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Home My WebLink AboutPermit PG15-0035 - SHEGER ARADA GROCERY - DUMP AND HANDWASH SINKSThis record contains information which is exempt from public disclosure pursuant to the Washington State Public Records Act, Chapter 42.56 RCW as identified on the Digital Records Exemption Log shown below. PG 15-0035 SHEGER ARADA GROCERY 14645 TUKWILA INTERNATIONAL BOULEVARD RECORDSDIGITAL D-) EXEMPTION LOG THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION Page # Coda Exemption, � � � I3ri6f Explanatory 6escrlofion, Sfatutte/Ruilo The Privacy Act of 1974 evinces Congress' intent that social security numbers are a private concern. As such, individuals' social security Personal Information — numbers are redacted to protect those Social Security Numbers individuals' privacy pursuant to 5 U.S.C. sec. 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. 552(a), and are also exempt from disclosure 552(a); RCW 552(a); RCW under section 42.56.070(1) of the Washington 42.56.070(1) 42.56.070(1) State Public Records Act, which exempts under the PRA records or information exempt or prohibited from disclosure under any other statute. Redactions contain Credit card numbers, debit card numbers, electronic check numbers, credit Personal Information — expiration dates, or bank or other financial RCW DR2 Financial Information — account numbers, which are exempt from 42.56.230(5) RCW 42.56.230(4 5) disclosure pursuant to RCW 42.56.230(5), except when disclosure is expressly required by or governed by other law. Personal Information — Redactions contain information used to prove RCW 19 DR3 Driver's License. — RCW identity, age, residential address, social security 42.56.230 (7a 42.56.230 number or other personal information required to & c) (7a & c) apply for a driver's license or identicard. Redacted content contains a communication between client and attorney for the purpose of obtaining or providing legal advice exempt from RCW Attorney -Client Privilege — disclosure pursuant to RCW 5.60.060(2)(a), 5.60.060(2)(a); DR4 RCW 5.60.060(2)(a); RCW which protects attorney -client privileged RCW 42.56.070(1) communications, and RCW 42.56.070(1), which 42.56.070(1) protects, under the PRA, information exempt or prohibited from disclosure under another statute. SHEGER ARADA GROCERY 14645 TUKWILA INT'L BLUR PG15-0035 - 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 PLUMBING/GAS PIPING PERMIT Parcel No: 0040000865 Permit Number: PG15-0035 Address: 14645 TUKWILA INTERNATIONAL Issue Date: 4/6/2015 BLVD Permit Expires On: 10/3/2015 Project Name: SHEGER ARADA GROCERY Owner: Name: OBRIEN TIMOTHY M Address: 14217 59TH AVE S , TUKWILA, WA, 98188 Contact Person: Name: REDIAT SALVE Address: 5144S HAZEL ST, SEATTLE, WA, 98178 Contractor: Name: EMERALD CITY PLUMBING & MECHAN Address: 5144 S HAZEL ST , SEATTLE, WA, 98178 License No: EMERACP871QH Lender: Name: Address: DESCRIPTION OF WORK: INSTALL (1) DUMP SINK AND (1) HAND WASH SINK Phone: (206) 856-8191 Phone: Expiration Date: Valuation of Work: $1,350.00 Fees Collected: $144.96 Water District: 125 Sewer District: VALLEY VIEW SEWER SERVICE Current Codes adopted by the City of Tukwila: International Building Code Edition: 2012 National Electrical Code: 2014 International Residential Code Edition: 2012 WA Cities Electrical Code: 2014 International Mechanical Code Edition: 2012 WAC 296-466: 2014 Uniform Plumbing Code Edition: 2012 WA State Energy Code: 2012 International Fuel Gas Code: 2012 Permit Center Authorized Signature: Date: / S 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 permit and agree to the conditions attached to this permit. Signature. ( tt Date: r Print Name: 4k-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: ***PLUMBING/GAS PIPING PERMIT CONDITIONS*** 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. S: 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. 13: The applicant agrees that he or she will hire a licensed plumber to perform the work outlined in this permit. 14: All new plumbing fixtures installed in new construction and all remodeling involving replacement of plumbing fixtures in all residential, hotel, motel, school, industrial, commercial use or other occupancies that use significant quantities of water shall comply with Washington States Water Efficiency ad Conservation Standards in accordance with RCW 19,27.170 and the 2006 Uniform Plumbing Code Section 402 of Washington State Amendments PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 8004 GROUNDWORK 1900 PLUMBING FINAL 8005 ROUGH -IN PLUMBING CITY OF TUKW r Community Development Department Permit Center _0 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukAilaWA.Rov SITE LOCATION Site Address:_ Tenant Name: Plumbing/Gas ?ermit No. Project No. Date Application Accepted: 17 I C� Date Application Expires: � -[ �7 (For office use onl 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" �King Co sessor's Tax No.: �1 �t " ` ALTsuite Number: Floor: Pry New Tenant: ❑..... Yes �No PROPERTY OWNER Name: Address: City: State: Zip: CONTACT PERSON — person receiving all project communication \ Name: - Address: CityS State- Zip- Phone - Fax: Email• 1 PLUMBING CONTRACTOR INFORMATION Company Name; - Address:. ak City: State:14- Zipm i -ty Phone: S`6 ' Fax: C ntr Reg No.:� xp Date: / 0716 Tukwila Business License No.: /K 04- Valuation of Project (contractor's bid price): $ 50 Scope of Work (pleAse provide detailed information):- 5 E`(�(i( �� S.•`w Building Use (per lnt'l Building Code): Occupancy (per Int'l Building Code): Utility Purveyor: Water: Sewer: za H:Wpplications\Forms-Applications On Line\2011 Applications\Plumbing Permit Application Revised 8-9-1 I.docx Revised: August2011 bh Page 1 of 2 Indicate type of plumbing fixtures and/( s piping outlets being installed and the quant elow: Fixture Type Qty Bathtub or combination bath/shower Dishwasher, domestic with independent drain Shower, single head trap Sinks Z Rain water system — per drain (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 in 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 mm) diameter or smaller Atmospheric -type vacuum breakers not included in lawn sprinkler backflow protections over 5 PERMIT APPLICATION NOTES - 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 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). 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 AUTHORIZED AGENT: Signature: QQ Date: Print Name: k.0_ U IJ C ,SG �� DayTelephone: 26 G - 3 Mailing Address: 5-1 1�c"E4 te vi-t- -1Y1 t City State Zip H:Wpplications\Forms-Applications On Line\2011 Applications\Plumbing Permit Application Revised 5-9-11.docx Revised: August 2011 Page 2 of 2 bh DESCRIPTIONS ACCOUNTQUANTITY PermitTRAK PAID $117.08 PG15-0035 Address: 14645 TUKWILA INTERNATIONAL BLVD Apn: 0040000865 $117.08 PLUMBING $111.50 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $32.50 PERMIT FEE R000.322.100.00.00 0.00 $79.00 TECHNOLOGY FEE $5.58 TECHNOLOGY FEE R000.322.900.04.00 •R4987 0.00 $5.58 1: Date Paid: Monday, April 06, 2015 Paid By: REDIAT SALVE Pay Method: CREDIT CARD 060329 Printed: Monday, April 06, 2015 2:03 PM 1 of 1 SYSTEMS Date Paid: Tuesday, March 17, 2015 Paid By: H & R BLOCK CLIENT Pay Method: CREDIT CARD 020713 Printed: Tuesday, March 17, 2015 10:08 AM 1 of 1 CR? SYSTEMS INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 5otithcenter Blvd,, #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Prect: , Typ4qf Insog on, 510"ei- I'T AA Add' s Date Called! IIVY T-A -r?At Special Instructions. Date Wanted- a.m. S-- (y- -5--- p.m.R—equesker- h one No: 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 INSIRMON NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 5outhcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 436-9350 Project- TV -De -of Inspec,tion. AtItiress, I �r -F,&t [special :kd (ile ate CaIW�- P Instructions. Date wante& 4 a.m. p.rn, Requester: P one No,. Inspector: I Date: REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. _1enL K INSPECTION RECORD Retain a copy with permit TI I C TION tM PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd,, #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 .5 he, *j- Aivd A Type Inspection, ov-C�U�u Addr, . ( 6 U 1-f Lr— I to Called: Special Instructions: Date Wjnje( a.m. 11 - p.m. Requester' REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. City of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director March 24, 2015 REDIAT SALVE 5144S HAZEL ST SEATTLE, WA 98178 RE: Correction Letter # 1 PLUMBING/GAS PIPING Permit Application Number PG15-0035 SHEGER ARADA GROCERY - 14645 TUKWILA INTERNATIONAL BL Dear REDIAT SALVE, This letter is to inform you of corrections that must be addressed before your development permit can be approved. All correction requests from each department must be addressed at the same time and reflected on your drawings. I have enclosed comments from the following departments: BUILDING - PG DEPARTMENT: Allen Johannessen at 206-433-7163 if you have questions regarding these comments. • (GENERAL NOTE) PLAN SUBMITTALS: (Min. size l 1x17 to maximum size of 2406; all sheets shall be the same size. New revised plan sheets shall be the same size sheets as those previously submitted.) (If applicable) All Structural Drawings and structural calculations sheets to be stamped (original signed wet stamp, not copied) by Washington State licensed architect; structural engineer or civil engineer. (BUILDING REVIEW NOTES) 1. Previously a plumbing permit PG12-132 for rough in plumbing with waste, a three compartment sink and grease interceptor was completed with final inspection. Then a building permit application D14-0057 submitted for this building for a restaurant TI was submitted and has expired. The plan provided for this plumbing permit is quite vague and does not accurately represent the actual plan of the building nor the previous permit plans from previous permits. Since this permit is a not consistent with previous permit applications, some additional information shall be necessary to provide clarity for this permit in order to proceed with this plumbing permit. Provide an explanation for the expiring of previous permit D14-0057. Was any of that work done as indicated on the previous building permit plan or has the TI plan changed or will it be eliminated? Where will the new proposed plumbing fixtures be located in the building to include any alterations of the interior? The plans shall be clear and accurately drawn with all fixtures specified. Sizes of all plumbing drain waste and vent with supply pipes shall clearly show where all connections shall tie into the existing plumbing system. Plumbing plans shall show plan view and isometric illustration drawings of the new proposed plumbing system. Existing plumbing including new proposed plumbing and fixtures in the building shall be clearly identified on the floor plan with location of each plumbing fixture. 2. If the proposed plumbing for this permit is related to proposed work on the previous permit D14-0057, a new building permit application shall also be required. Any alteration to the building for installation of new plumbing system and fixtures shall require a building permit. Please provide revised plans and notes with clarity to all items in question listed above. Please address the comments above in an itemized format with applicable revised plans, specifications, and/or other documentation. The City requires that two (2) sets of revised plan pages, specifications and/or other documentation be resubmitted with the appropriate revision block. Hann c.....1...,---- D—I.... ..4 c..:.- 41nn T1,1-1'--.-- n4144 m Dl,.. - 'In.< A? 1 24In In order to better expedite your resubmittal, a 'Revision Submittal Sheet' must accompany every resubmittal. I have enclosed one for your convenience. Corrections/revisions must be made in person and will not be accepted through the mail or by a messenger service. If you have any questions, I can be reached at 206-431-3670 . Sincerely, Megan Par ons Permit Tee nici File No. PG15-0035 ,<ann a,....G------ i? ..1 .. 1 a..:.- 41nn - T..1 ..:1 IV--1:..,.—. 00190 - O7 .. 71)4 42 7 947n - El_.. In-1 A-17 s,<4c PERMIT COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: PG15-0035 DATE: 03/31/15 PROJECT NAME: SHEGER ARADA GROCERY SITE ADDRESS: 14645 TUKWILA INTERNATIONAL BLVD Original Plan Submittal X Response to Correction Letter # 1 DEPARTMENTS: N� - pNWL - Building Division Fire Prevention Public Works ❑ Structural PRELIMINARY REVIEW: Not Applicable ❑ (no approval/review required) REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Approved ❑ Corrections Required ❑ (corrections entered in Reviews) Notation: REVIEWER'S INITIALS: Revision # before Permit Issued Revision # after Permit Issued ❑ Planning Division ❑ ❑ Permit Coordinator a DATE: 04/02/15 Structural Review Required ❑ DATE: DUE DATE: 04/30/15 Approved with Conditions Denied ❑ (ie: Zoning Issues) Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ DATE: `q' H Staff Initials: 12/18/2013 PERMIT COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: PG15-0035 DATE: 03/17/15 PROJECT NAME: SHEGER ARADA GROCERY SITE ADDRESS: 14645 TUKWILA INTERNATIONAL BLVD X Original Plan Submittal Response to Correction Letter # DEPARTMENTS: Revision # before Permit Issued Revision # after Permit Issued COW 3'Z`�'(/ BuiNding Division Fire Prevention ❑ � J6 46", Public Works Structural ❑ PRELIMINARY REVIEW: Not Applicable ❑ (no approval/review required) REVIEWER'S .INITIALS: APPROVALS OR CORRECTIONS: Approved ❑ Corrections Required (corrections entered in Reviews) Notation: REVIEWER'S INITIALS: Planning Division ❑ Permit Coordinator 0 DATE: 03/19/15 Structural Review Required ❑ DATE: DUE DATE: 04/16/15 Approved with Conditions ❑ Denied ❑ (ie: Zoning Issues) DATE: Perinit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg N Fire ❑ Ping ❑ PW ❑ Staff Initials: 12/18/2013 City of Tukwila Department of Community Devel 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Web site: http://www.Tukwi]aWA.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 ChecldPermit Number: PG15-0035 ❑ Response to Incomplete Letter # ® Response to Correction Letter # 1. ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: SHEGER ARADA GROCERY Project Address: 14645 rTUKWILA INTERNATIONAL BLVD . Contact Person: Phone Number: 2 V , ;? 'T Summary of Revision: "CIF TUKWRA MAR 312015 PERA!11T C E1t TES Sheet Number(s): "Cloud" or highlight all areas of revision including date o revisio Received at the City of Tukwila.Permit Center by: W-- Entered in TRAKiT on 31 `6 ( - i T W:\Permit Centcr\Tcmplatcs\F'orms\Rcvision Submittal Pormt.doc Revised: March 2014 4/2/2015 Emerald City Plumbing & Mech 111110011111116 Washington State Department of Labor & Industries Emerald City Plumbing & Mech Horns: Inicincu I?.I.Tuuu>I contti+'� iSearCh L&I f A-L Indea help 'Mv Secure .L&I Safety Claims & Insurance 01orkpiace Rights Trades & Licensing Owner or tradesperson 11238 Renton Ave S Sahle, Rediat G SEATTLE, WA 98178 206-856-8191 Principals KING County Sahle, Rediat G, PARTNER/MEMBER Doing business as WA UBI No. Business type 603 225 705 Limited Liability Company Governing persons REDIAT SAHLE License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor Active. .......................................................................... Meets current requirements. License specialties PLUMBING License no. EMERACP871 QH Effective — expiration 11/08/2013— 11/08/2015 Bond ..._........... Wesco Insurance Co $6,000.00 Bond account no. 46wb37992 Received by L&I Effective di 11/08/2013 11/07/2013 Expiration aate Until Canceled Insurance ............................... Security National Insurance $1,000,000.00 Policy no. NA107033401 Received by L&I Effective date 11/06/2014 11/07/2014 Expiration date 11/07/2015 Insurance history Savings ................... No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against 1.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 https:/Isecure.Ini.wa.gov/verify/Detai I.aspx?U BI=603225705&LIC=EM ERAC P871 QH &SAW=False 1/2 Credit Card Receipt 2015 Outside Contractor - Business License Application Finance Department 1 Date Time: 04/06/2015 13:46:PM CARD NBR: **** **** **** 5002 AMOUNT: $67.00 AUTH#: 054631 PAYFILE/COST: 1509601-1/25 loff FILL OU7 THIS FORM IN ITS ENTIRETY INCOMPLETEAPPLICATIONS WILL NOT BE PROCESSED OI, uf,'t 1, i c, r_ ii(ense to conduct business, OR tc conducting business. ALL LICENSES EXPIRE DECEMBER 31 me Change ❑ Address Change ❑ Usage Change ❑ UBI # Change SIGN: _ ---- % Mailing Address (if different than business address) r1 / Address Suite # **************CUSTOMER COPY************* ,ST www.tukwilawa.gov 206-433-1835 rite# City 'ZIP Corporate Email Corporate Phone # Email i �� 'Bus Phone # Are you a Utility Company 'xx--vt�� Ownership Status /�t.v l p ❑Individual/ Sole Proprietor El Corporation `No ❑ Yes, if yes specify type: f 1d ❑ Partnership ❑ Non -Profit 501C3 ❑ Governmen c Duration of Work here in the City: WA STATE Contractor's License # WA STATE UBI # REQUIRED TemporaryJob/Work: ❑ No ❑ Yes (Example�:Contractor) WliiC4��Li I Regular Work/Service provided: ❑ No /0 Yes Service Provider � (Example: ) (required if ontractor) /`;�?,r..}:•L..-ICi�-r-i,.r j Z 7c)3 Description of Business (in detail, list services and/or type of products sold or stored) REQUI Planning & Building Information Are you presently doing any installation of New Signage or Changes to existing signage, including copy changes? ❑ No ❑ Yes If yes, you mu- t complete the City of Tukwila Sip,n Affidavi' stat:n: fh c •ou have reed and under, Land Tf: C-Title 19 S:rn Cod: List all • •needed) Name 1: Title: Driver's License # REQ Issuing State �+ 1- Address City, ST & ZIP Phone: Work / Cell / Home Date of Birth REQ 5174 Name 2: Title: Driver's License # Issuing State Home Address City; ST & ZIP Phone: Work / Cell / Home - Date of Birth 'Business License Fee Licenses are valid JANUARY 1- DECEMBER 31 (Licenses are not pro -rated.) l A. Total Number of Hours worked in Tukwila by Owners, Managers & Employees, Jan - Dec. • One Full -Time Equivalent (FTE) Employee = 1,920 hours (per WA State Dept. of Labor & Industries) • Report only those hours worked in Tukwila, • Report all hours worked for each job in Tukwila, this would include on -site, planning, office hours worked etc. B. Multiply line "A" by $0.34896 (If less than $67, pay $67 minimum) C. Business License Fee, enter amount from line "B". Please make checks payable to "City of Tukwila" (All fees paid are non-refundable.) I certify the information contained herein is correct. I understand that any untrue statement is cause for revocation of my license. Print Name 'Title/Position Signature._ CJTkclt Acine Number FINANCE USE ONLY Received by: Customer #: / Activity #: P+• i, yi r-1 0 "o N) =1 i- to Ifl � ct•, 0 0 f�l h_ u