HomeMy WebLinkAboutPermit PG12-222 - OJUROVICH RESIDENCEOJUROVICH RESIDENCE
5166 S 166 ST
EXPIRED 12/23/2014
PG12-222
City ofTukwila •
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.aov
Parcel No.: 5379200187
Address: 5166 S 166 ST TUKW
Project Name: OJUROVICH RESIDENCE
PLUMBING /GAS PIPING PERMIT
Permit Number: PG12 -222
Issue Date: 12/27/2012
Permit Expires On: 06/25/2013
Owner:
Name: OJUROVICH MARIANNE
Address: PO BOX 595 , 105 E PENNSYLVANIA AVE 98941
Contact Person:
Name: STEPHEN OJUROVICH
Address: PO BOX 595 , ROSLYN WA 98941
Email: OJURO V IC H @YAHOO. C O M
Phone: 206 - 708 -9233
Contractor:
Name: OWNER AFFIDAVIT - STEPHEN OJUROVICH Phone:
Address:
Contractor License No: Expiration Date:
DESCRIPTION OF WORK:
COMPLETE WORK STARTED UNDER EXPIRED PERMIT PG08 -062, (1) FINAL INSPECTION.
INSTALL WATER HEATER IN ADDITION PORTION OF HOUSE. INSTALL GAS PIPING FOR WATER
HEATER, COOK -TOP, (2) FIREPLACES AND FURNACE.
Value of Plumbing /Gas Piping:
Fees Collected:
Electrical Service Provided by:
Permit Center Authorized Signature:
$3,500.00
$143.85
(JO
Uniform Plumbing Code Edition: 2009
International Fuel Gas Code Edition: 2009
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 and obtain this plumbing /gas piping permit and agree to the conditions
on the back of this permit.
Signature: , Date: /Z�2..'7 2 Z—
Print Name: ?4 'c i t G9J a 'c, v _&
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.
r1nr.• IIP(: -4/1n
P(119-999 Printari• 19-97-9019
PERMIT CONDITIONS
Permit No. PG 12 -222
1: ** *PLUMBING AND GAS PIPING * **
2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila
Building Division.
3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing
inspector.
4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas
Code.
5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved.
6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code.
Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to
make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection.
7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless,
adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the
conditioned space shall be insulated to minimum R -3.
8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be
protected by steel nail plates not less than 18 guage.
9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No plumbing
piping shall be directly embedded in concrete or masonry.
10: All pipes penetrating floor /ceiling assemblies and fire- resistance rated walls or partitions shall be protected in
accordance with the requirements of the building code.
11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin layers to
twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, cinderfill,
frozen earth, or construction debris.
12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an
approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the
jurisdiction.
r1nr. I IPi -4/10
PC419 -722 PrintAd• 19 -97 -7017
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
•
Plumbing/Gas Permit No �4 11
Project No.
Date Application Accepted:
Date, Application Expires:
(For office use only)
PLUMBING / GAS PIPING 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: 57 L a $7-.
Tenant Name: OJV ROIr/G!t_
PROPERTY OWNER
Name: 5reP4Git eDJu ' ennok
Address: p0• 8.0X 915"
Name:71tCtr/4M►N.C. COcteav /eJ
Phone: z"4-70s, 9133 Fax:
Email: cvto,oir c4.4a. v4rhOO. GeK
Address: /
O. 48.0x is
State:
City: D_� State: wet..
Y
Zip:
41
CONTACT PERSON— person receiving all project
communication
Name: 5reP4Git eDJu ' ennok
Address: p0• 8.0X 915"
City: p It State: ii4. Zip:1014i
Phone: z"4-70s, 9133 Fax:
Email: cvto,oir c4.4a. v4rhOO. GeK
King Co Assessor's Tax No.:
Suite Number: Floor:
New Tenant: ❑ Yes ;R] ..No
PLUMBING CONTRACTOR INFORMATION
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contr Reg No.:
Exp Date:
Tukwila Business License No.:
Valuation of Project (contractor's bid price): s re i'llo 4 ' l) 4cocs. x.q 5
Scope of Work (please provide detailed information): Cey,K ?jc yJp�El y�,,oQ�,.- ?;rbx Yerm i t-4i
P&& -c 2.. t F #k et L in . ,;,t L1..egf 1.�4'rtr- , 1 t 7•iost_
ParTiu` d F frt'M . /k 57-W-1- a-45 7;r /klf> 4a0ti- 4 .", Coo& ere) vtatPipee I'141ces.7"
Building Use (per Int'l Building Code). (2) G�
Occupancy (per Int'l Building Code): J
Utility Purveyor: Water:
H:\Apphcauons\Forms- Applications On Lme\2011 Apphcattons\Plumbmg Permit Application Revised 8- 9- 11.docx
Revised: August 2011
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Sewer
Page 1 of 2
Indicate type of plumbing fixtures and /or gas piping outlets being installed and the quantity below:
Fixture Type
Qty
Bathtub or combination
bath/shower
Dishwasher, domestic with
independent drain
Shower, single head trap
Sinks
Rain water system — per
dram (inside building)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Each additional medical
gas inlets /outlets greater
than 5
Atmospheric -type vacuum
breakers not included m
lawn sprinkler backflow
protections (1 -5)
Fixture Type
Qty
Bidet
Drinking fountain or water
cooler (per head)
Lavatory
Urinal
Water heater and/or vent
Repair or alteration of
water piping and/or water
treatment equipment
Backflow protective device
other than atmospheric -
type vacuum breakers 2
inch (51 min) diameter or
smaller
Atmospheric -type vacuum
breakers not included m
lawn sprinkler backflow
protections over 5
Fixture Type
Qty
Clothes washer,
domestic
Food -waste grinder,
commercial
Wash fountain
Water closet
Industrial waste
treatment interceptor,
including trap and vent,
except for kitchen type
grease interceptors
Repair or alteration of
drainage or vent piping
Backflow protective
device other than
atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Gas piping outlets
Fixture Type
Qty
Dental unit, cuspidor
Floor drain
Receptor, indirect waste
Building sewer and each
trailer park sewer
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity
Medical gas piping
system serving 1 -5
inlets /outlets for a specific
gas
Each lawn sprinkler
system on any one meter
including backflow
protection devices
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 extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing
and justifiable cause demonstrated. Section 103.4.3 International Plumbing Code (current edition).
1 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 OWNER OR..M THOi1d EH GENT:
Signature:
Print Name: -re? ur 0J10.roviO4,
Mailing Address: * AC). $ear "Iftr
H:\Applications \Forms- Applications On Line \2011 Applications\Plumbing Permit Application Revised 8 -9 -1 l.docx
Revised: August 2011
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Date: /2 -2--r -zor
Day Telephone: Z474- 71:55?-1"7-37
City
State Zip
Page 2 of 2
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
Parcel No.: 5379200187
Address: 5166 S 166 ST TUKW
Suite No:
Applicant: OJUROVICH RESIDENCE
RECEIPT
Permit Number: PG12 -222
Status: PENDING
Applied Date: 12/27/2012
Issue Date:
Receipt No.: R12 -03382
Payment Amount: $206.85
Initials: WER Payment Date: 12/27/2012 11:22 AM
User ID: 1655 Balance: $0.00
Payee: MARIANNE OJUROVICH
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 5127 206.85
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
GAS - RES
PLUMBING - RES
000.322.103.00.00 96.60
000.322.103.00.00 110.25
Total: $206.85
rinr.• RRrpint -nf PrintpA• 17 -97 -9(119
dd5
INSPECTION NO.
INSPECTION RECORD
Retain a. copy with permit
PERMIT NO.
CITY OF TUKWILA-BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
I Z ' L7
Project:
all-U10 i,CL �e5
Type f Inspection:
Kol.► (9 H TA, /6
Address: "
5 1 I rr i I In 5<
Date Called:
Special Instructions:
Date Wanted: /�
(2
—7 /
t.,0
_ {/'
/ 7
'41m�
p.m.
Requester:
Phone No:
Approved per applicable codes. EJ Corrections required prior to approval.
COMMENTS:
0 - 6J `5t/
Date:
it
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
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 .
Proj ,.
U.3vfdV∎C
1 °G-5
Type of I pectin . :
14S0U (7t Win/�t� )
Addressi
`r1 6� .
1 b(._ST
Date Called:
Special Instructions:
Date Wanted:
�. �.f �'
. mr
p.m.
Requester:
Phone No:
EJApproved per applicable codes. Corrections required prior to approval.
COMMENTS:
PA
OK (Zlo.06f v
.6 tTo
Inspector
Date:
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
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
(206) 431 -3670
toCo(2 -?ZZ
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 431 -2451
Project: •
c3� O u Vt.( its,
Type_of Inspection:
Type_ of U G- i N GAS
Address: (( i
• 5 I I tot ,, 1 1(7 ( 0 ~ 5 T
Date Called:
i' o b o C v )-1`0 /\
e:',' Al C2/-15
Special Instructions:
Date Wanted:
o IS �,
—a_ De
P.m.
Requester:
Phone No:,
j
0 Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
i' o b o C v )-1`0 /\
e:',' Al C2/-15
1,\ tji S \J,,,i— 0A - '
j
Inspec,tor:
(
1_.\LN
Date:
a r
n 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 G,
6300 Southcenter Blvd., #100, Tukwila. WA 98188. (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
11�utOVf e_- ► KeS k
Ty of Inspection: .
: o U & 1� `z=�c1
S
Addless:
,S-1 (p : It/ o ( -sr -
Date Called:
Special Instructions:
...�n �,f.��
t� / .
%
Date Wanted: -
12.' / -I
a:dti
p.m.
Requester:
Phone No:.
0 Approved per applicable codes.
Corrections required prior to approval:
COMMENTS:
AS
too ( `r '- i7.2
Dater
1_(3
REINSPECTION FEE RE( ' IRE'. Prior to next inspection: fee must be .
paid at 6300 Southcenter Blvd:, Suite 100. Call to schedule_reinspection:
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
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:
a iz∎Rovle0 2t-S
Type Inspection:
.Ran1A- )1v GAS
Address: S
Date Called:
Special Instructions:
Date Wanted:
12.—
/ (3
.m.
Requester: 1/
Phone No:
ElApproved per applicable codes.
Corrections required prior to approval.
COMMENTS:
NC' .A AA/Su/0Q 47 i 0aQ
NO firs/74 fi7 1iea*f4FP
Date: ,
REI4�ECTION FEE REQUIID. Prior to next inspection, fee must be
pai at 6300 Southcenter Blvd.. Suite 100, Call to schedule reinspection..
Jai
INSPECTION RECORD
Retain a copy with permit-
INSPECTION NO. PERMIT N0.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
Type of Inspection:
Address:
.� f(p6 ! 1 iU Si-
Date Galled:
V`--i V 1V \
r
,1Xi
Special Instructions:
•
Date Wanted:
�a"'m.
Requester:
Phone No//:
7 J
9133
ElApproved per applicable codes. Corrections required prior to approval. /,/s.
COMMENTS:
1 J X41 e
NJ =Li. Yrk.ef f, J rc,J- f :fir % .e,
inspector: )
A tfi
n REINSPECTION FEE WIRED. Fri,4 to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Date: r
ct�
: �>.. I�- a�..'-^ F1ar�- •..r�- ?�..s,,...,..�- •-,,.. ,. K-. v`. �' �s-- c;..'-"' tl'" ,,,,..^'.- .�.— �•"'."`f''�.�?:a_ ,,.- c'.�.�.:`.tr'e...: -- ^ter- �... -.._. .,.,.--
11/3/2014
City of Tukwila
Department of Community Development
STEPHEN OJUROVICH
PO BOX 595
ROSLYN, WA 98941
RE: Permit No. PG12 -222
OJUROVICH RESIDENCE
5166 S 166 ST
Dear Permit Holder:
Jim Haggerton, Mayor
Jack Pace, Director
In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building
Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and /or the National
Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and
become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of
such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has begun
for a period of 180 days. Your permit will expire on 12/23/2014.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206- 438 -9350 to schedule for the next or final inspection. Each
inspection creates a new 180 day period, provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven(7) days before it is due to expire.
Address your extension request to the Building Official and state your reason(s) for the need to extend your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your
extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and /or receive an extension prior to 12/23/2014, your permit will become null and
void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
V\\
er Marshall
Technician
File Igo: PG 12 -222
41,
6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206 - 431 -3670 • Fax 206 - 431 -3665
5/1/2014
City of Tukwila
Jim Haggerton, Mayor
Department of Community Development
STEPHEN OJUROVICH
PO BOX 595
ROSLYN, WA 98941
RE: Permit No. PG12 -222
OJUROVICH RESIDENCE
5166 S 166 ST
Dear Permit Holder:
Jack Pace, Director
In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building
Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National
Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and
become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of
such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has begun
for a period of 180 days. Your permit will expire on 6/15/2014.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206 -438 -9350 to schedule for the next or final inspection. Each
inspection creates a new 180 day period, provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven(7) days before it is due to expire.
Address your extension request to the Building Official and state your reason(s) for the need to extend your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your
extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and/or receive an extension prior to 6/15/2014, your permit will become null and void
and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
'OA L
enni er Marshall
ermi!t Technician
Fili?'Pdo: PG12 -222
6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206 - 431 -3670 • Fax 206 - 431 -3665
11 -01 -2013
City of Tukwila
Jim Haggerton, Mayor
Department of Community Development Jcick Pace, Director
STEPHEN OJUROVICH
PO BOX 595
ROSLYN, WA 98941
RE: Permit No. PG12 -222
OJUROVICH RESIDENCE
5166 S 166 ST TUKW
Dear Permit Holder:
In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building
Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National
Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and
become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date
of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has
begun for a period of 180 days. Your permit will expire on 12/17/2013.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206 - 431 -2451 to schedule for the next or final inspection.
Each inspection creates a new 180 day period, provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven (7) days before it is due to
expire. Address your extension request to the Building Official and state your reason(s) for the need to extend
your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your
extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and/or receive an extension prior to 12/17/2013, your permit will become null
and void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
Bill Rambo
Permit Technician
File: Permit File No. PG12 -222
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone 206 -431 -3670 • Fay- 206 -431 -3665
05 -01 -2013
:City of Tulirvla
;Iirte Haggerton,.11fayor
Department of Cornmunity Development Jack Pace, Director
STEPHEN OJUROVICH
PO BOX 595
ROSLYN WA 98941
RE: Permit No. PG12 -222
OJUROVICH RESIDENCE
5166 S 166 ST TUKW
Dear Permit Holder:
In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building
Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National
Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and
become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date
of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has
begun for a period of 180 days. Your permit will expire on 06/25/2013.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206 - 431 -2451 to schedule for the next or final inspection.
Each inspection creates a new 180 day period, provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven (7) days before it is due to
expire. Address your extension request to the Building Official and state your reason(s) for the need to extend
your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your
extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and /or receive an extension prior to 06/25/2013, your permit will become null
and void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
er Marshall
t Technician
File: Permit File No. PGI2 -222
000 S`outhcenter Boulevard Suite #100 Tukwila Washington 081884 Phone 206- 431 -3670 Fax 206 -431 -3665
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -3670 FAX (206) 431 -3665
E -mail: tukplan@ ci.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)
COUNTY OF KING
ss.
S t-'ke . OJkrovic&
[please print name]
, states as follows:
PERMIT NO: 1)(9
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 !3 , 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 construction work.
Eq. �
� !� Mws
OTAq
1 t 43 G
�i�9?9L1
er /Owner's Agent*
Signed and sworn to before me// this
a7 day of lF'/1'LUe/- , 20
i ,,11
Lli//I�t� Q (� 6(-4
NdT Y PUBLIC in and for the State of Washington
Residing at j l /i C' , County
Name as commissioned: La/7 AWer P
My commission expires: (2 ' 1 7
18.27.090 Exemptions. The registration provisions of this
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 46.7o 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 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
mak
chapter do not apply to:
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 holds a valid electrical contractor's
license under chapter 19.28 RCW that employs a certified
journeyman electrician, `a certified residential specialty
electrician, or an electrical trainee meeting the
requirements of chapter 19.28 RCW to perform plumbing
work that is incidentally, directly, and immediately
appropriate to the like -in -kind replacement of a household
appliance or other small household utilization equipment
that requires limited electric power and limited 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.