HomeMy WebLinkAboutPermit D12-159 - SHIKARNY HOMES - DEMOLITIONSHIKARNY HOMES
DEMOLITION
13311 37 AV S
D12-159
City o�I'ukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -431 -3670
Inspection Request Line: 206 - 431 -2451
Web site: http: / /www.TukwilaWA.gov
Parcel No.: 7358600310
Address: 13311 37 AV S TUKW
Suite No:
Project Name: SHIKARNY HOMES DEMO
DEVELOPMENT PERMIT
Permit Number: D12 -159
Issue Date: 05/25/2012
Permit Expires On: 11/21/2012
Owner:
Name: NALIVAYKO VLADIMIR
Address: 13311 37 AV S , TUKWILA WA 98168
Contact Person:
Name: VLADIMIR NALIVAYKO
Address: 5211 S 170 LANE , SEATAC WA 98188
Phone: 253- 334 -4762
Contractor:
Name: OWNER AFFIDAVIT- VLADIMIR NALIVAYKO Phone:
Address:
Contractor License No: Expiration Date:
Lender:
Name:
Address:
DESCRIPTION OF WORK:
DEMOLISH & REMOVE THE EXISTING STRUCTURES ON THE PROPERTY AND DIG A HOLE FOR NEW FOUNDATION.
PROJECT ON VALLEY VIEW SEWER AND WD #125 WATER SERVICE (5/8" WM LOCKED ALREADY).
PUBLIC WORKS ACTIVITY INCLUDES EROSION CONTROL AND CONSTRUCTION ENTRANCE.
Value of Construction: $4,000.00 Fees Collected: $551.43
Type of Fire Protection: NONE International Building Code Edition: 2009
Type of Construction: V -B Occupancy per IBC: 0022
Electrical Service Provided by: SEATTLE CITY LIGHT
* *continued on next page **
doc: IBC -7/10
D12 -159 Printed: 05 -25 -2012
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: Y
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
Y
Water Main Extension:
Water Meter: N
Permit Center Authorized Signature:
I hereby certify that I have read and
governing this work will be complie
Number: 0 Size (Inches): 0
Start Time:
Volumes: Cut 0 c.y.
End Time:
Fill 0 c.y.
Start Time: End Time:
Private:
Profit: N
Private:
Date:
Public:
Non - Profit: N
Public:
ned this permit and know the same to be true and correct. Al provisions of law and ordinances
whether specified herein or not.
The granting of this permit does not p
construction or the performance of work
to this permit.
Signature:
me to give authority to violate or cancel the provisions of any other state or local laws regulating
• I am authorized to sign and obtain this development permit and agree to the conditions attached
Date:
s/z s7/
Print Name: Rfid1122 / Y GNP v� ht:7
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.
PERMIT CONDITIONS:
1: ** *BUILDING DEPARTMENT CONDITIONS * **
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 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.
4: 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.
5: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila
Building Department (206- 431 - 3670).
6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
doc: IBC -7/10
D12 -159 Printed: 05 -25 -2012
Department (206- 431 - 3670).
•
7: 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.
8: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
9: The applicant must notify the City Project Inspector at (206)433 -0179 upon commencement and completion of work at least
24 hours in advance. All inspection requests for utility work must also be made 24 hours in advance.
10: Contractor shall notify Public Works Project Inspector at (206)433 -0179 of commencement and completion of work at least
24 hours in advance.
11: Permit is valid between the weekday hours of 7:00 a.m. and 3:30 p.m. only.
12: Flagging, signing and coning shall be in accordance with MUTCD for Traffic Control. Contractor shall provide certified
flagmen for traffic control. Sweep or otherwise clean streets to the satisfaction of Public Works each night around
hauling route (No flushing allowed). Notify City Inspector before 12:00 Noon on Friday preceding any weekend work.
13: Any material spilled onto any street shall be cleaned up immediately.
14: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation
off -site or into existing drainage facilities.
15: From October 1 through April 30, cover any slopes and stockpiles that are 3H:1 V or steeper and have a vertical rise of
10 feet or more and will be unworked for greater than 12 hours. During this time period, cover or mulch other disturbed
areas, if they will be unworked more than 2 days. Covered material must be stockpiled on site at the beginning of this
period. Inspect and maintain this stabilization weekly and immediately before, during and following storms.
16: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at least monthly. All
disturbed areas of the site shall be permanently stabilized prior to final construction approval.
17: The site shall have permanent erosion control measures in place as soon as possible after final grading has been
completed and prior to the Final Inspection.
doc: IBC-7/10
D12 -159 Printed: 05 -25 -2012
CITY OF TUKii
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd, Suite 100
Tukwila, WA 98188
http: / /www.TukwilaWA.gov
Building Pere No. )-- ( S9
Project No.
Date Application Accepted: s—( 0 (
Date Application Expires: \ ` —(0--(..2—
(For office use only)
CONSTRUCTION PERMIT APPLICATION
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 LOCATION / 3 3 // 3 7 , Vr
King Co Assessor's Tax No.:
Site Address: 133 // -37 /OF S. � �4at 4 / �/t Suite Number: Floor:
Tenant Name: Ali i K(I✓' )1,9 J k ') S F /e--I
PROPERTY OWNER
JJ
Name: V 6.4l0 11, /
Name: Waiirmirie, /Vow va
Company Name:
Address: S2l( s. 00 `6Y .e
s--z. S
City: Sza/Kac State: j/,,52
Zip: 9p1gg
CONTACT PERSON — person receiving all project
communication
JJ
Name: V 6.4l0 11, /
c cd
Company Name:
Address:
s--z. S
City:
State:
City: �ovi-�G
State: j /,
Zip: qes' g k
Phone: (3)33.
t(7
7
ax :(Zot) 73(-s
\\
Email:
Exp Date:
Tukwila Business License No.:
GENERAL CONTRACTOR INFORMATION
Company Name:
Address:
Company Name:
City:
State:
Zip:
Phone:
Fax:
City:
State:
Contr Reg No.:
Phone:
Exp Date:
Tukwila Business License No.:
H:\Applications\Forms - Applications On Line\2012 Applications\Permit Application Revised - 2- 7- 12.docx
Revised: February 2012
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New Tenant: ❑ Yes .. No
ARCHITECT OF RECORD
Name:
Address:
Company Name:
Architect Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
ENGINEER OF RECORD
Name:
Address:
Company Name:
Engineer Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
LENDER/BOND ISSUED (required for projects $5,000 or
greater per RCW 19.27.095)
Name:
Address:
City: State: Zip:
‘ilkr5
Page 1 of 4
BUILDING PERMIT INFORMATIO- 206 - 431 -3670
Valuation of Project (contractor's bid price): $
•
Existing Building Valuation: $
Describe the scope of work (please provide detailed information):
o S/ ov,e Wit •C1S4 S irk a e- 2 1/1/frv��c
,� d d,, (13. o1 /L 4 — p ./0. -1411'�.
Will there be new rack storage? ❑ ....Yes
❑ ..No If yes, a separate permit and plan submittal will be required.
Provide All Building Areas in Square Footage Below
PLANNING DIVISION:
Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): 900 Floor area of principal dwelling: Floor area of 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: Compact:
Handicap:
Will there be a change in use? ❑ Yes No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑ Sprinklers ❑ Automatic Fire Alarm lil None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes [I ] No
If `yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11" paper including quantities and Material Safety Data Sheets.
SEPTIC SYSTEM
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health
Department.
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Revised: February 2012
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Page 2 of 4
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
lat Floor
7"
2nd Floor
3`d Floor
Floors thru
Basement
Accessory Structure*
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
PLANNING DIVISION:
Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): 900 Floor area of principal dwelling: Floor area of 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: Compact:
Handicap:
Will there be a change in use? ❑ Yes No If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑ Sprinklers ❑ Automatic Fire Alarm lil None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes [I ] No
If `yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11" paper including quantities and Material Safety Data Sheets.
SEPTIC SYSTEM
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health
Department.
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Revised: February 2012
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Page 2 of 4
PERMIT APPLICATION NOTES —
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 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.
BUILDING OWN
Signature:
OR AUTHORIZED AGENT:
Print Name: V LI1 fv AJd ' L
Mailing Address: ,C-2- I I S. ` ?-0 L7
Date: //
Day Telephone: (&3) 3 397 `7 76 Z--
S- eovA-e- WI 912
H:\ApplicationsWorms- Applications On Line \2012 Applications\Permit Application Revised - 2- 7- 12.docx
Revised: February 2012
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City State Zip
Page 4 of 4
PUBLIC WORKS PERMIT INF TION - 206 - 433 -0179
•
Scope of Work (please provide detailed information): J2Gsy,,OLr - .��e -C-re . P14-2., r
e
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ .. Tukwila ...Water District # 125
❑ .. Water Availability Provided
Sewer District
❑ .. Tukwila
❑ .. Sewer Use Certificate
...Valley View
❑ ...Sewer Availability Provided
❑... Highline
❑... Renton
0... Renton
0... Seattle
Septic System:
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department.
Submitted with Application (mark boxes which apply):
❑ .. Civil Plans (Maximum Paper Size — 22" x 34 ")
❑ .. Technical Information Report (Storm Drainage)
❑ .. Bond ❑... Insurance 0... Easement(s)
Proposed Activities (mark boxes that apply):
❑ .. Right -of -way Use - Nonprofit for less than 72 hours
❑ .. Right -of -way Use - No Disturbance
❑ .. Construction/Excavation /Fill - Right -of -way ❑
Non Right -of -way ❑
❑ .. Total Cut
❑ .. Total Fill
cubic yards
cubic yards
❑ .. Sanitary Side Sewer ❑
❑ .. Cap or Remove Utilities ❑
❑ .. Frontage Improvements ❑
❑ .. Traffic Control ❑
❑ .. Backflow Prevention - Fire Protection
Irrigation
Domestic Water
0... Geotechnical Report
0... Maintenance Agreement(s)
❑ .. Traffic Impact Analysis
❑ .. Hold Harmless — (SAO)
❑ .. Hold Harmless — (ROW)
0... Right -of -way Use - Profit for less than 72 hours
0... Right-of-way Use — Potential Disturbance
0... Work in Flood Zone
0... Storm Drainage
...Abandon Septic Tank
... Curb Cut
...Pavement Cut
...Looped Fire Line
>>
❑...Grease Interceptor
❑ ... Channelization
❑ ... Trench Excavation
❑...Utility Undergrounding
❑ .. Permanent Water Meter Size (1) " WO # (2) " WO # (3) " WO #
❑ .. Temporary Water Meter Size (1) " WO # (2) " WO # (3) " WO #
❑ .. Water Only Meter Size " WO # ❑ .. Deduct Water Meter Size
❑ .. Sewer Main Extension Public ❑ Private ❑
❑ .. Water Main Extension Public ❑ Private ❑
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ .. Water ❑ .. Sewer ❑ .. Sewage Treatment
Monthly Service Billing to:
Name: Day Telephone:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
City
State
Zip
Day Telephone:
City
State
Zip
H:\Applications\Forms- Applications On Line\2012 Applications\Fermit Application Revised - 2- 7- 12.docx
Revised: February 2012
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Page 3 of 4
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 -431 -3665
Web site: http: / /www.Tukwila WA.gov
Parcel No.: 7358600310
Address: 13311 37 AV S TUKW
Suite No:
Applicant: SHAKARNY HOMES DEMO
RECEIPT
Permit Number: D12 -159
Status: PENDING
Applied Date: 05/10/2012
Issue Date:
Receipt No.: R12 -01551
Initials:
User ID:
WER
1655
Payment Amount: $275.43
Payment Date: 05/10/2012 02:06 PM
Balance: $0.00
Payee: VLADIMIR NALIVAYKO
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd MC
Authorization No. 879073
ACCOUNT ITEM LIST:
Description
275.43
Account Code Current Pmts
BUILDING - NONRES
PLAN CHECK - NONRES
STATE BUILDING SURCHARGE
000.322.100
000.345.830
640.237.114
Total: $275.43
164.20
106.73
4.50
doc: Receipt-06 Printed: 05 -10 -2012
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.TukwilaWA.Eov
Parcel No.: 7358600310
Address: 13311 37 AV S TUHW
Suite No:
Applicant: SHIKARNY HOMES DEMO
RECEIPT
Permit Number: D12 -159
Status: APPROVED
Applied Date: 05/10/2012
Issue Date:
Receipt No.: R12 -01704
Initials:
User ID:
JEM
1165
Payment Amount: $276.00
Payment Date: 05/25/2012 02:50 PM
Balance: $0.00
Payee: SHIHARNY HOMES LLC
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 1004 276.00
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
PW BASE APPLICATION FEE
PW PERMIT /INSPECTION FEE
PW PLAN REVIEW
000.322.100
000.342.400
000.345.830
Total: $276.00
250.00
13.00
13.00
doc: Receiot -06 Printed: 05 -25 -2012
-- INSPECTION RECORD 'q
Retain a copy with permit t
INSPECTION NO. PERMIT NO. t
CITY OF TUKWILA BUILDING \DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 #. (206) 431 -367'
Permit Inspection Request Line (206) 431 -2451
Project: i.
5 !fit 1(4-01,/
1-1)M
Type of Inspection:
L.5?u: ( t
Address:
t-3 ( 1r) r---7
G
Date Called:
Special Instructions: '
Date Wanted:/.^ , ,---- a.my
W —(--( _p.m.
Requester:
Phone `j ?
'334 "117 CO Z.
Approved'per applicable codes. D Corrections required prior to approval.
COMMENTS:
rJIA �� i 1u 'w/o
Insp
041\11 1
Date''
—U.' a.--
r :REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
• -paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
•
".•
•
INSPECTION RECORD
Retain a copy with permit
INSPECTIO NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 Az. (206) 431-367
Permit Inspection Request Line (206) 431-2451
Dii - (55
Proj Pct. • itheAf
_S' 7 ' 00 kiej
Typkof Inspection: ..,.._
' K (p (--Dik•-i r -
-
Address: i-I4-
1 3-c 1 ( '-i AVE
Date Called:
Special Instructions: :
— ' At 0
Date WantecIsi.7,..„ ....t.,,,
i L--
P.m.
Requester:
Approved per applicable codes. Corrections required prior to approval. 1
COMMENTS:
....■•••••••••■•••....,)
Inspector:
Dater■--)
ri REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
I paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
'INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project: ;
? i Ke .
rnes rno
Type of Inspection:
} e. -CD'1-
Address:'
1331'1 3
Lie 3
Date Called:
0*(9 s h,.
Date Wanted:.
O5 ?9%/ P.m.
Special Instructions:
%/�.,/ /
1 (fit / I - 7
17)(e---: l
)Y, 0f
f
Requester:
V /adi ,'tr
Phone No:
a.3-33V -Y7Gd.
1 Approved per applicable codes. E Corrections required prior to approval.
COMMENTS:
Ccrld(.1.t ('d lliffk • orr-c ifs
Inspector:
Date:
REINSPECTION. FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter.Blvd., Suite 100. Call to schedule reinspection.
PEkNT WW1 i`PLAN EVIEW /ROUTING SLIP
ACTIVITY NUMBER: D12 -159 DATE: 05 -10 -12
PROJECT NAME: SHIKARNY HOMES DEMOLITION
SITE ADDRESS: 13311 37 AV S
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision # After Permit Issued
DEPARTMENTS:
Building
1-4 CSA
Division
�JS mac,
Public Works
NlA t i rt
Fire Prevention
Structural
y
� Fre ()cip--
tanning Division
Permit Coordinator
st
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
DUE DATE: 05 -15 -12
Complete Incomplete ❑ Not Applicable ❑
Comments: TTT
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES /THURS ROUTING:
Please Route Structural Review Required ❑ No further Review Required I I
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 06 -12 -12
Approved Approved with Conditions ›Q Not Approved (attach comments) n
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents /routing slip.doc
2 -28-02
Approved Transaction Page 1 of 1
pscleanair.org
Puget Sound Clean Air Agency
Single - Family Notification Case #: 201201427
This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for
inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $65.00
Credit Card Transaction # VSHF9A04A34E
05/25/12
Transaction Date
Owner's Name
Project Street Address
City
Contact Person
Mailing Address
Vladimir Nalivayko
13311 37th AVE S.
Tukwila, WA
Vladimir Nalivayko
5211 S. 170th Lane
SeaTac , WA 98188
Phone
Zip
Phone
(253) 334-4762
98188
(253) 334-4762
This project includes asbestos removal.
Project Size 13 linear feet / 39 square feet
Project Start Date 05/25/12 Completion Date 05/26/12
Asbestos will be removed by the home owner
RECEIVED
CITY OF TU KWILA
MAY 2 5 2012
This project includes a demolition.
Demolition Start Date 05/26/12 Completion Date 06/15/12
Demolition will be completed by the home owner
This is an emergency project. The emergency reason:
The project must proceed to avoid imposing an unreasonable burden.
I certify that:
(1) This is a single - family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
Create Another Notification
If you have questions, contact us at asbestos @pscleanair.org or 206.689.4058.
DIz-ii
https: / /secure.pscleanair.org /Asbestos /Approved.aspx 5/25/2012
OUTSIDE
INSIDE
REPAIRS
DEPOSIT$ 7t7 c'•-
C
OWNER // /c3 �.fim / /°
HOUSE ADDRESS • 712 2 / /
alley letirT
PHONE: 206 - 242 -3236
SIDE SEWER PERMIT
VALLEY VIEW SEWER DISTRICT
3460 South 148th Street, Suite 100 • Seattle, Washington
PERMIT 6901
EASEMENT No.
RECEIPT No. 5 7 / q
DATE
'2707 JA <> CONTRACTOR: Se /7(-•
?77A''A1/E
NAME SUB - DIVISION (2'?) 3.:341-476Z.
Permit has been granted 5/Z S /1Z
Approved by /2 "
BASEMENT: YES NO
LOT No. BLK. No.
Expiration Date S// 5/ / 3
Permits not valid unless signed by district representative.
Inspector's Report
RE
MAY 2 �
5 2012
Test Report WATER ❑
Roof, Downspouts, Building Footing Drains, any Ground Water Drains, etc.,
are not allowed to be hooked into the sewer under this permit. ALL PLUMBING
OUTLETS WILL BE CONNECTED TO THE SEWER.
This permit is granted subject to the conditions set forth on the District's
Application For Permit and is subject to all stipulations of the District's Side Sewer
Resolution as amended and which are by this reference incorporated herein as
though set forth in full.
Inspector
"CAUTION"
NO BUILDING ON
SEWER EASEMENTS
CALL FOR INSPECTION AT 242 -3236
• DEWATER DITCH BEFORE INSPECTION
• DISTRICT INSPECTION BEFORE BACKFILL
• TEST SIDE SEWER BEFORE AND DURING INSPECTION
SEPTIC TANK
The King County Health Department Uniform Plumbing Code requires septic tanks to be completely
pumped and filled with earth, sand, gravel, concrete or other approved material.
SAFETY
The Contractor shall comply with the Washington Industrial Safety and Health Act (RAW 49.17) and
Safety and Health Standards such as Safety Standards for Construction Work (Chapter 296 -155
WAC), General Safety and Health Standards (Chapter 296 -24 WAC), General Occupational Health
Standards (Chapter 296 -22 WAC) and any other appropriate safety and health codes.
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -367o FAX (206) 431 -3665
E -mail: tukplan@ ci.tukwila.wa.us
Permit Center /Building Division
206 431 -367o
Public Works Department
206 433 -0179
Planning Division
206 431 -3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
COUNTY OF KING )
/ Mt V ,VIA P , states as follows:
[please print name
1. I have made application for a permit from the City of Tukwila, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington, a copy of which is printed on the reverse side of this Affidavit. I have
read or am familiar with RCW 18.27.090.
3. I understand that prior to issuance of a permit for work which is to be done by any contractor, the
City of Tukwila must verify either that the contractor is registered by the State of Washington, or that
one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,
I consider the work authorized under this permit to be exempt under number i and will therefore
not be performed by a registered contractor.
5. I understand that the licensing provision of RCW 19.28.161 through 19.28.271 shall not apply to
persons making electrical installations on their own property or to regularly employed employees
working on the premises of their employer. The proposed electrical work is not for the construction
of a new building for rent, sale or lease.
ss.
PERMIT NO: l (2._—(
I understand that I may be waiving certain rights that I might otherwise have under state law in any decision
to engage an unregistered contractor to perform constructio work.
Owner /Owner's Agent*
Signed and sworn to before me this
Ss day of MC/ , 2017/.
u)2-t-c(
T ' Y PUBLIC in and for the State of Washington
Residing at ( G]
Name as commissioned:
My commission expires:
, County
18.27.ogo Exemptions. The regietion provisions of this chapter do not apply to
1. An authorized representative of the United States
government, the state of Washington, or any incorporated
city, town, county, township, irrigation district, reclamation
district, or other municipal or political corporation or
subdivision of this state;
2. Officers of a court when they are acting within the scope
of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their own
business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground mine
or mineral deposit when performed by an owner or lessee;
5. The sale of any finished products, materials, or articles of
merchandise that are not fabricated into and do not become
a part of a structure under the common law of fixtures;
6. Any construction, alteration, improvement, or repair of
personal property performed by the registered or legal
owner, or by a mobile /manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW who shall
warranty service and repairs under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site or
reservation under the legal jurisdiction of the federal
government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them into, or consuming
them in the performance of, the work of the contractor;
9. Any work or operation on one undertaking or project by
one or more contracts, the aggregate contract price of
which for labor and materials and all other items is less
than five hundred dollars, such work or operations being
considered as of a casual, minor, or inconsequential nature.
The exemption prescribed in this subsection does not apply
in any instance wherein the work or construction is only a
part of a larger or major operation, whether undertaken by
the same or a different contractor, or in which a division of
the operation is made into contracts of amounts less than
five hundred dollars for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in this
subsection does not apply to a person who advertises or
puts out any sign or card or other device which might
indicate to the public that he or she is a contractor, or that
he or she is qualified to engage in the business of
contractor;
10. Any construction or operation incidental tothe
construction and repair of irrigation and drainage ditches
of regularly constituted irrigation districts or reclamation
districts; or to farming, dairying, agriculture, viticulture,
horticulture, or stock or poultry raising; or to clearing or
other work upon land in rural districts for fire prevention
purposes; except when any of the above work is performed
by a registered contractor;
11. An owner* who contracts for a project with a registered
contractor, except that this exemption shall not deprive the
owner of the protections of this chapter against registered
and unregistered contractors. The exemption prescribed in
this subsection does not apply to a person who performs
the activities of a contractor for the purpose of leasing or
selling improved property he or she has owned for less than
twelve months;
12.* Any person working on his or her own property,
whether occupied by him or her or not, and any person
working on his or her personal residence, whether owned
by him or her or not but this exemption shall not apply to
any person who performs the activities of a contractor on
his or her own property for the purpose of selling,
demolishing, or leasing the property;
13. An owner* who performs maintenance, repair, and
alteration work in or upon his or her own properties, or
who uses his or her own employees to do such work;
14. A licensed architect or civil or professional engineer
acting solely in his or her professional capacity, an
electrician certified under the laws of the state of
Washington, or a plumber certified under the laws of the
state of Washington or licensed by a political subdivision of
the state of Washington while operating within the
boundaries of such political subdivision. The exemption
provided in this subsection is applicable only when the
person certified is operating within the scope of his or her
certification;
15. Any person who engages in the activities herein
regulated as an employee of a registered contractor with
wages as his or her sole compensation or as an employee
with wages as his or her sole compensation;
16. Contractors on highway projects who have been
prequalified as required by RCW 47.28.070, with the
department of transportation to perform highway
construction, reconstruction, or maintenance work;
17. A mobile /manufactured home dealer or manufacturer
who subcontracts the installation, set -up, or repair work to
actively registered contractors. This exemption only applies
to the installation, set -up, or repair of the
mobile /manufactured homes that were manufactured or
sold by the mobile /manufactured home dealer or
manufacturer;
18. An entity who hold1, ali elec'tilcal _contractor's
license under chapte1 i9:28-RCWr,that,.employs a certified
journeyman electrician „certified residential specialty
electrician, or an electrical tt'ainee meeting the
requirements of chapter:i9.28 RCW to'ii rfoim plumbing
work that is incidentally, directly, and ini'mediately
appropriate to the like,i'n}- kindFreplaceinent;of a household
appliance or other sir;alliio Behold ;i�ti7izalion equipment
that requires limited e'lect"rigJp¢ 'eetandilitnited waste
and /or water connections:'An'electrical trainee must be
supervised by a certified electrician while performing
plumbing work.
• Per Washington State Department of Labor and Industries lessee has
been interpreted to be equivalent to owner for purposes of exemptions.