HomeMy WebLinkAboutPermit D13-305 - KNUDSON RESIDENCE - DEMOLITIONKNUDSON DEMOLITION
13140 56 AV S
D13-305
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.gov
Parcel No.: 2172000250
Address: 13140 56 AV S TUKW
Suite No:
Project Name: KNUDSON DEMOLITION
DEVELOPMENT PERMIT
Permit Number: D13-305
Issue Date: 10/22/2013
Permit Expires On: 04/20/2014
Owner:
Name: KNUDSON GERALD
Address: 6402 S 144TH , TUKWILA, WA 98589
Contact Person:
Name: HAN PHAN
Address: 5130 S 166 LN , SEATAC, WA 98188
Phone: 206-229-6422
Contractor:
Name: OWNER AFFIDAVIT - JERRY KNUDSON Phone:
Address:
Contractor License No: Expiration Date:
Lender:
Name:
Address:
DESCRIPTION OF WORK:
NO BUILDING TO DEMOLISH. BUILDING WAS DEMOLISHED 10 YEARS AGO BUT NEVER HAD ANY INSPECTIONS. SEE •
D03-160
PW ACTIVITY INCLUDES SEPTIC ABANDONMENT; SEPTIC TANK WAS PUMPED ON 6/24/2004 BY NORTHWEST
CASCADE,INC.
Value of Construction: $500.00 Fees Collected: $111.75
Type of Fire Protection: NONE International Building Code Edition: 2012
Type of Construction: V -B Occupancy per IBC: 0011
Electrical Service Provided by: SEATTLE CITY LIGHT
**continued on next page**
doc: IBC -7/10
D13-305 Printed: 10-22-2013
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:
(LLLt 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 a performance of work. I am authorized to sign and obtain this development permit and agree to the conditions attached
to this permi
Signature:
Print Name:
,ge-e4ev‘
AA, soA
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.
Date: GD _ ^ i
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
D13-305 Printed: 10-22-2013
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: Contractor shall notify Public Works Project Inspector Mr. Dave Stuckle at (206)433-0179 of commencement and completion
of work at least 24 hours in advance.
10: Any material spilled onto any street shall be cleaned up immediately.
11: Any septic tanks in the area shall be pumped empty and removed or filled with sand. A copy of the documentation from
the business that performed the pumping shall be provided to the City Utilities Inspector.
doc: IBC -7/10
D13-305 Printed: 10-22-2013
CITY OF TUKAA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd, Suite 100
Tukwila, WA 98188
http://wwvv.TukwilaWA.gov
Building Peri No. b 3o.-
r 0011
Date Application Accepted: cr-�j ��— t3
$
Date Application Expires: 17)-----/ 't
(For office use only)
Project No.
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
King Co Assessor's Tax No.: 2172000250
Site Address: 13140 -56th Ave South
Tenant Name:
PROPERTY OWNER
Name: Han Phan, PE
Name: Jerry Knudson
City: SeaTac State: WA Zip: 98188
Address: 13140 - 56th Ave South
Email: pbg.engr@yahoo.com
City: Tukwila State: WA
Zip: 98178
CONTACT PERSON — person receiving all project
communication
Name: Han Phan, PE
Address: 5130 S. 166th Lane
City: SeaTac State: WA Zip: 98188
Phone: (206) 229-6422 Fax:
Email: pbg.engr@yahoo.com
GENERAL CONTRACTOR INFORMATION
Company Name:
Address:
Company Name:
Address:
Architect Name:
City:
State:
Zip:
Phone:
Fax:
Phone:
Fax:
Contr Reg No.:
Email:
Exp Date:
Tukwila Business License No.:
H:\Applicalions\Forms-Applications On Line\201 1 Applications\Permit Application Revised - 8-9-1 Ldocx
Revised: August 2011
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Suite Number:
New Tenant:
Floor:
0 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:
Page 1 of 4
BUILDING PERMIT INFORMATIOl06-031-3670
•
Valuation of Project (contractor's bid price): $ 500
Describe the scope of work (please provide detailed information):
No building to demolish. Building was demolished 10 years ago but never has a final inspection.
Existing Building Valuation: $
Will there be new rack storage? ❑ Yes
0.. 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): 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? 9 Yes 0 No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0 Sprinklers 0 Automatic Fire Alarm
0 None
❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes 0 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.
H:Wpplications\Forms-Applications On Line \2011 Applications\Permit Application Revised - 8-9-11.docx
Revised: August 2011
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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
1St Floor
2nd Floor
3rd 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): 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? 9 Yes 0 No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0 Sprinklers 0 Automatic Fire Alarm
0 None
❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes 0 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.
H:Wpplications\Forms-Applications On Line \2011 Applications\Permit Application Revised - 8-9-11.docx
Revised: August 2011
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Page 2 of 4
PUBLIC WORKS PERMIT INFO
TION - 206-433-0179
•
Scope of Work (please provide detailed information):
Not applicable to Public Work
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ ...Tukwila 0... Water District # 125
❑ ...Water Availability Provided
Sewer District
❑ ...Tukwila
❑ ...Sewer Use Certificate
❑ .. Highline
❑ ...Valley View ❑ .. Renton
❑ ...Sewer Availability Provided
❑ .. Renton
❑ .. Seattle
Septic System:
O 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) ❑ .. Geotechnical Report
❑ ...Bond ❑ .. Insurance ❑ .. Easement(s) ❑ .. Maintenance Agreement(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
❑...Traffic Impact Analysis
❑ ... Hold Harmless — (SAO)
❑ ...Hold Harmless — (ROW)
❑ .. Right-of-way Use - Profit for less than 72 hours
❑ .. Right-of-way Use — Potential Disturbance
❑ .. Work in Flood Zone
❑ .. Storm Drainage
0 ...Sanitary Side Sewer 0 .. Abandon Septic Tank 0 .. Grease Interceptor
❑ ...Cap or Remove Utilities ❑ .. Curb Cut ❑ .. Channelization
❑ ...Frontage Improvements ❑ .. Pavement Cut ❑ .. Trench Excavation
❑ ...Traffic Control ❑ .. Looped Fire Line 0 .. Utility Undergrounding
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑ ...Permanent Water Meter Size... lf
WO #
❑ ...Temporary Water Meter Size .. f 1 WO #
O ...Water Only Meter Size 1 1 WO # ❑...Deduct Water Meter Size
❑ ...Sewer Main Extension Public 0 Private 0
❑ ...Water Main Extension Public 0 Private 0
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ ...Water ❑ ...Sewer 0 ...Sewage Treatment
Monthly Service Billing to:
Name: Day Telephone:
Mailing Address:
City State Zip
Water Meter Refund/Billing:
Name:
Mailing Address:
Day Telephone:
City
State Zip
H:Wpplications\Forms-Applications On Line \2011 Applications\Permit Application Revised - 8-9-11.docx
Revised: August 2011
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Page 3 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 OWNER OR AUT%�ZED AG •
Signature:
Print Name: Han Phan, PE
Mailing Address: 5130 S. 166th Lane
H:\Applications\Forms-Applications On Line\201 1 Applications\Permit Application Revised - 8-9-I I.docx
Revised: August 2011
bh
Date: 09/26/2013
Day Telephone: g.99
SeaTac WA 98188
City State Zip
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
Parcel No.: 2172000250
Address: 13140 56 AV S TUKW
Suite No:
Applicant: KNUDSON DEMOLITION
RECEIPT
Permit Number: D13-305
Status: PENDING
Applied Date: 09/27/2013
Issue Date:
Receipt No.: R13-02763
Initials:
User ID:
WER
1655
Payment Amount: $111.75
Payment Date: 09/27/2013 03:59 PM
Balance: $0.00
Payee: PHAN BUSINESS GROUP LLC
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 1089 111.75
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: $111.75
65.00
42.25
4.50
PrinfPd- 00-77-9(111
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
.1)13-305
Project:•
1AsJLib SO,•1 t) E rx()
Type of Inspection:
i=!J1L-
Address:
1 1 LiC) 5 c, A U 5
Date Called:
Special Instructions:
Date Wanted:
10 /�c f t j
ci.m)
p.m.
Requester:
Phone No:
06- -73D-zez5
Approved per applicable codes. 0Corrections required prior:tbapproval.
COMMENTS:
:
Date:
JJ !G'.2.�% I�
REINSPECTION FEE REQUIRED. rior to nixt inspection, fee must be
pai /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
b13-5
Project:
• --°-(1/11
Type of Insp ction:
fil )
Addres3:Date
� c-('P4e „co,
Calleli:
1
v3//
Spl';1
ciallnstructions:
— �
C/i
Ir- WaLC -EA (r/t...
Date Wanted:-
1 �1-
.m
Requester:
Ph9�,1,; �#
t
-'Sc
❑ Approved per applicable codes.
DCorrections required prior to -approval.
COMMENTS:
F t VI/Jeri
Inspector:
.9s
REINSPECTION FEE REQUIRED. Prior to next inspection;:fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule: reinspection.
57 l(11.01-(44. .c"uV7J
Permit No.
Plan MOM approval Is subject to errors and omlabn
A ., documents does not aided
p ,
violation of any ...... code or ardlimnoe. Ma*
of approved Held •. and =form Is admane dpe
No changes AM be made to the coops
or work without prior approval of
I?Z
Q¢m�5
/3 /4
Cal
REVIEWED FOR
LODE COMPLIANCE
APPROVED
JUL 0 9 2004
City Of 1U wile
UILD1NG DIVISION
ysf(r
4,0 iC 4-fheler
(I3)
FM.A.
Tukwila Building Obhlon.
NOTE: Revlslons will require a new plan subnYlW
• and may Include addldonal plan review fees.
-Se) "I2dilo4
Sin .6 /4 °'u - Cor) -11-!J
Doi- !Go
NORTHWEST CASCADE, INC.
P.O. BOX 73399 • PUYALLUP. WA 98373
NORTHCIta68G
(253) 048-2371
CHARGEABLE MILEAGE
SIM i Sian
TANK HOLE BOTTOM
DAL U Finn 051areNg Wan;O
0 WEE U,dW Tang 0 FID UnaariaM
O lora a Carts
0 tarn Line 0 5nR 0 Fmm 0,41n O Punt Racy
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TAM LIQIIO LEVEL
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PRODUCTS/SERVICES
UNIT
PRICE
TOTAL
AMOUNT
Pop s-e�he /-‹ 14
Fr ale vnfl, 4t%4 F114 I CIS
.rn -I.rZ )'Jac%( --
f`l�siv s -/.rnr"S Ile
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RFVIEWED OR -.
_
CODE COMP ANI.t:
APPROVED
J 2004 suei&At`°:'
. -
li%!L
jk-44
2ViS
JUL 0
io...:...
city of I ukWRa
DING DIVICInN
ELWOUENCT CHARGE ON PAST DUE ACCOUNTS.
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246-9456 Fax: (206) 246-2274
June 28, 2004
City of Tukwila
6300 Southcenter Boulevard, Suite 100
Tukwila, Washington 98188
Attn: Ms. Kathryn A. Stetson
Re: 13140 561h Avenue South
Tukwila, Washington 98178
Public Works Department Comments Response
Permit No. D03-160
Dear Ms. Stetson:
REVIEWED FOR
CODE COMPLIANCE
APPROVED
JUL 0 9 2004
City Of Tukwila
BUILDING DIVISION
The following is our response to the Public Works Department Comments dated
June 5, 2002. (Copy enclosed for reference.)
#1 Septic System
The septic system was pumped empty on June 24, 2004 and was filled with sand
today. The lid has been destroyed. A copy of the paperwork received from Northwest
Cascade has been enclosed for your use. The location of the septic system is indicated on
the plan.
#2 Water Service
The water service has been included on the plan. Because we intend to use the water
service again, it will be capped at the water meter.
#3 Erosion Prevention / Sediment Control Plan
No storm system in street or on property.
Runoff water to be retained on site.
Silt fence where necessary.
Water for dust control; fire hydrant shown on plan.
#4 Utilities Capping Estimate
Capping water service $ 100.00
Septic tank pump $ 210.00
Septic tank fill $ 125.00
Erosion control $ 750.00
Total $ 1,185.00
CORRECTION
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is 0.5' norm
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northerly ins shed
0 0.5' norm
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fence is 0.1' north
cnai n link fence is 0.9' norm S
2.0' west of tale. Po9tlon.
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found 3/4' pipe
(no identification)
i
wood fence
0.4' north
ritneosterly en
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/chain Ink fence is on line
east end than fink fence Is
0.2' south dc O..' west of
talc position.
SD SD SD
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57TH AVE SOUTH
SD SD SD AD
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FLARI MG. APPROVED e
No changes 'can be madeto these
plans without approval from the
Planning Division of DCD
pproved By:
Dater q-30.1
ltrf
14
edge asphalt
2
G G
SS
V2''9oars
0
55
W W
S5
SEPARATE PERMIT
REQUIRED FOR:
SS �O.
found 5/8' steel pn SS- SS SS 55
(no identification)
Mechanical
l 'EIectric aI
E1'hlumbing
R as Pipino
of Tukwila
...";G DIVISION
1
REVISIONS
No changes shall bo made to the scope
of work without prior approval of
?-0,: Bila Building Division.
I` --'f T =: INiSiC13 ?:visit-3will require a new plan submittal
cni guy include additional plan review fees.
55 --4t7 ^4,7+
:49
SD SlL—r— so —$�j— SD
^67 H
w —/ w —- wl W w @ya__
PLAN
HORIZONTAL GRAPHIC SCALE
20 10 0 10 20
1 inch = 20t
SD SD
FILE COPY
Permit N0.1),I3' 50 5
Pier review approval is subject to errors and omissions.
f,' : . - ,' of . construction documents does not authorizo
t,,. ;. iort os or:y adopted code or ordinance. Receipt
,Y1 w proved Field Copy and =cations is acknowledged:
By Y
Z
w w w
City Of Tiukwlla
BUILDING DIVISION
REVIEWED FOR
BODE COMPLIANCE
APPROVED
SD —
OCT 21 2013
Cityof Tukwila
BUILING DIVISION
p\3- 305
RECEIVED
OCT 012013
TUKVviuA
PUBLIC WORKS
RECEIVED
CITY OF TUKWILA
SEP 2 7 2013
PERMIT CENTER
REFERENCE
SHEET NO.
SP1
SHEET
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OF
SHEETS
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DESIGNED BY:
_
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_
CHECKED BY:
PROJ. MNGR:
REVISION DESCRIPTION
2 -
CO
P'ERMIT COORD COPY •
PLAN REVIEW/ROUTING SLIP
ACTIVITY NUMBER: D13-305 DATE: 09-27-13
PROJECT NAME: KNUDSON DEMOLITION
SITE ADDRESS: 13140 56 AV S
X Original Plan Submittal Response to Incomplete Letter #
Response to Correction Letter # Revision # After Permit Issued
DEPARTMENTS:
, r �3 J/4 t-)yvvoO° • ` l
Building Division hr evention Planning Division
Public Works C Structural Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 10-01-13
Complete
Incomplete
Not Applicable
n
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg 0 Fire 0 Ping 0 PW 0 Staff Initials:
TUES/THURS ROUTING:
Please Route
Structural Review Required
No further Review Required
n
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 10-29-13
Approved U Approved with Conditions 1V Not Approved (attach comments) n
Notation:
REVIEWER'S INITIALS: DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg 0 Fire 0 Ping ❑ PW ❑ Staff Initials:
Documents/routing slip.doc
2-28-02
•
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
206 431-3670
Public Works Department
206 433-0179
Planning Division
206 431-3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
) ss.
COUNTY OF KING
JLrr 14/tA050N
please print name]
, states as follows:
PERMIT NO:
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 l a , 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 cotion work.
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s Agent*
Signed and sworn to before me this
2a
day of OGAD , 20 L3 .
NOTARY PUBLIC in and for the State of Washington
Residing at
Name as commissioned:
, County
My commission expires: 1� b ) ^O /5-
18.27.090 Exemptions. The registration 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 purposeof 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;
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 sok 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;
01 f 1'r), e44
18. An entity who,p20 20 a,yand,el_ectricalcontractor's
license under chapter 19128.RCWsttiatemploys a certified
journeyman electricianta certified r side tial specialty
electrician, or ail electrical trainee'inehing the
requirements otchagter 19.28 RCW to`perform plumbing
work that is inci'dei'itally, directly;.andiinmediately
appropriate to theli=in-kind replayemetrt of a household
appliance or otheFsmajT'hoiisehold utilization equipment
that requires limited'etatric1power and'Iimited waste
and/or water connectiong!'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.