HomeMy WebLinkAboutPermit D12-334 - WESTFIELD SOUTHCENTER MALL - DAILY TREASURES (HICKORY FARMS) - KIOSKDAILY TREASURES
(HICKORY FARMS)
2800 SOUTHCENTER MALL
D12 -334
City Tukwila
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
DEVELOPMENT PERMIT
Parcel No.: 9202470010
Address: 2800 SOUTHCENTER MALL TUKW
Suite No:
Project Name: DAILY TREASURES (HICKORY FARMS)
Permit Number: D12-334
Issue Date: 10/29/2012
Permit Expires On: 04/27/2013
Owner:
Name: WESTFIELD PROPERTY TAX DEPT
Address: PO BOX 130940 , CARLSBAD CA 92013
Contact Person:
Name: DEE WALLS
Address: 811 MADISON AV, 5TH FLOOR , TOLEDO OH 43604
Phone: 419 725 -9336
Contractor:
Name: OWNER AFFIDAVIT - THOMAS RAGER Phone:
Address:
Contractor License No: Expiration Date:
Lender:
Name:
Address:
DESCRIPTION OF WORK:
SET UP TEMP KIOSK
Value of Construction: $700.00 Fees Collected: $122.31
Type of Fire Protection: International Building Code Edition: 2009
Type of Construction: 11B Occupancy per IBC: 0019
Electrical Service Provided by: PUGET SOUND ENERGY
* *continued on next page **
doc: IBC -7/10
D12 -334 Printed: 10 -29 -2012
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant:
Flood Control Zone:
Hauling: N Start Time: End Time:
Land Altering: Volumes: Cut 0 c.y. Fill 0 c.y.
Landscape Irrigation:
Moving Oversize Load: Start Time: End Time:
N Number: 0
Size (Inches): 0
Sanitary Side Sewer:
Sewer Main Extension: Private: Public:
Storm Drainage:
Street Use: Profit: N Non - Profit: N
Water Main Extension: Private: Public:
Water Meter: N
Permit Center Authorized Signature:
Date: ) U —2-4-14
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 permi does -not presume to give authority to violate or cancel the provisions of any other state or local laws regulating
construction or the p o ce of ork. I am authorized to sign and obtain this development permit and agree to the conditions attached
to this pe
Signature: 1 Date: O
Print Name: Y%'%K5
This permit shall become null and void if the worn 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: 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.
5: Manufacturers installation instructions shall be available on the job site at the time of inspection.
6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
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,
doc: IBC -7/10
D12 -334 Printed: 10 -29 -2012
any violation of any of the provisions of theding code or of any other ordinances of the iii of Tukwila. Permits
presuming to give authority to violate or c the provisions of the code or other ordinana1P6f the City of Tukwila
shall not be valid. The issuance of a permit b ed 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.
doc: IBC -7/10
D12 -334 Printed: 10 -29 -2012
x(31
•
CITY OF TUKWILA
Community Development Department
Public Works Department
Permil Center
6300 Southcenter Blvd.. Suite 100
Tukwila. I1'A 98188
http: / /www.TukwitaWA.gov
•
Building Permit No.
Project No.
Date Application Accepted:
Date Application Expires:
(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
Site Address:
t,JesV -e ld SWken-kc
(vr" SIx frrnIl�Seo+- I.etwA
Tenant Name: j I { eacOrP�
PROPERTY OWNER
Name: -bee wo 11 s
Name: k , @n�,�_ ie Id �
\� C
Address:
i n r f�Y't(
City: CMS-K.
State: t _\ n Ztp:(i') gg
CONTACT PERSON; - person receiving all project
communication
Name: -bee wo 11 s
Address: i i rnrL 1 Qn Ow./ / h ciL
City: --roterio State:on Zip:4 ,,,/
��f
Phone: i I(]_7as- _433t0Fax: ,_.._
Email:' icin ► u fl s Qt1t day an tams. Ccfn
GENERAL CONTRACTOR INFORMATION
Company Name: nia
Company Name:
,,.1'Q
Address:
Address:
City:
State:
City:
Zip:
Phone:
Fax:
Fax:
Contr Reg No.:
Exp Date:
Tukwila Business License No.:
H:\Applications \Forms- Applications On Line \2011 Applications \Permit Application Revised - 8 -9 -I I.docx
Revised: August 2011
bh
King Co Assessor's Tax No.: , 2,, 2--41,V 01 0
Suite Number: q 1c Floor:
New Tenant: Yes ❑ ..No
ARCHITECT OF RECORD
Name:
Company Name:
,,.1'Q
Architect Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
ENGINEER OF RECORD.;.
Name:
Company Name:
i
RIO
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:
Page 1 of 4
BUILDING PERMIT 1NFORMATI — 206 -431 -3670
Valuation of Project (contractor's bid price): $ D /el
Describe the scope of work (please provide detailed information):
5e up of -- eempocory k_loS k
Will there be new rack storage? ❑ Yes
Existing Building Valuation: $_ rieb, to
N.. No If yes, a separate permit and plan submittal will be required.
Provide All Building Areas in Square Footage Below
Existing
Interior Remodel
Addition to
Existing
Structure.
New
Type of
Construction per.
IBC
Type of
Occupancy per
113C
1 StFloor
2 "d Floor
3rd Floor
Floors thru
Basement
Accessory Structure*
1210
d13
No
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: i ^� /�
Lot Area (sq ft): (\ 1() Floor area of principal dwelling: Floor area of accessory dwelling: I t�+V
*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: Mal 1 cU.Ckerlo Compact: Handicap:
Will there be a change in use? ❑ Yes No If "yes ", explain:
FIRE PROTECTION /HAZARDOUS MATERIALS:
El Sprinklers ❑ Automatic Fire Alarm ❑ None g, Other (specify) t \ tCII I C)Ct znr1
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes 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.
HAApplications \Forms- Applications On Line\201 I Applications\Permit Application Revised - 8- 9- 11.docx
Revised: August 2011
bh
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).
1 HEREBY CERTIFY THAT 1 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 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER OR AUTHQ
Signature:
Print Name: U'
Mailing Address:
Date: *ail a
oi-h no 1 CR-° Day Telephone: `1' I _ '7615 = g33(0
' `fee_ Walls , gl trncrlison Ave., 5 +h kth1 otl o64(
City State Zip
H: Applications \Forms - Applications On Line \2011 Applications \Permit Application Revised - 8- 9- 11.docx
Revised: August 2011
bh
Page 4 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.TukwilaWA.gov
RECEIPT
Parcel No.: 9202470010 Permit Number: D12-334
Address: 2800 SOUTHCENTER MALL TUKW Status: PENDING
Suite No: Applied Date: 10/16/2012
Applicant: DAILY TREASURES (HICKORY FARMS) Issue Date:
Receipt No.: R12 -02871
Payment Amount: $122.31
Initials: JEM Payment Date: 10/16/2012 12:44 PM
User ID: 1165 Balance: $0.00
Payee: HICKORY FARMS
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 135105 122.31
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
BUILDING - NONRES
PLAN CHECK - NONRES
STATE BUILDING SURCHARGE
000.322.100
000.345.830
640.237.114
Total: $122.31
71.40
46.41
4.50
doc: Receiot -06 Printed: 10 -16 -2012
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 = 367.0'
Permit Inspection Request Line (206) 431 -2451
Project:
.1—\11101.,-( 77_CkC7( 11,S
Type of Inspection:,
Fx,JAl.
:.
Address:
_229)6 (0 SUenr; MA t\
Date Called:
-
Special Instructions:
i,..
1
Date Wanted:. .
In -40 —t
e m
P• .
Requester:
Phone No:
2-S3 -PC. - !C-a l
Approved per applicable codes.
COMMENTS:
Corrections required prior to _approval.
Inspector:,
0-kj(1,:kir!
V >✓''
n REINSPECTION FEE REQUIRED Prior to next inspection fee must bef
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule+ reinspection;
Date:-
10-_
O
O
0
FILE COPY
Permit t No.
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72'—o"
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LADY
FOOTLOCKER
2162 sf
NCIERGE
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62' -1"
H
LILLY HICKS
9990sf
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4591 sf
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1463 sf
PARFUIv
1065 sf
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57 -10
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CLARKS
2700 sf
68'
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 2 R 21
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City of Tukwila
BUILDING DIVISION
El
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1020
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HICKORY FA S
SEPARATE PERMIT
REQUIRED FOR
elidechanical
2:Trrk.
City of Tukwila
BUILDING DIVISION
REVISIONS
No changes shall be made to the scope
of work without prior approval of
Tukwila Building Division.
1 ! F',.,.:ViSIGri3 will require a new plan submittal
j may include additional plan review fees. 1
GENERAL NOTES
NAME OF MALL
CITY, STATE
SITE PLAN
FI E COPY
Permit No. 1 a.— 3341-I
Plan rtcvir approval is subject to errors and omissions.
of construction documents does not amaze
.: ation o =hy adopted code or ordinance. Rece- r t
of; proved Fi y and conditions is ac wo iesIg6d:
By
City Of Tukwila
ILDING DIVISION
1 ' REVIEWED F
CODE
APPROVE
OCT 2 COMPLI 6 2a
kCtY of Tuk%
/'
ULDNG DI\
�
RECEIVED
CITY OF TUKWIL
OCT, 16 2012
PERMIT CENT
ISOMETRIC
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JOB NUMBER
83862
SHEET NUMBER
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VINYL TRANSITION STRIP
CONTINUOUS
CARPET
FOAM PAD
OSECTION DETAIL
SECURE TO FLOOR
W/ DOUBLE FACE
CARPET TAPE
FULL SCALE
PLAN
—i
a
ELEVATION A
S-0"
17r-0'
I— 7-8' —i
eO ELEVATION B
1.
ELEVATION C
OD ELEVATION D
17 =Rr
]y yl
1� I
r -e' —4
17 =TV
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 2 R 2012
City of Tukwila
BUILDING DIVISION
NOTES:
1. MATERIAL SPECS
CABINETRY AND 'WOOD' COMPONENTS ARE FIRE REATED
'DURAFLAKE' PARTICLE BOARD.
UNDERWRITERS LABORATORIES INC. CLASSIFIED WOOD PARTICLE
BOARD: NOT OVER 100 PIECES
SURFACE BURN CHARACTERISTICS: (BASED ON 100 FOR
UNTREATED RED OAK)
FLAME SPREAD: 20
FUEL CONTRIBUTED: 0
SMOKE DEVELOPED: 25
ALL ELECTRICAL COMPONENTS, INCLUDING THE LIGHT FIXTURES,
ARE UL /CSA APPROVED.
2. SEE THE ASSEMBLY INSTRUCTION MANUAL FOR FURTHER DETAILS.
3. ALL DIMENSIONS IN () ARE BASIC, NOT HELD TO.
4. 10' X 17 CARPET AND PAD:
MOHAWK'ELITE IMPRESSIONS 1008' BC305 COLOR = 7238 SELF
AWARENESS WITH BOUND EDGES.
HOLES PRE CUT FOR ELECTRICAL HARNESS.
Carpet Performance:
Static: AATCC -134 Under 3.5 KV
Flammability: ASTM E 648 Class I
Smoke Density: ASTM E 662 Less than 4RECEI Y 4I
ED
CITY OF TUKWIIA
OCY162012
PERMIT CENTER
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NEW KIOSK FOR
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JOB NUMBER
83862
SHEET NUMBER
A -2
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4
CALENDAR MODULE
QUANTITY 1
CALENDAR/POS MODULE
QUANTITY 1
POS / CASH WRAP
QUANTITY 1
DIGITAL MODULE
QUANTITY 1
\/14
CARD MODULE
QUANTITY 1
REVIEWED FOR
CO a COMPLIANCE
APPROVED
OCT 2 6 2012
City of Tukwila
BUILDING DIVISION
RECEIVED ..
CITY OF TUKWILA,
OCT 16 2012
PERMIT CENTER
0
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NEW KIOSK FOR
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JOB NUMBER
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SHEET NUMBER
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THE PARTICLEBOARD SO WTION OF CHOICE fORFIRE.SAFETT NEEDS
Ducaaake• FR f csnl Flalebabdf is d. panel d chat. Nan b 4dng coda and pubic miser
apedAcat;ou demand fun Wet, con ■anra awaliNee• FRpanidaba.daa Vl• approved,
Qas, AA] ass: +mad fire.w•eant panoi Oval ideal lox ino:ier,.tonruttur, 1, ua an,reauranis
cdnofs.hospitals, hack maa. ri•pal:OBvs a+dpAic b ]ding,.
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0 PARTICLE BOARD SPECIFICATION
STEEL
BRIDGE
VIDEO
PLAYER/
MONITOR
LIGHT
FIXTURE
144'
CALENDAR
MODULE
FEVER CORD - A
POVER CORD - A
ALL POVER
SOURCE (T.B.D.)
MODULE
LIGHT
FIXTURE
POST
PRINTER
ITEM NO.
DESCRIPTION
PART NO.
DUPLEX RECEPTACLE
5320VCP
2
LOCKING SINGLE RECEPTACLE
4710
3
SINGLE POLE SVITCH
1451 -4V
4
LOCKING PLUG
4720C
5
RIGHT ANGLE PLUG
55266CA
6
POWER CORD
SJOV14 /3 -CUT
7
FLANGED INLET
4715 -C
8
LOCKING CONNECTER
4729 -C
POVER CORD - B
POVER CORD - C
POWER CORD - A
CALENDAR/PIS
MODULE
OWIRING DIAGRAM
24" X 24" FOAM
CARPET PAD
ELECTRICAL
POWER CORD W/
FLAT PLUG
NTS
240`
LIGHT
FIXTURE
(3X) POVER CORD - At)
(1)0 POVER CORD - B
(IX) POWER CORD - C
ITEM
QTY
BULB
VOLTS
WATTS
TOTAL AMPS
1V MONITOR
1
-
120V
3
VIDEO PLAYER
1
120V
2
POSIPRINTER
1
12011
3
LIGHTS
8
FLUORESCENT
120V
25W EACH
1.67
NOTE:
LIGHT FIXTURES ARE ETL APPROVED
TOTAL AMPS
9.67
+25%
2.4
MAX AMP SURGE
12.07
CARPET
•
1111 ________
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 2 fi 2012
City of Tukwila
BUILDING DIVISION
10' X12'
MALL FLOOR
AM CARPET PAD
W/ OUT AT STEEL BRIDGE
STEEL BRIDGE
aO SECTION DETAIL
FULL SCALE
MALL FLOOR OUTLET
RECEIVED
CITY OF TUKWIL.A
OCY 16 2012
PERMIT CENTER
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Flakeboard
DURAFLAKE FR fire rated partideboard
THE PARTICLEBOARD SOLUTION OF CHOICE FOR FIRE SAFETY'NEEDS
Duraflake® FR from Flakeboard is the panel Of choice when building code and public safety
specifications demand fire safety compliance Duraflake® FR particleboard is a UL® approved,
Class A/Classi-rated fire retardant panel that's ideal for interior, non-structural use in restaurants,
schools, hospitals, hotels, malls, airports, offices •and public buildings.
Duraflake® FR offers;
• Superior strength and dimensional stability
• Low linear expansion and thickness swell
• Smooth surface properties for laminating and finishing
• Easy machining and low tool wear
• Wide range of products and sizes
DuraFlake® FR Particleboard Specification. (Albany, OR)
:Grade • •
Duraflake® FR Particleboard - Albany
Thicknes.s.•(in)'
Specification r
Density(ocf)
. •
MOIZ(tati)!: ,.• .••• .•
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•
MO•(pi)
• :, •
4inteen:or
Face SCre■o•HOld.(lb)
Linear Expansion (%)
'• • -.- • • :.• ".. 7:7'7;
:i•ThicknessTelerancelinY • •
Length and:Width. (in)
•
..:Squareness(in)
*. Metric thickness available. The ebos:re phYtical p!operiies. are based �n averages c.if:nortnal preduction.
" • Look forfSC° Certified prOduCts .. .
. • • •
. • Product suitability for a particular applicatiOn is the !responsibility of dte.fabricator or end:user. • .. . .
r ConiOliesWitbECC4:11,'ANSI A208.14069; HUD 24 CFR, arid Cailiorrile 93120 Phase 2 •Ferintildohyclit"EMisSien" Litnito
• „ .. ... . .. . . . .. . .. ••• .. •
Moterial Safety, Data 5heet,s aro evailibleUportrequeiti..,
• •
All panels are approved for use in interier.'nerettiral applications
• ContainS10016 Rocycled/Recovereil Weedcontont . '
APPLICABLE STANDARD TESTS . . . . ... • . . • -
• •
ASTM E B/t•Standard rest for 5urfaceBurning'Charaetaiirtics of Building Materials
-• ASTM C23e'QUirded Hefei:6c Test.'
• •
UL72.316st for Surface Burning Characteristics of Building Material* .. .
• CAN/ULC - 5102 Test forSurface Burning Characteristiciof Building Materials
• BUILD19GCOOES . . .. .
' • .I6C•Antornallonal Code Council - 2009. International Fire Code
• • NFRA... National Fire Protection ASedaten • NFPA'101 tife Safety COdii, NF.PA5000:Buildiii9onstinittioniafetyCeclel
•AGENCY.APPROVALS' .
. . . .
..:.
Caiiforrtia.Siate Firefvforshall.2660-1627:1uu;:xty6f-New•York.igATt.7,78,1,44:4Anlo44ka 24111.1,
Underwriter's Laboratories; Inc..;atiasifieid Wood.Partlefeboat.cf Ward Burning "Chareterisiiii of Building klaeriab
UL•723:8,C.ANAJLC.;...5102.(Baied an 100 for Untreated Rod Oaf!,
flame Spread 20 USA • '1$t*ii•Sclii,
Smoke Oeirelekd 25 USA 25:Canada-
• -. • .. .. :• ••• • • :". • •••
Thermal Conductivity ikla nd•TherrtizilResi#00 (1 t.k.,* !tr.
fhicknesS (in) " • •• • "
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03*
•
0.62
• 110' —
0.69
1
.USAGE NOTES . . . . . .
, . . . . . . . . .
. .
Some laminaesapplied to.Oureflake, FR pertieleboareitwaychartgethaflante spreadiiating::Standard'available wootitvorking:glueshave been successfully used in '
lamination; However; Sortie 'adheiNes may have 'compatibility problems with the chemical systemused tcirnarnifactUre Duraflako! FR'portideboard, KO adheshie shouldr
.60 tested for comPatibility With .the chemical system irtDuraflaki9 FR particleboard prior to full gluing. QUest:ons.should bedireeted to the glue aupPliei. When
using l).ureflake, ER.panklebeard irfwall. Systeins i. an integral vapor barrier MO be a properly installed component :Of the wall'in•an-yoftheitilloWing conditions : the .Wall
has an 'exterior side and the wall seParates'speres conditiOnediurreqUally.•Jeints between parielatobe designedlo.ectomrnoriate moieenient of up to .40 perrent:•Splined
or articulated joints hie reveals per AVV1SectiOn 500, 500A4-4,;leints and Transitiorti7,ar similar ii'.s.uggested..
STORAGE AND HANDLING . . .
Durallake• FR particleboa rd•sheuld never bo stored or usedbutdoors. The indoor storage woe should be ;loan, dr,.voll ventilated; and-free of- dust;.dirt or particles
that could contaminate the particleboard .'Store flat on stickers on a 160, hard, dry surface Constant reiative:humidity andteMperiatureehould be -Maintained:
Before use, allow to stabilise to the -same conditions as are expected after -the panel is installed.- ontfitiori 48 to 72 hours prioe.to.laMination:For more info/elation; see
Composite Panels ASsociationTechniCal Bulletin:-Storage .andHandling of Particleboard and MDF.
CALIFORNIA PROPOSITION 65 REQUIREMENT . - •
Warning: Drilling, sawing, sanding or machining wood, products generates wood dust, a sUbstanceknown to State Of Californietocausecancer: Avoid inhaling wood
dust or use o dust mask or-other safeguards fOr personal protecticin.
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PARTICLE BOARD SPECIFICATION rn
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#PERMIY COORD COPS \
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D12 -334 DATE: 10/16/12
PROJECT NAME: DAILY TREASURES
SITE ADDRESS: 2800 SOUTHCENTER MALL, .(A,
-U
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter #
Revision # after Permit Issued
DEPARTMENTS:
"Building Division
�j 6, N N 1`). I'L
Public Works Mi
AvA Af
Fire Prevention
Structural
Pyv\ w lb- 1-
Planning Division El
Permit Coordinator n
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 10/18/12
Complete igj
Incomplete ❑
Not Applicable ❑
Comments:
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 ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved n Approved with Conditions Not Approved (attach comments) n
Notation:
DUE DATE: 11/15/12
REVIEWER'S INITIALS:
DATE:
PermltCenter Use, Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -367o FAX (206) 431 -3665
E -mail: tukplan0ci.tukwila.wa.us
Permit Center /Building Division
206 431 -3670
Public Works Department
206 433 -0179
Planning Division
206 431 -3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
) ss.
COUNTY OF KING
, states as follows:
PERMIT NO: 1 L - 7' O
-;\
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 requirem t of RCW 18.27.090,
I consider the work authorized under this permit to be exempt under number j, 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.
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.
- p.fal4'rarr
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VJ'°tIB% -'�'
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�►�
b OF W P -
Owner /Owner's Agent*
Signed and sworn to before me this
�CO day of J ,20)a.
NOTARY PUBLIC in and for the State of Washington
Residing at
I
, County N
Name as commissioned: - -� -SGI -f ock
My commission expires:
18.27.090 Exemptions. The regi ion provisions of this chapter do not apply toll,
1. 'An authorized representative of the United States
government, the state of Washington, or any incorporated
city, town, county; towiiship,'irr'igation 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;
F
3. Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their own
business;
y
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 46.7o RCW who shall
warranty service and repairs under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within thelimits 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 liundred'dollars; such work Of 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 br 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 to the
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;
*An owner*
1-'11 N. for a- project 1. ith a :registered
contractor, ;except that this exemption shall, not deprive the
owner of the protections ofthis chapter against registered
and unregistered contractors: Tale' 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 ith o`ved property he or shehas '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 t�
any person who performsThe activities of a contractor on
his or her own property for the purpose of selling,
demolishing, or leasing the property;
13. An owner* who performsrmaintenance ,-repair,`arid
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 solelyin 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 bya 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 compensationor as an employee
with wages as his or her sole compensation;
• 16. Contractors on,highway projects who have been
prequalifi.ed as required by RCW 47 28.07o, 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 holds a validtelect i alicontractor's
license under chapter 19.8W t teemployssa certified
journeyman electrician0 certified residentiahspecialty
electrician, or an electrical trainee: meeting; the' \.
requirements of chapter 1928 RCW toC'per'fom plumbing
work that is incidentally, directly,and-immeldiately
appropriate to the like, in ;kind replacement of a household
appliance or other small hiouseholdiutilization equipment
that requires limited ele cic pociei and limited waste
and /or water connections connectiontrAii4terfacirginee must be
supervised by a certified electrician whileiperforming
plumbing work.
• Per Washington State Department of Labor and Industries lessee has
been interpreted to be equivalent to owner for purposes of exemptions.