HomeMy WebLinkAboutPermit MI2000-274 - NGUYEN SHORT PLAT - DEMOLITIONNGUYEN
SHORT PLAT
City of Tukwila
(206) 431 -3670
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
MISCELLANEOUS PERMIT
WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES,
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands:
547680 -0280
10436 47 AV S
DEMO
MISCPERM
LDR
001
North: .0 South:
SEATTLE Sewer:
Slopes:
Fire
.0 East:
SEATTLE
Y
Contractor License No: AMERII *031PH
OCCUPANT NGUYEN SHORT PLAT
10436 47 AV S, TUKWILA, WA 98188
OWNER JONES CORINNE
PO BOX 28137, SEATTLE WA 98118
CONTACT LONG NGUYEN
510 RAINIER AV S, 31, SEATTLE WA 98144
CONTRACTOR AMERILAND INC
510 RAINIER AV S, SEATTLE, WA 98144
t****,********************************************** * * * * * * * * * * * * * * * * * * * * * ** * * * * * * **
Permit Description:
DEMOLITION OF 900 SQUARE FOOT RESIDENCE.
PUBLIC WORKS ACTIVITIES INCLUDE CAPPING OF THE
EXISTING SANITARY SEWER LINE i THE PROPERTY LINE
ALONG 47 AVE S AND REMOVING EXISTING WATER SERVICE
AT METER.
** * * * * * ** * *** * * * * * * * * * * * * * * ** ********************** * * * * * * * * * * * * * * * * * * * * * * ** * * * * * **
Permit No:
Status:
Issued:
Expires:
Occupancy:
UBC:
Protection:
.0 West:
Streams:
MI2000 -274
ISSUED
11/22/2000
05/21/2001
DWELLING
1997
.0
Phone:
Phone: (206)723 -2538
Phone: 206 - 266 -3756
Phone: 206 - 226 -3756
Construction Valuation: $ 4,000.00
PUBLIC WORKS PERMITS: *(ureter Meter Permits Listed
Curb Cut /Access /Sidewalk /CSS: N
Fire Loop Hydrant: N No:
Flood Control Zone: N
Hauling: N Start Time:
Land Altering: N Cut:
Landscape Irrigation: N
Moving Oversized Load: N Start Time:
Sanitary Side Sewer: Y No:
Sewer Main Extension: N Private:
Storm Drainage: N
Street Use: N
Water Main Extension: N Private:
*****'****+******************************************* *k * * ** ** * *** * *** * * * ** * * * * * * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 71.50
***************************************************** * *** * * * * * * * * * * * * * * * * ** * * * * * * **
Date I
� w�w
Separate) Eng. Appr: JJS
S1ze(ln): .00
End Time:
Fill:
End Time:
Public:
Public:
Permit Center Authorized Signature:
w OW MP
I hereby certify that I have read and examined tliis permit and know the same
to be true and correct. All provisions of law and ordinances governing this
work will be complied with, whether spr cified herein or not.
The granting of this permit does not presume to give authority to violate or
cancel the provision of any other state or local laws regulating construction
or the performance of work. I am authorized to sign for and obtain this
development perm)t.
Signature:,-,
Print Name:
LaAICt- 1111117P.El•C/
Date:
//� ZU /U U
y P
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.
Address: 10436 47 AV S.
Suite:
Tenant:
Type: MISCPERM
Parcel #: 547680 -•0280
CITY OF TUKWILA
Permit No: M12000-2 74
Status: ISSUED
Applied: 11/13 /2000
Issued: 11/22/2000
. kith************** k* k****** k** *k * *1kkk * *1*kAkk *k* *.akk'Itk *J k* ** *** * * * *1N *k ** * **
Permit Conditions:
1. No changes will be made to the plans unless approved by the
Engineer and the Tukwila Building Division.
2. All construction to be done : in conformance with approved
plans and requirements of the Uniform Building Code (1997
Edition) as amended, Uniform Mechanical Code (1997 Edition),
and Washington State Energy Code (1997 Edition).
Validity of ;Permit.: The issuance of a permit or approval of
plans, specifications, and computations shall not be con-
strued to be a permit for, or an approval of, any violation
of any ,of ' the provisions of the building code or of any
other 'ordinance: of the jurisdiction. No permit presuming to
give ;authori ty to violate or cancel the provisions of this
.code: shs l 1. be valid.
All ;,perrni ts, inspection records, and approved plans sha 1.1 be
available at the job site prior to the start of any core- -
struation. These documents are to be . maintained and eva i 1
eb1,e. unti 1 final Inspection approval is granted,
TotpWrary erasion control ' measures shell be implemented as
,th'e,iirst order of business to prevent sedimentation off -:
si`te, or Into existing storm drainage fecillties
The ;`site shall have permanent erosion control measures in
piece as soon as possible after final grading has been F.
completed and prior to the Final inspection.
Contractor ;shall notify Public Works Utility Inspector,
eat 206 ,.433 -0179 of commencement and completion of work crt.
1 tnat t24:.itcrur In advance.
'Work. affecting .traff ic flows shall be closely coordinated
with the City Utilities inspector... Traffic control P1:ans
'shall be submitted to the Inspector for• prior approval.
Sewer and water utilities shall be plugged at the Mains if
• they are to be` epandoned. if they w,1ji be used; again in
the near future for _ a new building, they shr;►l l lie capped
at the property 1 ine end at the water :met.er respectively.
I hereby certify that 1 have read these conditions and will comply
W I tlr there as outlined. All provisions of law and ordinances governing
this work will be complied with, whether specified herein or not.
The granting of t:) i s permit does not presume to give authority to
violate or cancel the provisions of any other work or local laws
regulating constr/ilction or the performance of work.
y _.
Date: ////.227/
ate : // ,2 2„C
CITY OF : JKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98 188
(206) 431 -3670
' R STAFF USE ONI Y
Project Number:
Permit Number.
N� ?coa -2"lu
Miscellaneous Permit Application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
Project Name/Tenant: ..,&sk)5040.e`. A/ t/ S ) /ll
--tt' ten/ l� o (�-
V „i� of Constructs n:
cv
Site Address :
`0 17A 36 —'i
City State/Zip:
771 14-17-e S. !ik Wt fr /F6
'� ,/�L
Tax • arcel Number:
5-1/7:46-'JD az ?o -' f
Phone: (� 6) _ 2 2� ?�G
Property Owner: AN is f z-,'i
/'
Street Address:
1-7 B A . . G t r- h4:e. a
✓-c- _
City State /Zip:
. l .- ___(e'ci-., Wet Ids
Fax 11: (
)
Contractor:
4 R- /_ UA-71/j -?/trz
Phone: (
)
2 z 6_ 3 7.sY”
Street Address: City State/Zip:
x'10 i I- 4.- %� Ste# � l tt
Fax 11: (
)
Architect:
A t G t 41-
14 -'/
t
City Slat Zip:
Phone: O
Fax #: ( )
Street Addres s. L C
,,to
Engineer:
Phone: (
Fax 11: (,.
)
Street Address:
City State/Zip:
Contact Person: O N4- N r u
-#`1
Rhone: (7
) w 72. d_ ;7 6
Street Address:
City State/Zip:
Fax M: (
)
MISCELLANEOUS PERMIT REVIEW AND APPROVAL RE • UESTED: (TO BE FILLED OUT BY APPLICANT)
Description of work to be done (please be specific):
pflvk1'6)1 / a eiL Aot, 5--e-- goo bE
Will there be storage of flammable/combustible hazardous material In the building? ❑ yes ❑ no
Attach list o / materials and store e location on se 'orate 8 1/2 X 11 'o'er Indlcatln unntitles & Material Snlet Data Sheets
tJ Above Ground Tanks Antennas/Satellite Dishes Bulkhead /Docks Commercial Reroof
; aDemolition ❑ Fence ❑ �1 Manufactured 1- lousing.Replace111eitt only
❑ Parking Lots ❑ Retninin Walls t_..1 Tem fora Facilities ❑ Tree Cuttin
ChannelizntIor1/Strlping
Flood Control Zone
Landscape Irrigation
Storm Drainage
Water Meter /Exempt M
Water Meter /Permanent M
Water Motor Temp tt
Miscellaneous
APPLICANT RE UEST FOR MISCELLANEOUS PUBLIC WORKS PERMITS�
t_1 Curb cut/Access/Sidewalk Fire Loop/t'Iydrant (main to vault)M: Slze(sl;
❑ Land Altering: 0 Cut cubic yards 0 FIII cubic yards 0 sq, ft,grading/clearIng
Sanitary Side Sewer M; CliPP /Rk't ❑ Sewer Main I xlenslun 0 Private 0 Public
Street Use ❑ Water Main Extension 0 Private 0 Public
Slio(s); 0 Deduct 0 Water Only
AVMS
-StrOTOrmi.)
Size(s): Est, quantity; gal Schedule;
Mt'ving Ovorslzod Load/Hauling
MONTHLY SERVICE BILLINGS TO:
Name;
Phone:
Address:
City /Sta
e/Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name;
Phone:
Address:
City /Sta e /Zip:
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.
Date appli anon cepte
9/9/99
niiscprnr.doc
Data a pH exp c�,t
Appl
ken by: (initials)
IT APPLICATIONS MUST BrSUIJMI WITH THE FOLLOWING:
> ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
• BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
> ARCHITECTURAL DRAVVINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
> STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED
STRUCTURAL ENGINEER
> CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.)
❑
St1BMI1 APPI I( AT ION AND REQUIRED ( 11E( KI ISIS 1OR
Above Ground Tanks/Water Tanks - Supported directly upon grade
exceeding 5,000 gallon; and a ratio of height to diameter or width which
exceeds 2 :1
PERMIT REVIEW
Submit checklist No: M -9
❑
Antennas /Satellite Dishes
Submit checklist No: M -1
in
Bulkhead /Dock
Submit checklist No: M -10
Commercial Reroof
Submit checklist No: M -6
ry
Demolition
Submit checklist No: M -3
❑
Fences - Over 6 feet in Height
Submit checklist No: M -9
❑
land Altering/Grading/Preloads
Submit checklist No: M-2
❑
Miscellaneous Public Works Permits
Submit checklist No: H -9
❑
Manufactured Housing--(RE D INSIGNIA ONLY)
Submit checklist No: M -5
❑
Moving Oversized load /Hauling .::,`,.,.
Submit checklist No: M -5
❑
Parking Lots '' i .
Submit checklist No: M-4
❑
Retaining Walls - Over 4 feet in height
Submit checklist No: M -1
❑
Temporary Facilities
Submit checklist No: M -7
Tree Cutting
Submit checklist No: M -2
1pBuilding Owner /Authorized Agent If the applicant Is other thou the owner, registered architect /engineer, or contractor
licensed by the State of Washington, a notarized letter from tl►e, property owner authorizing the agent to submit this
ormit application and obtain the permit wiN be required as part of thls submittal,
❑ Current copy of Washington State Department of Labor and Industries Valid Contractor's License. If not
available at the time of application, a copy of this license will be required before the permit is issued, unless the
homeowner will be the builder OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ".
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.
Al pot
9/9!99
uiiscpmtdue
GIty. Ur, %W WYLAI WA
L)
4 * *A* *4* *4444 * *5 A *Ai A 4 A*A *4 *444A* 444 *.64,x444* 4**A,A *AA*44
TP.AN84XT .Numbers 89000396 Amount: 71.50 11/22/00 12:16
PAyu itit,Method: CASH Notation: LONG NGUY£N /nit: ILO
•• t f r •. w •• w of 4 w 1. + s. •: i. U w a. — w+ t• r. i• 4- •• w w 4: 4 •• s- • 4, 4. •• 4444
:pt#rmit Nis: 1412000••274 Typo: MISCPCb:i4 MISCELLANEOUS PL`i:14I1
P': 1 urc� Na: 547E40-0200
1tar Addr ias 10416 47 AV ii
Total F'#u *: 71.30
Th I Pi ymerit 71.50 1'otu1 ALL Pntu a 71.50
Sul anC<<: .00
*444444 AAA,:#;, A*414 14 44 + *4#!kA4A * *A *** * ** ** *4 ** * ***** * siko ** *4a#
Account Gudu Aoacriptlun Amooll:
.000/322.100 0UX1I01NC • 11UNRCG 47.00
000/306.904 tITAT4 OUILDINO UURI I4i RU, 4.30
4(44442,400 I WO t' LC - SMI /W3 20.00
. . • • M t • t... • t • .• W +• •t4 . k . • • s ..J W . * r t i s • • r • s 44 . c s• ,1t a. ..A 40 04 •t ti s/ W
•':1,414. •1Ww•1MaltW t1. 11s•+.f.1•M
t :9715 TAI 7
INSPECTION No.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd,' #100, Tukwila, WA 9818
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
(206)431.3670
Prot : t: /0 /
J /
Type of In . • on:
AK /
t , s :
Date ea =.. ism ""'" - /
Special instructions:
Date wanted: ,2 , a
: ,m.
Requester: I.
t,J aki
Phone; G0. -.4 °",
2 2
Approved per applicable codes.
COM ENTS:
Corrections required prior to approval.
Inspector:
Date:
ti47 SPECTION f&E (WINED. Prior to inspection, fee must be paid
at : ''' Southcenter BIvd. ' /he 100. Cali to schedule reins action.
Receipt No;
City. of 71dcwila
Fire Department
Project Name
Address
•
John W. Rants, Mayor
TUKWILA FIR* DRPARTH2NT
FINAL APPROVAL FORM
- I
-1 -* '11 , Suite #
Thomas P. Keefe, Fire Chief
Permit No. jril-t9e04-.2-7ill
Retain current inspection schedule
Needs shift inspection
Approved without correction notice
Approved with correction notice issued
Sprinklers:
Fire Alarm:
Hood & Duct:
:Halons
Monitors
Pre-Fires
Permits:
Authorized Signature
FINALAPP,FRM
T.F.D. Form F.P. 85
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Mow (206) S7S-4404 • Fix: (206) S7.5-4439
.."
INSPECTION ftE(,..RD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
PERMIT NO
(206)431 -3670
Proles :
,
a
.,
Type • f Ins ectton:
/-
fJ
L4'
rrJ'
�
•J
n : t cal IS ;
co
Special instructions:
D . to wanted:
a.m.
Requester:
.:.r
/�j
/nut
Phone:
iiii i
fa
Approved per applicable codes.
COMMENTS:
Corrections required prior to approval.
Inspector:
Date: I
El $47.00 REINSPECTION Fif REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. Call to schedule reins s ection.
Receipt No:
Date:
INSPECTION RECORD
Retain a copy with permit
INSPECT OM NO. ,
,CITY OF TUKWILA !WILDING DIVISION
61p0'Southcenter Blvd, 4100, Tukwila, WA 98188
A
PERMIT NO.
(206)431 -3670
Pr+ ject:
i . _.
Type of inspection: 55 livw
.Ads es ,
∎ "}
Date called:
11 2-$ c ..)
lnMrMLWIMIIIIIIIIIIIIIII
Special instructions :.
' `
''
Date wanted:
It I,/
a.m.
Reques er: y�
,..._ �l ,_'.
Phone: /
... i ,
.
Approved per applicable codes, n Corrections required prior to approval.
COMMENTS:
.
lnMrMLWIMIIIIIIIIIIIIIII
lir
a iiiiimuil
WUMV.01, ..J
rnfr
_L*.,;11.t_,, ANA-.
•
r
Q $47.00 REINSPECTION FIE REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. Call to schedule reins ection.
Receipt No: Date:
11
INSPECTION NO,
INSPECTION RECO Di
Retain a copy with permit
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188 (206)431-3670
Project:
►, ( .AAA S1t, i-
y e of inspection:
--- ►601 C'
Add ss:
Special instructions:
LS
Date . lied:
GO
Date anted
2-
IP•
::m.
is
Req APAIt
KApprovetl per applicable codes. Corrections required prior to approval.
COMMENTS:
$47.00 REINSPECTION FEE REQUIRED, Prior to inspection, fee must be paid
at 6300 Southcenter Blvd,, Suite 100. Call to schedule reins action.
Receipt No: Date:
10
1
1
MOM : A 1c,r'Gabth? 40:4, ient. 1. t'!'YA H , : 425'"C O _r
C, j .i
f h_A •. C.? 2000 11: 48AM P1
Ai 1E0140411LE A8ATEMENT,INC.
3'732 SMITH AVE, UNIT 11 EVERETT,WA 98201
AFFOItA11O6CF
'1'AX I1) M 91.147.3845
OFFI C1"'. 425. 303.8072
FAX 425 - 303.0634
CERTIFICATE OF COMPLETION
for
Asbestos Abatement t
AMMVED
erre of TUKWILA
'i 1n 1 3 2000
oERMIT CENTER
:: =eat: LUNG NGUYEN
Re: Site Address: 111436 SO. 017M- V1'dWaA,w11 lit? 44
As per r;1rec :tAc cy owner
Asbestos abatement services was performed by our firm at .
10438 SO, 47TH AVE SEATTLE.WA 98144
Be assured that all activities performed were conducted in accordance with all currently
applicable environmental regulations and contract specifications.
All Regulated waste generated during this process Was placed In a asbestos
certified landfill In arlington Oregon
Asbestos liability insurance and a contractor's surety bond was in effect during these
operattond.
Please feel free to contact our customer service representative at (206) 840.5337
between 800 AM and 5 :00 PM Monday through Friday if you have any further
questions at our toll free 0 1.1100 672.2283
or need additional documentation.
DATE. 11-9-NI
Sincerely,
CALL RLCH 1,
C E.O.
A StateContractors Llcanse >r' AFFORA1106CF
WA.State Asbestos Contractor Certification. a! 1079
FILE, COPY
r,.y +1Os are
Mlmoo ziy
_i;fi1'1 r+i'i'.'t'r,I.�G1�? A ?. tether!:, ..
Agency CrtSe No
200003814
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-r;'5.31.3.31-1":%:74 Ne: •, '?? :,l. aiP
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PUGET SOU:NL) CLEAN A114
AGENCY
110 t.r•;tlnit street, suite Sot)
S:utlte, WA ')KIoi.2011t
vrtvw.pf.1.'eattat :.ti: t3
NOTICE OF INTENT
Date RecelveJ
RECEIVED
NOV ry ITION1tb
Pro ect'1' e:
. Asbestos Removal
• Asbestos 'tonlmvur i Demntitian 3. (�emntirinn No Aic epos lto nt
Property
Owner:
Alt!, Owner's
ing Addrulc:
LIMO NGUYEN
.�Ir1 RAiNII1R AVL S()
Phone.. 206) ?26.1736
i;its': S!:ATV1.1:
!►1tI ::: W'A ): ')8144
bAs
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Cotltreetort - -, �.�� Afordable Abatement, fuc. .... w ...
4 /. .
!Mg Address:
3732 Smith Ate refs
Eve tt
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State " WA Zi
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ti..-net-CL(1.
Ilex Citio o
Plume w 1s23i
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103407:
(42A. 1t13.t)t 34
Mkt
Address:
Site
Menages,
Asbestos Surveyor
Cal Mnt'I Presumed:
.. -.0 ..,,. a s,; ONO
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tt141 S(1, 4 111 AVV.
LUNG yC UY(iN
ass. as
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.ds....►..wr., -Pelf r.. ...�..P..s_te r.moormollo.a._.....
'1I ;KWII,A ....�.l�tl7: 1)KI44
1 Lu'ni Phone :(20G1 226•171It
i✓�. aI . =�— .1..Dale Asbestos{ Norio
Strsicttlres: 1 l''stt C'uI1t11lL:R: $:
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1 �♦ ur,,a .rr , rpN.l'1lalnul►nlvt•rla„ ,1
Aply4A liuiltfltt In.it c�o�' :.=__«,
CertiliCtitlt'n Nt1.
„i1:1 1, SCHROEt1I•R
N1040070:2
ut'inullllult
1Itfo 'mallnnt
Demolition
Contis ctor:
4•••44 MO ONO
Stitt No. 0
~!radon's: 1
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ION 4_44_4.. , .. .
Phone! (3001 2200730
Aiibui tur I'rajocl 1 Wni k Dori' M ,'t' , 'Plt r An Su
Ilirarntti(lolI Start Untt, �,_ 1. imels!iun I)utl,,,,,_,, —„�„r urn
utenownmassmorawanimaronr.rms v,11 ills Iiiulllu it.hu t1,'tti1! ht N.,
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f it:in Mot'l r =ire
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Sit 10,1 c,11111 Rv�tuvnv.:' (CItvvl4 belt A 4.; ll I't�r tosbeitll, flvtr►tviii tl ttaitic111t, RECEIVE
K )' OI1N OF Tt)t�WILA
Ai.h,*lfs Itontovai lit'11jeet A. Prior NuiiC4
I)w)Itllitiun Irrtl v l Nni! 1 a llli R. 10 I1,ty,
IttWes1 I'uv Seliv'J1114.
N1tn.1te1..It.l;;tt!t.
1'a ;t (.'.ivory Astiotok
It, III) 'ai d:• 1l64111iiititul
All Other Dental
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PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
DATE: 11 -13.7
ACTIVITY NUMBER: M12000 -274
PROJECT NAME: HGUYEN SHORT PLAT
SITE ADDRESS: 10436- 47TT" AVENUE S SUITE NO:
X ,Original Plan Submittal
Response to Incomplete Letter # . _.
Response to Correction Letter #_._ ______ .Revision # ..__.._m. After Permit Is issued
DE ARTMENTS:
BO_ Division
Arr 11.14
Publ c Works
FIN �'� evention PI ni1n Division
►+c. t14 ti!L)
Structural ❑ Permit Coordinator
DETERMINATION OF COMPL,E,TENESS: (Tues., Thurs.) DUE DATE: 11 -14 -2000
Complete DI°
Comments :.
Incomplete
Not Applicable El
TUES /THURS ROUT G:
Pled Route
,� Structural Review Required
REVIEWER'S INITIALS:
No further Review Required
APPROVALS R CORRECTIONS: (ten days)
Approved E"...]
DATE:
■.111111.
DUE DATE 12. 12.2000
Approved with Conditions Q Not Approved (attach comments) El
REVIEWER'S INITIALS:
DATE:
CO„R ]O ION: DUE DATE
Approved Approved with Conditions Not Approved (attach comments) E
REVIEWER'S INITIALS: DATE:
VILIIOUI
i;
s _ ' 4 . •',., 1 '
• ►
r-�- -- Detach And Display Certificate ---
•
•
DEPARTMENT OF LABOR AND INDUSTRIES
REGISTERED AS PROVIDED BY LAW AS
CONST CONT GENERAL
4.40 , �,r$EO 8T:` ' #; ,t:1;? EXP .: DATE
:.,
. g."7. ' x* 3i tH� 0/7 /,o1 /200i
, 4 x,0001907
AMERILAND INC
510 RAINIER AVE 8
SEATTLE WA 98144
t
p
WOMMaf ”s,S n ss s•• MILe
•
•
•. • • •
r.
H$u:ost.000 cw!i,
•
Detach And Display Cenilcato
REGISTERED AS PROVIDED BY LAW A
CONST CONT •GENERAL
REOIST. # EXP. DATE
ccol• 'AMERII *031PH 07/01/2001;
MIPFECTIVE ' DATE 10/08/1997
AMERILAND INC
510 RAINIER: AVE ; 8
SEATTLE. 191.1 .'.98144 •
•
Signature
Issued by DEPARTMENT OF LABOR AND INDUSTRIES
f
Please Remove
And Sign
Identification
Card Before
Placing In
Billfold
i t .
•
•