HomeMy WebLinkAboutPermit D14-0367 - ALLEN TOWN GROCERY - SUSPENDED CEILINGALLEN TOWN GROCERY
12404 42 AVE S
D14-0367
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
Parcel No: 0179003238 Permit Number: D14-0367
Address: 12404 42ND AVE S Issue Date: 11/25/2014
Permit Expires On: 5/24/2015
Project Name: ALLEN TOWN GROCERY
Owner:
Name: HARRIS IVY
Address: 10529 SE 213TH ST, KENT, WA, 98031
Contact Person:
Name: IVY HARRIS Phone: (253) 852-7095
Address: 10529 SE 213 ST, KENT, WA, 98031
Contractor:
Name: LEROY RED ROOFING
Address: 903 30 AVE , SEATTLE, WA, 98122
License No: LEROYRR897JH
Lender:
Name:
Address:
Phone: (206) 898-6841
Expiration Date:
DESCRIPTION OF WORK:
CONSTRUCT CRICKET TO GIVE POSITIVE FALL FROM 1/3 SECTION OF ROOF DOWN TO PARAPET WITH CRICKET
LEADING TO CORNER DOWN SPOUTS.
REVISION #1 TO ADD REPLACEMENT OF THE SUSPENDED CEILING GRID AND TILES. APPROVED SUBJECT TO FIELD
INSPECTION
Project Valuation: $7,000.00
Type of Fire Protection: Sprinklers:
Fire Alarm: YES
Type of Construction: VB
Fees Collected: $391.26
Occupancy per IBC: M
Electrical Service Provided by: TUKWILA FIRE SERVICE Water District: TUKWILA
Sewer District: TUKWILA 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 International Fuel Gas Code:
2012 WA Cities Electrical Code:
2012 WA State Energy Code:
2012
2012
2014
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
Permit Center Authorized Signature:
co-J1-
Date: I)---1
I hearby 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
development permitted agree to the conditions attached to this permit.
Signature:
Print Name:
Date/Z —
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: Insulating materials, where exposed as installed in buildings of any type of construction, shall have a flame
spread index of not more than 25 and a smoke development index of not more than 450. Where facings
are installed in concealed spaces in buildings of Type III, IV, or V construction, the flame spread and smoke -
developed limitations do not apply to facings, that are installed behind and in substantial contact with the
unexposed surface of the ceiling, wall or floor finish.
5: All construction shall be done in conformance with the Washington State Building Code and the
Washington State Energy Code.
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: 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.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
0406 SUSPENDED CEILING
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.eov
DEVELOPMENT PERMIT
Parcel No: 0179003238 Permit Number: D14-0367
Address: 12404 42ND AVE S Issue Date: 11/25/2014
Permit Expires On: 5/24/2015
Project Name: ALLEN TOWN GROCERY
Owner:
Name: HARRIS IVY
Address: 10529 SE 213TH ST, KENT, WA, 98031
Contact Person:
Name: IVY HARRIS Phone: (253) 852-7095
Address: 10529 SE 213 ST, KENT, WA, 98031
Contractor:
Name: LEROY RED ROOFING Phone: (206) 898-6841
Address: 903 30 AVE , SEATTLE, WA, 98122
License No: LEROYRR897JH Expiration Date:
Lender:
Name:
Address:
DESCRIPTION OF WORK:
CONSTRUCT CRICKET TO GIVE POSITIVE FALL FROM 1/3 SECTION OF ROOF DOWN TO PARAPET WITH CRICKET
LEADING TO CORNER DOWN SPOUTS.
Project Valuation: $7,000.00
Type of Fire Protection: Sprinklers:
Fire Alarm: YES
Type of Construction: VB
Fees Collected: $391.26
Occupancy per IBC: M
Electrical Service Provided by: TUKWILA FIRE SERVICE Water District: TUKWILA
Sewer District: TUKWILA 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 International Fuel Gas Code:
2012 WA Cities Electrical Code:
2012 WA State Energy Code:
2012
2012
2014
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
Permit Center Authorized Signature:
Date:
I hearby certify that I have read and : -d this permit and know the same to be true and correct. All
provisions of law and ordinances gove his 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 gree to the cor,.ditions attached to this permit.
Signature: /4�% 2�� Date:
Print Name::
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: Insulating materials, where exposed as installed in buildings of any type of construction, shall have a flame
spread index of not more than 25 and a smoke development index of not more than 450. Where facings
are installed in concealed spaces in buildings of Type III, IV, or V construction, the flame spread and smoke -
developed limitations do not apply to facings, that are installed behind and in substantial contact with the
unexposed surface of the ceiling, wall or floor finish.
5: All construction shall be done in conformance with the Washington State Building Code and the
Washington State Energy Code.
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: 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.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
CITY OF TIL.. . ILA
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:
(Wf Tic
(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 / y„ ,r L T/
milKing Co Assessor's Tax No.: (.9LOD — 313
Site Address: ' /7_) y- Suite Number: Floor:
Tenant Name:
PROPERTY OWNER
Name: 7 V /L7/4 e '/
Address: ' Q ,A 9 5C' /3
-- S/
City: �"7/./ T f State: 24)4
Zip: ,t0,3
CONTACT PERSON — erson receiving all project
communication
Name:
Address:
City:
State:
Zip:
Phone:
jci,/lr
c
Email:
GENERAL CONTRACTOR INFORMATION
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contr Reg No.:
Exp Date:
Tukwila Business License No.:
New Tenant: ❑ Yes ❑ .. No
ARCHITECT OF RECORD
Company Name:
..-
Architect Name:
Address:
City:
State:
Zip:
Phone:
F :
Email:
ENGINEER ceRECORD
Company Name:
Engineer Name:
Address:
City:
State:
Zip:
Phone:
.•
Email:
LENDER/BOA ISSUED (required for projects $ ,000 or
greater per RCW 19.27.095)
Name:
Address:
City: te: Zip:
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Revised: February 2012
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Page 1 of 4
BUILDING PERMIT INFORMAT — 206-431-3670
/ Valuation of Project (contractor's bid price): $ 71)oa
Existing Building Valuation: $
Describe the scope of work (please provide detailed information):
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
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)r2 �!'O . ' Floor area of principal dwelling: Floor area of accessory dwelling:
*Provide documentation that sliws that the principal owner lives in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Compac
Handicap:
Will there be a change in use? ❑ Yes No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑ Sprinklers Automatic Fire Alarm ❑ None ❑ Other (specify)
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
O 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\Permit Application Revised - 2-7-I2.docx
Revised: February 2012
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Page 2 of 4
PUBLIC WORKS PERMIT IN IMATION — 206-433-0179
Scope of Work (please provide detailed information):
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ .. Tukwila ❑ ...Water District #125
❑ .. Water Availability Provided
Sewer District
❑ .. Tukwila
❑ .. Sewer Use Certificate
Septic System:
❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approvd 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) 0... Geotechnical Report 0 .. Traffic Impact Analysis
❑ .. Bond 0... Insurance ❑... Easement(s) 0...Maintenance Agree r ent(s) 0 .. Hold Harmless — (SAO)
❑ .. Hold Harmless — (ROW)
❑... Highline 0... Renton
❑ ...Valley View ❑ ... Renton
0 ...Sewer Availability Provided
❑... Seattl
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
0 .. Sanitary Side Sewer
❑ .. Cap or Remove Utilities
0 .. Frontage Improvements
❑ .. Traffic Control
❑ .. Backflow Prevention - Fire Protection
0...Abandon Septic
❑... Curb Cut
❑... Pavement C
0...Looped Fi Line
Irrigation
Domestic Water
❑ .. Permanent Water Meter Size (1)
❑ .. Temporary Water Meter Size (1)
❑ .. Water Only Meter Size
❑ .. Sewer Main Extension Publ.
❑ .. Water Main Extension P , is
❑... Right-of-wa se - Profit for less than 72 hours
0...Right-of- y Use — Potential Disturbance
ork in Flood Zone
torm Drainage
0... Grease Interceptor
❑... Channelization
❑ ...Trench Excavation
❑... Utility Undergrounding
WO # (2) " WO # (3) " WO #
WO # (2) " WO # (3) " WO #
WO # 0 .. Deduct Water Meter Size "
Private 0
Private 0
FINANCE INFORMATION
Fire Line Size at Property Li Number of Public Fire Hydrant(s)
0 .. Water % .. Sewer ❑ .. Sewage Treatment
Monthly Service Bil g to:
Name: Day Telephone:
Mailing Ads. ess:
Wate eter Refund/Billing.
me:
City
State Zip
Day Telephone:
Mailing Address:
City State Zip
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Revised: February 2012
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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 0
Signature`
Print Name:
R OR AUTHORI , D ' ENT:
Mailing Address< S—? �& Z
Date: l -2-r'�
jay Telephoner? 5 - FS
City State Zip
H:Wpplications\Forms-Applications On Line\2012 Applications\Permit Application Revised - 2-7-12.docx
Revised: February 2012
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Page 4 of 4
Cash Register Receipt
City of Tukwila
DESCRIPTIONS ACCOUNT QUANTITY
PermitTRAK
PAID
$391.26
D14-0367 Address: 12404 42ND AVE S Apn: 0179003238 $391.26
DEVELOPMENT $374.75
PERMIT FEE
R000.322.100.00.00
0.00
$370.25
WASHINGTON STATE SURCHARGE
B640.237.114
0.00
$4.50
TECHNOLOGY FEE $16.51
TECHNOLOGY FEE R000.322.900.04.00 0.00 $16.51
TOTAL FEES PAID BY RECEIPT: R3644 $391.26
Date Paid: Tuesday, November 25, 2014
Paid By: HARRY'S FINE FOODS NO. 1
Pay Method: CHECK 9552
Printed: Tuesday, November 25, 2014 1:00 PM 1 of 1
CIPSYSTEMS
DLL/•-036—r
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206) 431-3
Permit Inspection Request Line (206) 438-9350
INSPECTION RECORD
Retain a copy with permit
Project: "Type
of Inspection:
Address:
12-1401A L42.AoC
Dl to Called:
Special Instructions:
Date Warned:
Al4
km.12ie3
0rn5
Requester:
`
Phone No:
Approved per applicable codes. � Corrections required prior to approval.
COMMENTS: IZ,c1 roc- RP .1.7OVe (1
't_4 Cp F AA F(Sc a r
+
.Z.)
tf r en, -k ( 4-vv1 Q if -le 1-1 rJ AL,—
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/ , f.
/ j
gsAf57s 5 hep'Y-7r-roi(:If
g-. e fr rf ?I'eV'iefOc/
1
N.
REINSFECTION FEE REQl1IFED. Prior 6 next inspection, fee must be
paid at/6300 Southcenter Blvd.) Suite 1p0. 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) 438-9350
Dig-6367
Project:
iJ 70-1,0 Li
Type of Inspection:
F--/ Aift i
Address: 4 142., /lop c
Date Called:
Special Instructions;
Date Wanted:
( 2_122 Iv
a.m.
Requester:
Phone No:
92, —
LJApproved per applicable codes.
Corrections required prior to approval.
COMMENTS:
,
1 ) r) / r' Z-1,0-I
Ze A 7 A 6, - AcE.tis -(0 13,
13( '17 ett'cl
Itnspec
r -
----LEINOECTION FEE REQ'bIRED. Prior to next inspection. fee must be
paid,at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
Date:
NORTHWEST
200993-0
30620 Pacific Hwy S, # 103,
Federal Way, WA 98003
(253) 941-4343
Attn: Leroy Red,
Enclosed please find the analytical report for one or more samples submitted for analysis by
Polarized Light Microscopy.
The samples were analyzed in accordance with EPA method 600/R 93/116 and 600/M4-82-020.
The analyst used a stereomicroscope to visually inspect the sample to determine homogeneity
and material descriptions. The sample was then viewed under the polarized light microscope to
determine the presence and percentage of asbestos and non -asbestos fibers.
The limit of detection for PLM 600/R-93/116 is approximately 1%. The EPA recommends that
samples found to have asbestos percentages I%-10% be point counted to acquire a more accurate
percentage. We provide 400 point counts and 1000 point counts. The limits of detection are
0.25% and 0.10% respectively.
After analysis is complete, all paperwork will be filed together, and kept in a secure locked filing
cabinet away from other clients and laboratory staff. Asbestos Northwest ensures that the files
will not be tampered with at any time, and will be removed from the filing cabinet only if the
client requests a modification on the report or re -analysis. If you have any concerns or
comments, feel free to contact Asbestos Northwest.
Thank you,
eut°4
RECEIVED
CITY OF TUKWILA
DEC 03 2014
PERMIT CENTER
-These results are only applicable to the samples enclosed, and may not be reproduced, except in
full, without the approval of the laboratory. This report may not be used to claim product
endorsement by NVLAP, NIST, or any other agency.-
NORTHWEST
30620 Pacific Hwy S. #103, Federal Way, WA 98003
(253) 941-4343 NVLAP #: 200993-0
Bulk Samples Chain of Custody (EPA 6OO/R-93/116)
Company Name:
Address: i "
Phone #: S
Project Man
Project Location:Number of Samples: a �rQ
Batch #:
.4- it i S Date: 2- -, Z
c/o
2Hi
Asbestos NW
PM Email /.T, �s !OS 2
PM Cel l#: 4
Project4: l gec ?i
Turn around time:
•
#
Customer Sample ID
Description
Location/Condition •
1
2
.
3
C-4
6
'
g
-
9
-10
11
12
•
13
.
14
-
15
16
17
18
'pee v 7 c'? yes
4)45 0 o „0AA
19
. —
20
21
22
23
24
'
25
* Client will be notified if subcontracting is required
Print S
C
Sampled by:
_
Relinquished by:
.
Delivered by:
r 2 -2
_/ `f Z,: C
Accepted by:
I
Y
et-- tt __
(
2: 0
Analyzed by:
r'
Reviewed by:
ASBESTOS
NORTHWEST
Asbestos Northwest, LLC
30620 Pacific Hwy S. #103, Federal Way, WA 98003
Ph: (253) 941-4343 Fax: (253) 941-4175
200993-0
Batch Number: 201410828
PLM Analysis by EPA Method 600/M4-82-020 and 600/R-93/116
Attn: CS Harris
12404 42nd Ave S
Project: 12404 42nd Ave S
Date Received: 12/2/2014
Date Analyzed: 12/2/2014
Samples Received: 1
Samples Analyzed: 1
Client Sample
ID
Lab Sample ID
Layer
Description
Matrix
°A Non -Asbestos
Fibers
% Asbestos
Fibers
1
Brown fibrous material
with paint
Filler. Paint
90% Cellulose
None Detected
Black asphaltic material
Asphalt/binder
7% Cellulose
None Detected
Analyzed"- v: (Dan Lafle,'�
Page I of 1 Reviewed By: Cathy Butler
Date:
AUTHORIZATION FOR ALTERNATE PLAN
SUBMITTAL (LIMITED SCOPE OF WORK)
IBC & IRC Section 104.1
1 f -2S-I�
Address:
l 24 04 zi'L k_
Permit/Application Number: D it4 -.D5/1
Tukwila, WA 981
Description of Work: (J A S-ru L f dice_( 6 <
glo—
w �/'t� l 1-e - 0--obiA vv«
The above project permit applicant, due to the limited scope of work, is authorized to submit reduced plan
requirements described below:
1. Complete permit application(s):
Building ❑ Mechanical ❑ Plumbing/Gas Piping
2. Plan and/or Specification (minimum):
suratiecr TO
MELD IR9SP[ cy" rock,
Electrical ❑ Other
❑ Site Plan ❑ Floor Plan n Elevations ❑ Foundation ❑ Structural Calcs
❑ Cross Sections ❑ Roof Plan ❑ Narrative n Narrative WSEC Compliance
3. Required Inspections (only completed when to be issued over the counter):
❑ Framing ❑ Glazing ❑ Final ❑ Other: fFl,U#L-
4. Other Special Instructions:
110--U-e t� _�f` e A - ye 6 1!u (
Authorized By:f Date: ( —Z 114
(Authorization void 30 days after date)
Printed Name:
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 431-3670 • Fax: 206 431-3665
W:\Permit Center\Templates\Forms\Auth for Reduced Plan Submittal.docx
ef:H Dy7,D
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Web site: http://www.TukwilaWA.gov
REVISION
SUBMITTAL
Revision submittals must be submitted in person at the Permit Center.
Revisions will not be accepted through the mail, fax, etc.
Date: Plan Check/Permit Number:
‘Nw-a3i0 �
❑ Response to Incomplete Letter #
❑ Response to Correction Letter #
( Revision # after Permit is Issued
— Revision requested by a City Building Inspector or Plans Examiner
Project Name: 4\'Pv -Th tm
Project Address: 1A-L{02-1 .4vC S
Contact Person: Vi I -la �2 % Phone Number: 2 5- 3- g S 2— 7 ZY9
Summary of Revision:
y
i--At,D �1 e. M t `r LL S .dAe k `-r--) R -4 0 STru L2 cs1 NC
vik/D Kt- ( 5 V s? ed\c -ed. S 7,rr741 , .4-U(
CITY OF TUKWILA
PERMIT CENTER
Sheet Number(s):
"Cloud" or highlight all areas of revision including date o revisio
Received at the City of Tukwila Permit Center by:
0--- Entered in TRAKiT on (2
LEROY RED ROOFING
Page 1 of 2
Washington State Department of
Labor & industries
LEROY RED ROOFING
Owner or tradesperson
RED, LEROY
Principals
RED, LEROY, OWNER
Doing business as
LEROY RED ROOFING
WA UBI No.
602 952 767
903 30th Ave
SEATTLE, WA98122
206-898-6841
KING County
Business type
Individual
License
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor
License specialties
ROOFING
License no.
LEROYRR897JH
Effective — expiration
04/08/2011— 09/09/2016
Bond
American Contractors Indem CO
Bond account no.
100250968
Suspended.
Does not meet L&I licensing requirements.
Suspend date
11/05/2014
$6,000.00
Received by L&I Effective date
09/09/2014 09/09/2014
Cancelation date
11/25/2014
Bond history
Insurance
No current insurance account. See the insurance history.
Insurance history
Savings
No savings accounts during the previous 6 year period.
Lawsuits against the bond or savings
No lawsuits against the bond or savings accounts during the previous 6 year period.
L&I Tax debts
No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602952767&LIC=LEROYRR897JH&SAW= 11/25/2014