ; change of use Overall building. plan:: • ••Tenant;location ,' Use of adjacent.(common wall) tenant •.Coverall .dlmenslon of building or square footage Floor: plan of.propospd;tenant space %.Tenant space plan with use of oath room :labelli `;Exit doors, ogress' patterns NeW.walis,;o osting.wall' and. walis.to.be domolishe Construction details. Cross sections: showing ,wall constru�tion`and method of attachmenNor:fl,oarandceiluig ;; .`: Structural caiculatons stamped:by a. Washington State(iconsod. engineer maybe tequired f str e.douctural work is to"be done (2 seta)` NOTE 1! any utilityv ork is, ";`to bite submd ceparata utility perm't ; application an l plans REROOF :' <: Compietod buliding permit applic tion;.(ono ror each structure Assessor: :Account. Number; Narrative •describing existing •roof rnatorial boing.rornoved an :material being Jnstalledi ;NOTE A.ceruhcat/on lctter,is required prior to final,inspection and sign 'Off the armrt P, ........... ..................... ... ANTENNN/SATELLiTE: DISHES L] Logal doscription L_I Assessor Account Number L1 Two sets (2) of working drawmgs':�h iah include • Silo plan . .). (On plan show: clo esi hydrant Idcat/on •: Foundation plan Include: access to bulldingrshOWIff • Floor plan tvddi and !ennh of access) • Roof plan . Building elevations (ail views •;Building cross - section • Structural framing plans Completed building pormit application Assessor Account Number Twa (2) set plans, which include Site Plan (showing s of buliding and location of antennalsaleliito di fi Detali(antennaisate'lite dish and tnuthod of attaohmorrt Structural calcutations t.tamped;by a Washington State iiconaod: ongineermay: be REMODEL.:' �Comploted building pormit application 'one for each structure) r1Assessor Account Number Two (2) sots of working drawings which include; I_ Washington Mate Energy Code data:' r Complotod utili y pormit application r j Six (G), sots of sito plans showing utilities: ito plan ountlation plan lodr:plan Roof: plan Blinding elevations (all views Building cross section; Structural f rarning plans`, NOTE .if any utility, wurk'ls to be dons& and p1An '(just.basubniitted ;BEROOFS: NOTE: Building sits plan and utility site pinn may ho combined Sue utility permit application and;chocklist for specific. submittal roquirements. AckrRional topographical and soils informatiorrmay be required if unique:. sito conditions.' . Coriipletod buildingporrnitapplicatlon` Assessor Accpunt Number . tJarrativo cP�Ij existing roof, material being mater)01t12(jg,inataliq NOTE A'cerUficaiion. letter Is roctuirod priorto /trot Inspactlon and sign= off of the pormit . ^ • ;:f 6 **k****k}rk* *kkk***kk *. ** k* kkkkk* k*** kk*•c**hkk**kk**k**A*k***kkkk. LITY OF TUKWILA, WA 1RANaMTT h,4*•kk*kk****k*•k* k** ah******* kkkk k* k***** ****kkk** **kJh***N**kkkk* A• TRANSMIT Number: '':+3001760 Amount: 147.60 12/09/93 15:47 permit Not 893-0472: Type: [1 -BUILD BUILDING PERMIT Parcel Na: 2i.7200-- 0W91p• Site Address: 13ooll 56 AV S. St: 01. F1: Uri:. Payment Method: CHECK; Notation: JEFF STEPHENSONI Init: SAO ****i*k A***** A* A*****k• k****** **** * * *A******* *k**k*M***ik ** *k*** 12/10/93. Account Code 000/322.100 000/345.830 000/386.904 Description BUILDING - •RES .PLAN CHECI( - RES STATE BUILDING SURCHARGE Total (This payment) :. Total Fees: Total All payments: Balance: 147.60 147,.'6/0 .00. Paid 108.00 35.10 4.50 147.60 GENERA 108.00. GENERA 35.10 GENERA 4.50 TOTAL 147.60 CHECK 147.60 CHANGE 0.00 6976A000 15:38 CITY OF TUKWILA Address; 13004 56 AV S Suite Tenant :' STEPHENSON itlEFF Type: B -BUILD . Parcel #; 217200 -0295 Permit No: B93 -0472 Status: ISSUED Applied: 12 /09/1993 Issued: 01/10/1994 *k' k*• k**• k********• k**• k*k* k* k* k• kk* A*• A* k• k• k.***• kk**• k***• k* k•k•k*kkk•k * **k *k *kkk•*k•k *k•k* Permit Conditions: 1. No changes wi l 1 be made..toy�`the;�pl inst.'(in1:ess,approved by the Tukwila'Bu11ding Divisi 2. Electrical , ";.. per mi,�.�a =11 be ob,tainedr��througti th�,,��i1.a,shington 'State Division /rof. Labor aind' 'I dustrr-i #es and all '"e"�lectr1cal work wi 11, be, iOsp c.ted.'•b>y tha`;; agency (248;. ;,�b630) . :, 3. ` A l l mechan j; a ► wo.r4k' sl)a 1 1' be under separate perm,„l t through the C i ty •o�f,K;�,Iiu k , i 1'ik k., , 4, �,, 0 ,z ,3 , 00 ;'ors} ' 4:'j' '� Cti4 r 't 'i,F sF a r, ti ." 4. All per .s °, Itsspcti'onerecar fs, and approved pia s` °shall Abe maint,ai.n4'e 1 .av'a`i.�,l.able.at the "':j;ob /1ct�l a prior t"o the; start ofd' any construction`. T ese Add urnents Fare to be mai,nta'i,n:ed �,, av ail abVeFyuntil final inspection appiova1 ,is gral,�ted.�`';. *' 5. Al 1 c'o_ s.tr'u t i on ,`to be done tn,, conformance with approved p 1 a •S 'nd��r�,eliui ;�ementsc9f the'/Uniform. But lding Code:, (1'991x' Edi n) as mended by thee...Wa'sjhington State Building'„ Code'', Uni o m Mechan�fca1 Code•M,c,�199 Editi;an)^,^,".and Washington State Energ! Code ( 1(991 Second Ed�ii i o;,)( '� r , , ,�_ '` Valk ;d.i ty of; P4rmf1 t.; `'Tt e i ss ante ,pfd per�mi t or appr:.ova l of p1 , , s, pe.dlf1:ca,tions " "ah'ri- „..,0o putat°ians shal.l not be can-I str d to. �b'e a pe evil' for , dr\`'an ;pproval`'a , any vio;latri;on, of , dt. the rov1s'ion t (tai's cod.ew...or f any other* or d ;fiance of the jun,.lsd.ictton. ' ,tMo ;�pe, m{ C.¢p.resum1ng #o give- . aut '�i ty or v' Yo 1 ate or cancel t`hi'ef pro' l s l ons,.;4)f this code y :sha p e Vali � .,� INSPECTION RECORD (V. Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Soythcenter Blvd., #100, Tu ila, WA 98188 .._(2Q6,�431 -3670 @' Approved per applicable codes. ❑ Corrections required prior to approval. COMMENTS: ' ynlS -Ar t c)rJ r--/LA APP ILO V\ Q Inspector: t �. Date: 7/, ❑ $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd„ Suite 100. Call to schedule reinspection. AVFMAIEN Date anted: / NAMEN -"°41111.11MIL''' 11641111011110W1 47.:m stnld , .. • squealer, alff •iii iii @' Approved per applicable codes. ❑ Corrections required prior to approval. COMMENTS: ' ynlS -Ar t c)rJ r--/LA APP ILO V\ Q Inspector: t �. Date: 7/, ❑ $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd„ Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 �Pr ect: ,Q, �J��.:�'�4L,��%.� - Type of Inspection: //�� ��C-n ��.J Date Called; 49 Instructions: Dale Wanted: 6: — i7y-9i a.m.r Requester Phone No.: 01/ / • 0 Approved per applicable codes. Corrections required prior to approval. COMMENTS: 0 $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. 0 INSPECTION RECORD 0 Retain a copy w/th perm/t CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 7-4-a: 33 cc `5 y Type of Inspec iorfi/„ / ��se Address: , 5�� Date Called: Special Instruct ons• Date wanted: Requester: Phone No.: ❑ Approved per applicable codes. Corrections required prior to approval. ❑ $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION RECORD 0 Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 015-o1-ra PERMIT NO (206) 431 -3670 Project: C- v.12 pry i� »1, -f-f Type of Inspection: Ix w a Address: I �^ ^ v ,s :J 1'\ Date Calved: 3—%;1)— q Special Instructions: r Date Wanted: 3 " S' r am, p.m. Requester: Clam Pt,orre No,: c2 _ — Approved per applicable codes. Corrections required prior to approval. • COMMENTS: ' , A speder: 4-' A A A. cis. 0 $30.00 REINSPECTIO fEE RE UIRED. Prior to reinspection, Date: tee must be paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 -Pio la ; ' ,,. a: . .r_ �, �, I n , to a--� o r) Addrew: . O L/ 5G a �o s Date Called: L. /�. / q r r Special � strudiwss: = . Date Yy4nt : / � 3/1///4/ / .2 ,'P� am. m. Fequester. p Prone No.: 3z( a- Lf 36 J Approved per applicable codes. ❑ Corrections required prior to approval. ❑ $30.00 REINSPECTION' EE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Leaegflo.: .INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 0 /8673 -- PMIT NO. (206) 431 -3670 Project. ; / , �a.{� 2!�'t'� Type of Inspection A. 1i Special . Date Wanted: .- ._ cP - % I am. m. Requester `A Phone No.: "� ,17 Y 9 /„..... 5(( � 0 Approved per applicable codes. KCorrections required prior to approval. COMMENTS: ' 2) .61_44,1., 51- (,1- bt i t- k- "4.4 S1 l41 vt/‘,14"t--) ---- $ c/o �� -z O $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Race* No.: I Hale: 9 INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431 -3670 •r.. i 1 ) • ilju u_, ypeo � .: . 1' aka hx.. Address: i I /� v Date Calved: _ �� , / Y i , / Y' �stru .. Ions: Date Wanted; ' P.- 9/ ma Requester Phone No.: _ 13 I ❑ Approved per applicable codes. A Corrections required prior to approval. COMMENTS: ' ��-' mt.-7 110 --mil /0©4 /4-76. Giv► O $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali to schedule reinspection. [WW1's.: Date: INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 r0.13W\9eide • Type of Inspection: j.,,,,,w/ ,56.4cD,...s Address: 4.0 — 6 ./..( _ Date Called: nstrucilons: " Date ' anted: Requester: —Pi tricr ' Phone No.: Approved per applicable codes. Corrections required prior to approval. , COMMENTS: 1 Inspector. Date2.— 9--7 I El $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be pkid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. recoil No.: Date: INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 0 gl- o (172-- PERM' NO. (206) 431 -3670 l /-4=-'\k4" ,t 1? S 1.1 A-T i-1 i ,,X7 Address; i 2.0.0' -/ 5G i►-✓ S . Date Called: - 2 Special Instructions: Date Wanted: L -3 'q am. Requester: T -F Phone No.: ❑ Approved per applicable codes. Corrections required prior to approval. COMMENTS: Ma ❑ $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. 4. -kw -- MY. _ .-a_ s..... • REAL ESTATE EXCISE TAX AFFIDAVIT -��- Form No. 84 000IA CHAPTER 82.45 RCW - CHAPTER 458 -61 WAC For Use at County Treasurer's Office (Use Form No. 84 -0001B for Reporting Transfers of Controlling Interest of Entity Ownership to the Department of Revenue) Tt11S AFFIDAVIT' WILL NO'T BE ACCLI'T'LU UNLESS ALL 1'I'EMS ARE FULLY COMPLETED This form is your receipt when stamped by cashier. SELLER • GRANTOR Name • `i 3•' /rJ b A ) 1 -•, 11 i /& BUYER els GRANTEE Name I 1 ,i , Street City Street ..,, , •'''' j / "r -r i / r t ; ..., 1 ; `-' ,3• `` .'> /a P A State 10 1 ?I Zip 1 �' -1. City ' r ti j t . r Stater i Zip . .41.:.—ft: . ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE Name Street City /State Zip A /17eta(- fit. :: '1.iV Jr. {:•J::t1 {CF / \JVKG{�il"{>711iL'f•: ^:: A.5S13SS.E.0 VAT U. It? T!17t: X. 1f•':T•.:: El LEGAL DESCRIPTION OF PROPERTY SITUATED IN ❑ UNINCORPORATED x $.A. COUNTY El OR IN CITY OF � ht +�(� Street Address (if property is improved). / �� ( ) � A 6'6 r//-, Co C ( k A T JZ.,r U ri 2T o /.j ( i9 K.O'e 7.7?. $ 1a,6D Z-10-./t,i /03 F7 Does this transfer of real property reflect the transfer or acquisition of the controlling interest in an entity with an interest in real property in this state? Yes❑ No❑ If yes, this transfer of controlling interest must also be reported to the Department of Revenue within five days of the sale on Form No. 84 000IB. ® Is this property currently: YES NO 0 Classified or designated as forest land? ❑ Chapter 84,33 RCW Classified as current use land (open space, farm and agricultural, or timber)? Chapter 84.34 RCW Exempt from property tax under nonprofit organizations? Chapter 84.36 RCW Receiving special valuation as historic property under? Chapter 84.25 RCW Property Type: ❑ land only ❑ land with new building ki land with previously ❑ land with mobile home used building (1) NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) If the new owner(s) of land that is classified or designated as current use or forest land wish to continue the classification or designation of such land, the new owner(s) must sign below, If the new owner(s) do not desire to continue such classification or designation, all compensating or additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due and payable by the seller or transferor at the time of salt. The county assessor must determine if the land transferred qualities to continue classification or designation and must so indicate below. Signatures do not necessarily mean the land will remain in classification or designation. If it no longer qualifies, it will be removed and the compensating taxes will be applied. All new owners must sign. This land ❑ does ❑ does not qualify for continuance. Date DEPUTY ASSESSOR (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) lithe new owner(s) of property with special valuation as historic property wish to continue this special valuation the new owner(s) must sign below. If the new owner(s) do not desire to continue such special valuation, all additional tax calculated pursuant to Chapter 84.26 RCW, shall be due and payable by the scllcr or transferor at the time of sale. (3) OWNER(S) SIGNATURE 0 Description of tangible personal property if included in sale (furniture, appliances, etc.) t . If exemption claimed, put WAC number and title. WAC Nuinbcr WAC'Titic Type of Document Date of Document ;;l Gross Sale Price Personal Property (deduct) Taxable Sale Price Excise Tax State Local Delinquent Interest: State Local Delinquent Penalty: State Total Due THERE IS A $2.00 FEE FOR PROCESSING THIS FORM IF NO TAX IS DUE. AFFIDAVIT I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signature of Grantor /Agent Name (print) • ► /. Date & Place of Signing ! r;i:..'. • Signature of ....../ "' Grantee /Agent Name (print) J Date & Place of Signing -- 7' 8 PERJURY Perjury is a class C felony which is punishable by imprisonment in a state correctional institution for a maximum term of not more than five years, or by a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment'and fine (RCW 9A.20.020 (1C)). DISTRIBUTION: Original - County Treasurer FORM REV 84 0001A (6-93) (PD 6-10-93) 1st Copy - Department of Revenue 2nd Copy - County Assessor FOR TREASURERS USE ONLY 3rd Copy - Taxpayer TUKWILA BUILDING DIVISION NOTES 1. All wood frame construction requirements of UBC Sec. 2516. detailed on plan submittal shall inspection. CITY OF TUKWILA APPROVED .JAN r; 19 3 AS shall comply with the Specific requirementsf g1c5rtNG DIJISInrd be subject to field 2. Proposed 4x12 beam shall not span more than 8 -feet of unsupported length unless a specific engineered design is submitted and approved. 3. All post to beam connection shall be made secure with wood gusset plates or approved metal framing connectors. 4. Individual concrete or masonry piers shall project at least 8- inches above exposed round unless the columns or posts which they support are of approved wood of natural resistance to decay or treated wood is used. 5. All new ceiling joists shall meet the size, spacing and spans allowed per UBC Table NO. 25- U -J -6. (copy attached) 6. All exterior wall cavities that are opened and are without thermal insulation, shall be filled with thermal insulation to the full depth of the stud wall cavity. 7. Replacement of roof /ceiling must include the installation of thermal insulation at the attic space when no insulation exists. Thermal insulation values shall be at minimum R =38 for electric resistance heating, and minimum R =30 for heating by other energy sources. 8. Provide smoke detectors in all bedrooms and in hallway or area leading to said bedrooms. SEPARATE PERMIT RE9UIRED FOR: CHANICAL 9.ECTRICA'. P MBINC rU(GAS PIPING CITY OF TUKWILA BUILDING DIVISION FILE COPY 1 understand that tho plan Check c subject to errors and omissions nnJ L cf plans does not authorize the violation cf c; �y adopted coda or =Ike % RsoNpt of contractor's copy of approved plans BY Date tIVWN6 r614.- • �. 5irettEi)Sb O (30 e' .510.6 114,5 WA 96744 e C1vkwit-A) , tf5te 61 0507 RECEIVED CITY OF TUKWILA DEC 9 1993 PERMIT CENTER tl><I Z Ji Y ►1 lO /yT (4 g