HomeMy WebLinkAboutPermit D14-0220 - VU RESIDENCE - REMODELVU RESIDENCE
12803 34 AVE S
EXPIRED
09/28/15
D14-0220
Parcel No:
Address:
Project Name:
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Inspection Request Line: 206-438-9350
Web site: http:/(www.TukwilaWA.gov
DEVELOPMENT PERMIT
7359600875 Permit Number: D14-0220
12803 34TH AVE S
VU RESIDENCE
Issue Date: 7/24/2014
Permit Expires On: 1/20/2015
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Contractor:
Name:
Address:
License No:
Lender:
Name:
Address:
ARNOLD JERRY D
12803 34TH AVE S, TUKWILA, WA,
98168
OANH VU
PO BOX 66834 , BURIEN, WA, 98166
OWNER AFFIDAVIT IN FILE
I I 1
Phone: (206) 351-0901
Phone:
Expiration Date:
DESCRIPTION OF WORK:
INSTALL NEW SHEETROCK, INSULATION, AND FRAMING FOR BATHROOM AND BEDROOM.
Project Valuation: $5,000.00
Type of Fire Protection:
Sprinklers: NO
Fire Alarm: NO
Type of Construction: VB
Electrical Service Provided by: TUKWILA FIRE SERVICE
Fees Collected: $324.62
Occupancy per IBC: R-3
Water District: 125
Sewer District: VALLEY VIEW SEWER SERVICE
Current Codes adopted by the City of Tukwila:
International Building Code Edition:
International Residential Code Edition:
International Mechanical Code Edition:
Uniform Plumbing Code Edition:
2012
2012
2012
2012
International Fuel Gas Code:
WA Cities Electrical Code:
WA State Energy Code:
2012
2012
2012
Public Works Activities:
Channelization/Striping:
Curb Cut/Access/Sidewalk:
Fire Loop Hydrant:
Flood Control Zone:
Hauling/Oversize Load:
Land Altering:
Landscape Irrigation:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter:
Volumes: Cut: 0 Fill: 0
Number: 0
No
el 1
Permit Center Authorized Signature 11�v \�
I hearby certify that I have read and
provisions of law and ordinances gov
xami
nin
Date:
Il Illqlluf
ed this permit and know the same to be true and correct. All
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
development permit and agree to the conditions attached to this permit.
Signature:
Print Name:
Date: 4 IA1-11 C*
This permit shall become null and void if the work is not commenced within 180 days for 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 PERMIT CONDITIONS***
2: Work shall be installed in accordance with the approved construction documents, and any changes made
during construction that are not in accordance with the approved construction documents shall be
resubmitted for approval.
3: All permits, inspection record card and approved construction documents shall be kept at the site of work
and shall be open to inspection by the Building Inspector until final inspection approval is granted.
4: All construction shall be done in conformance with the Washington State Building Code and the
Washington State Energy Code.
5: Notify the City of Tukwila Building Division prior to placing any concrete. This procedure is in addition to
any requirements for special inspection.
6: All wood to remain in placed concrete shall be treated wood.
7: 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.
8: All construction noise to be in compliance with Chapter 8.22 of the City of Tukwila Municipal Code. A copy
can be obtained at City Hall in the office of the City Clerk.
9: Every occupied space other than enclosed parking garages and buildings used for repair of automobiles
shall be ventilated in accordance with the applicable provisions of the International Mechanical Code.
10: Water heaters shall be anchored or strapped to resist horizontal displacement due to earthquake motion.
Strapping shall be at points within the upper one-third and lower one-third of the water heater's vertical
dimension. A minimum distance of 4-inches shall be maintained above the controls with the strapping.
11: 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).
12: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila
Permit Center.
13: 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.
14: All mechanical work shall be inspected and approved under a separate permit issued by the City of Tukwila
Permit Center (206/431-3670).
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
0409 FRAMING
0606 GLAZING
0104 REMOVE STOP WORK
0602 SLAB/FLOOR INSUL
0601 WALL INSULATION
0413 WALL SHEATHING/SHEAR
CITY OFT.'._ .VILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
Building Permit No.
Project No.
Date Application Accepted:
Date Application Expires:
fly- 0220
it-V-oo
of
(For office use only)
(; :ts-
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:
la05 5j4 All S
King Co Assessor's Tax No.: 131-� 1(0O v 1
Suite Number:
Tenant Name: New Tenant:
PROPERTY OWNER
Name: rto^ _
,
' 1
V '
Address: To :41(3G
e).,)4
City:. Uti(21C'IL
State: u/k
Zip: "IT)16c
CONTACT PERSON — person receiving all project
communication
Name: O Qn {A 1 /-
VGG??
Address: en bN' 4
City: u Q. fiLState: » Zip:q ),, V
b r
t 1 U
Phone:
�� 65 ( CM I Fax:
Email: Hnoncrvu 42A QJ�4 , 1co .Met
GENERAL CONTRACTOR INFORMATION
Company Name: rk , nQ Q.
�jlO
Address:
City: State:
Zip:
Phone: Fax:
Contr Reg No.:
Exp Date:
Tukwila Business License No.:
Floor:
❑ Yes ❑ .. No
ARCHITECT OF RECORD
Company Name:
GtORPk
Architect Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
ENGINEER OF RECORD
Company Name:
N A
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:
H:Wpplications\Forms-Applications On Line\2012 Applications\Petmit Application Revised - 2-7-12.docx
Revised: February 2012
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Page 1 of 4
BUILDING PERMIT INFORMAT—106-431-3670
MP
Valuation of Project (contractor's bid price): $OExisting Building Valuation: $
Describe the scope of work (please provide detailed information): ,� p �,
New r atztic gift u� "" ` cf t 2(Xil�, n peCeV1) )
fkOT12 e F C ti9� Tin �l? t f icrO 6�,� Tilde e (Th (th , �-t, ja ,
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
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
1° Floor
✓
2"d 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): 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/HAZAOUS MATERIALS:
❑ Sprinklers Automatic Fire Alarm ❑ None ❑ Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes CVNo
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:WpplicationsWorms-Applications On Line\2012 Applications\Pennit Application Revised - 2-7-12.docx
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 OWNER OR AUTHORIZE AGENT: `�
Signature: `` UJ1t / Date: 4' 1 'S I = l Q
Print Name:
Mailing Address:
Day Telephone: oP-6 gj5I GC/0i
g2,J46
City State Zip
H:\Applications\Forn s-Applications On Line \2012 Applications\Pennit Application Revised - 2-7-12.docx
Revised: February 2012
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Page 4 of 4
PUBLIC WORKS PERMIT P RMATION — 206-433-0179
Scope of Work (please provide detailed information):
Ca11 before you Dig: 811
Please refer to Public Works Bulletins#1 for fees and estimate sheet.
Water District
❑ .. Tukwila 0 ...Water District # 125
0 .. Water Availability Provided
Sewer District
❑ .. Tukwila
❑ .. Sewer Use Certificate
Septic System:
O On -site Septic System — For on -site se
❑ ... Highline
❑ .Valley View ❑...Renton
❑ s ewer Availability Provided
O ... Renton
❑ eattle
system, provide 2 copies of a current septic desi i' . , proved by King County Health Department.
Submitted with Application (mark boxes whi : i . I
❑ .. Civil Plans (Maximum Paper Size — 22" x
❑ .. Technical Information Report (Storm Drainage) ❑... Geotechnical ' port 0 .. Traffic Impact Analysis
O .. Bond ❑... Insurance ❑... Ease -nt(s) ❑... Maintenanc greement(s) 0 .. Hold Harmless — (SAO)
❑ .. Hold Harmless — (ROW)
Proposed Activities (mark boxes that apply):
❑ .. Right-of-way Use - Nonprofit for less than 72 hours
O .. Right-of-way Use - No Disturbance
❑ .. Construction/Excavation/Fill - Right-of-way 0
Non Right-of-way 0
❑ .. Total Cut
❑ .. Total Fill
❑ Ri: ' of -way Use - Profit for less than 72 hours
t-of-way Use — Potential Disturbance
cubic yards i ... • rk in Flood Zone
cubic yards ❑... St, Drainage
❑ .. Sanitary Side Sewer 0... Abandon ' 'rtic Tank ❑... Grease Interceptor
❑ .. Cap or Remove Utilities 0...Curb C 0... Channelization
❑ .. Frontage Improvements 0...Pave • t Cut 0... Trench Excavation
❑ .. Traffic Control 0... Lo, - d Fire Line 0... Utility Undergrounding
❑ .. Backflow Prevention - Fire Protection "
Irrigation
Domestic Water
❑ .. Permanent Water Meter Size (1)
❑ .. Temporary Water Meter Size (1)
❑ .. Water Only Meter Size
❑ .. Sewer Main Extension c
❑ .. Water Main Extension , lic
FINANCE INFORMATION
Fire Line Size at Property Lin Number of Public Fire Hydrant(s)
0 .. Water ■ . Sewer ❑ .. Sewage Treatment
Monthly Service Billin
Name: Day Telephone:
Mailing Address:
1)
WO # (2) " WO # (3) " WO #
WO # (2) " WO # (3) " WO #
WO # 0 .. Deduct Wat, eter Size "
Private 0
Private ❑
Water Meter Refund/Billing:
Name:
Mailing Address:
City
State Zip
Day Telephone:
City
State Zip
H:\Applications\Forms-Application, On Line\2012 Applications\Permit Application Revised - 2-7-12.docx
Revised: February 2012
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Page 3 of 4
DESCRIPTIONS
PernitTRAK
Cash Register Receipt
City of Tukwila
ACCOUNT
QUANTITY
PAID
$324.62
D14-0220
Address:
2803 34TH AVE S Apn: 7359600875
$324.62
DEVELOPMENT
$315.20
PERMIT FEE
R000.322.100.00.00
0.00
$188.30
PLAN CHECK FEE
R000.345.830.00.00
0.00
$122.40
WASHINGTON STATE SURCHARGE
B640.237.114
0.00
$4.50
TECHNOLOGY FEE
$9.42,
TECHNOLOGY FEE
TOTAL FEES PAID BY RECEIPT: R2590
R000.322.900.04.00
0.00
$9.42
$324.62
Date Paid: Tuesday, July 15, 2014
Paid By: HOANG V VU
Pay Method: CREDIT CARD 660316
Printed: Tuesday, July 15, 2014 12:42 PM 1 of 1
CRWSYSTEMS
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
614---(Z2.0
Project: n
4 1 t t'� --
Typc of Inspects
:kQ Ovk_tr?a tiV.....
d2 3 , t A
(Special
Date Called:
Instructions:ti
a
812,
0 A 1 k .._,_
0
Date W ntted: if
i
a.m.
.m.
•� 1
Requester:
Phone o
20 s 1--
(
0
proved per applicable codes. Q Corrections required prior to approval.
COI MENTS:
10 P l o✓ - \iZ-P Q1.1 oi%�r/'
Date:
y
NSPECTION FEE REGU ED. Prior to next inspection. fee must be
d at 6300 Southcenter 6l .. Suitet100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
D I L-O22c
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.
� U - r
(v
spectio
Typ inlitt
re
os
Date Called:
C4 I fSkF'r111 -rfL/
Special Instructions:
Ct
; D
Datemnteci_ �f
Requester
Ph C -72y `35V )
nApproved per applicable codes.
OCorrections required prior to approval.
COMMENTS: AiRk6,0 ujA (
U6cit4Jr - 1" f LT 60VF
D
D4 : ac
iy
SPECTION FEE REQUIR D. Prior to iiext inspection. fee must be
at 6300 Southcenter 8lv ., Suite 100. Call to schedule reinspection.
REVIEWED FOR
CODE COMPLIANCE
APPROVED
JUL 2 2 2014
City of Tukwila
BUILDING DIVISION
RECEIVED (1' A4
CITY OF TUKWILA 5
JUL 1 0 2014
PERMIT CENTER
SEPARATE PERMIT
R SQUIRED FOR:
• ,, echanical
S Electrical
geIumbing
as Piping
c=ty of Tukwila
`61..UI1.1 1NG DIVISION
PLANNING APPROVED •
No changes 'can be made.to these
plans without approval from the
Planning Division of DCD
I i
Approved By:
Date:
s
REVISIONS
No changes shall be made to the scope
• of work without prior approval of
Tukwila Building Division.
NOTE: Revisions ons will require a new plan submittal
and may include additional plan review fees.
vw
•
All hew eeCH5 rctc.T!'vr 'koI1 he NP,l c J • 19 fat Loos/O1eKf wWI/ perw►17f'
AffeP r Gt cAow pew M !r .err J' a Li 1,,
e fi %v F;(o) Zws ec.lior ' 4t A
,Th G NY V a Kf c dO'iPl,
oyH
iaµ -' tcn
FILE COPY
Permit No. 1/1....12.2
Plan review approval is subject to errors and omissions.
Approval of • • -• 'on documents does not authorize
•f any adopted code or ordinance. Receipt
pproved Field Copy and gcorpons is acknowledged:
By:JY
Date: 1 1a24,kk014
City of Tukwila
BUILDING DIVISION
REVIEWED FOR
CODE COMPLIANCE
APPROVED
JUL 2 2 2014
City of Tukwila
BUILDING DIVISION
cO
00
F-
rn
RECEIVED
CITY OF TUKWILA -
JUL 1 0 2014
DiLloz2mo
PERMIT CENTER Z
.-P
City of Tukwila
Department of Community Development
8/6/2015
OANH VU
12803 34 AVE S
TUKWILA, WA 98168
RE: Permit No. D14-0220
VU RESIDENCE
12803 34 AVE S
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 9/28/2015.
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 9/28/2015, 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,
q,J
Bill Rambo
Permit Technician
File No: D14-0220
6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
City of Tukwila Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
April 1, 2015
Oanh Vu
12803 34 Ave S
Tukwila, WA 98168
RE: Request for Extension
Permit Number D14-0220
Dear Mr. Vu,
This letter is in response to your written request for an extension to D14-0220. The Building Official,
Jerry Hight, has reviewed your letter and considered your request to extend the above referenced permit.
It has been determined that the City of Tukwila Building Division will be granting an extension to the
permit for an additional 180 days, through September 28, 2015.
If you should have any questions, please contact our office at (206) 431-3670.
Sincerely,
Bill Rambo
Permit Technician
File: Permit No. D14-0220
W:\Permit Cente,\Extension Letters\Permits\2014\D14-0220 Permit Extension #1.docx
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
MAR 2 7 2015
Request for Extension # I
Current Expiration Date: 3'2-6— S
Extension Request:
Approved for / 75 Q days
Denied (provide explanation)
Signature/Initials
City of Tukwila
Department of Community Development
2/2/2015
OANH VU
PO BOX 66834
BURIEN, WA 98166
RE: Permit No. D14-0220
VU RESIDENCE
12803 34 AVE S
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 3/28/2015.
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 3/28/2015, 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 No: D14-0220
6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
PERMIT COORD COPY
PLAN REVIEW/ROUTING SLIP
PERMIT NUMBER: D14-0220 DATE: 07/15/2014
PROJECT NAME: VU RESIDENCE
SITE ADDRESS: 12803 34 AVE S
X Original Plan Submittal Revision # before Permit Issued
Response to Correction Letter #
_ Revision # after Permit Issued
DEPARTMENTS:
Building Division
�� -c 1
ub tc Wo s
Fire Prevention
Structural
c pL AN' 7-D- f y
Planning Division .
Permit Coordinator ❑
PRELIMINARY REVIEW:
Not Applicable ❑
(no approval/review required)
DATE: 07/17/14
Structural Review Required
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved
Corrections Required ❑
(corrections entered in Reviews)
Notation:
Approved with Conditions
Denied
(ie: Zoning Issues)
ec( V'0 hI-
lAl1
DUE DATE: 08/14/14
REVIEWER'S INITIALS:
DATE:
ti.
CORRECTION LETTER MAILED:
Departments issued corrections:
Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
12/18/2013
CITY OF TUKWILA
Department of Community Development
630o Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-367o FAX (206) 431-3665
Permit Center/Building Division
206 431-367o
Public Works Department
206 433-0179
Planning Division
206 431-367o
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
) ss.
COUNTY OF KING )
.R1 et( C n h
[please print name]
, states as follows:
PERMIT NO: P [Li — l 7\
CLIP{- b 2
Dt(4-19i2
i. 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 1.8.27.090 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 11-, and will therefore
not be performed by a registered contractor.
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.
Owner/Owner's Agent*
Signed and sworn to before me this
day of )L,.' ,20 I11—.
1-
`ji. ,-(`
NOTARY P u BLIC in and for the State of Washington
Residing at t ram! , County
Name as commissioned. t
My commission expires: I D 15