HomeMy WebLinkAboutPermit D17-0169 - WINKLER RESIDENCE - POWDER BATHROOMWINKLER RESIDENCE
15909 48 AVE S
017-0169
Parcel No:
Address:
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
2223049016 Permit Number:
15909 48TH AVE S
Project Name: WINKLER RESIDENCE
Issue Date:
Permit Expires On:
D17-0169
8/17/2017
2/13/2018
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Contractor:
Name:
Address:
License No:
Lender:
Name:
Address:
WINKLER DAVID V
15909 48TH AVE S , TUKWILA, WA,
98188
MARGO CLINTON
22211 MARINE VIEW DR S , DES
MOINES, WA, 98198
POWELL RENOVATIONS LLC
22211 MARINE VIEW DR, DES
MOINES, WA, 98198
POWELRL939PE
DAVID WINKLER
15909 48 AVE S , TUKWILA, WA, 98188
Phone: (206) 718-1092
Phone: (206) 824-8001
Expiration Date: 10/5/2017
DESCRIPTION OF WORK:
ADDITION OF A POWDER BATH TO HOUSE
Project Valuation: $5,260.08
Type of Fire Protection:
Sprinklers:
Fire Alarm:
Type of Construction: VB
Electrical Service Provided by: TUKWILA
Fees Collected: $375.92
Occupancy per IBC: R-3
Water District: HIGHLINE
Sewer District: NONE
Current Codes adopted by the City of Tukwila:
International Building Code Edition:
International Residential Code Edition:
International Mechanical Code Edition:
Uniform Plumbing Code Edition:
International Fuel Gas Code:
2015
2015
2015
2015
2015
National Electrical Code:
WA Cities Electrical Code:
WAC 296-46B:
WA State Energy Code:
2014
2014
2014
2015
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: lJ �`t
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:
Print Name:
v(-1,vlt2714
Date: Oh/ 17
This permit shall becomnull 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: There shall be no occupancy of a building until final inspection has been completed and approved by
Tukwila building inspector. No exception.
6: 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.
7: 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.
8: 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).
9: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila
Permit Center.
10: Preparation before concrete placement: Water shall be removed from place of deposit before concrete is
placed unless a tremie is to be used or unless otherwise permitted by the building official. All debris and ice
shall be removed from spaces to be occupied by concrete.
11: 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.
12: Temporary erosion control measures shall be implemented as the first order of business to prevent
sedimentation off-site or into existing drainage facilities.
13: The site shall have permanent erosion control measures in place as soon as possible after final grading has
been completed and prior to the Final Inspection.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
0301 CONCRETE SLAB
0201 FOOTING
0409 FRAMING
0606 GLAZING
0603 ROOF/CEILING INSUL
4046 SI-EPDXY/EXP CONC
0602 SLAB/FLOOR INSUL
0601 WALL INSULATION
0413 WALL SHEATHING/SHEAR
CITY OF TUK, LA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.e.m
Building Peri1iit No. S
Project No.
Date Application Accepted: ‘)-� ` 1 7
e
Date Application Expires:
(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
Site Address: 01 O'i -1 `?j AV.c,
Tenant Name:
King Co Assessor's Tax No.: 222. D (p
Suite Number:
PROPERTY OWNER
Name: M!1 veto (il i v1 I -i v1
Address: ZZZII mA.VIvi,CVlLtA) 17v 6
Name: upkv I A VV 1 vl IL LC V
Phone: (Lo 00) --I 1 g -lo`1Z Fax: -
Email: wit ol v/i10 0 Po.t)-Z61 - N WVi25 Lo -/o
Address: I cA
Address:
City: � 11 v ku 1 11 State: kiU A
City: -rU, ILvtJ 1 IA State:
W A
Zip:1 ° t Cg3°
CONTACT PERSON - person receiving all project
communication
Name: M!1 veto (il i v1 I -i v1
Address: ZZZII mA.VIvi,CVlLtA) 17v 6
City: 04i, v V 1 vtQ , State: \A 4 Zip: %6 lt,i r6
Phone: (Lo 00) --I 1 g -lo`1Z Fax: -
Email: wit ol v/i10 0 Po.t)-Z61 - N WVi25 Lo -/o
GENERAL CONTRACTOR INFORMATION
Company Name: PO W -LI I /2.evi, 0va-I'i l7 -Vi S
Address: 2_7211 t\/ia.v i vt,Q. V 1 e ) Pv S
City: 12.t. Mvi vu, c, State: WA Zip: °;til .it5
Phone: (Zoip)1 lb _ IDeiz Fax: —
Contr Reg No.: row 6WzLpltt, i -Exp Date: 10(2 017
.,
Tukwila Business License No.: gkjc, 011,11 1,117 (. Z
H:AApplications\Forms-Applications On Line \2011 Applications VPermit Application Revised - 8-9-1 Ldocx
Revised_ August 2011
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Floor:
New Tenant: ❑ Yes ❑..No
ARCHITECT OF RECORD Ki 1A
IA
Company Name:
Company Name:
Architect Name:
Address: (1;. ,`i i 4/1 A V:, c:?
Engineer Name:
Address:
City: � 11 v ku 1 11 State: kiU A
Address:
City:
State:
Zip:
Phone:
Fax:
Phone:
Email:
Email:
ENGINEER OF RECORD
IA
Name: j flit (. V 1 t (ili I L 1 tl. V
l
Company Name:
Address: (1;. ,`i i 4/1 A V:, c:?
Engineer Name:
City: � 11 v ku 1 11 State: kiU A
Address:
±u.
City:
State:
Zip:
Phone:
Fax:
Email:
LENDER/BOND ISSUED (required for projects $5,000 or
greater per RCW 19.27.095) 1,1/A
Name: j flit (. V 1 t (ili I L 1 tl. V
l
Address: (1;. ,`i i 4/1 A V:, c:?
City: � 11 v ku 1 11 State: kiU A
Zip E
±u.
Page 1 of 4
BUILDING PERMIT INFORMATIO: 206-431-3670
Valuation of Project (contractor's bid price): $ 3
Describe the scope of work (please provide detailed information):
U1 .C,V1DG1.,ti/l
Will there be new rack storage? ❑ Yes
Existing Building Valuation: S 810, 000
Nr.. No If yes, a separate permit and plan submittal will be required.
Provide AH 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) _Ili
*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:
Wi11 there be a change in use? ❑ Yes
igj No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0 Sprinklers 0 Automatic Fire Alarm N. None
0 Other (specify)
Wi11 there be storage or use of flammable, combustible or hazardous materials in the building? 0 Yes ® No
11 '}'es'. attach list of materials and storage locations on a separate 8-1/2"x 11 "paper including quantities and Material Sakti' 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:'.Applications,}orm>-Application. On LincA2011 Applications Permit Application RCN ised - 11.docx
RCN iscd: 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
1' Floor
4310
N/A-
AZ
4112_
2"d Floor
1' ^^ O
3`d Floor
NIA
-
-
Floors thru
N //4'
—
Basement
1.1/A
Accessory Structure*
/A
Attached Garage
N IA
-
Detached Garage
ZZ
—
Attached Carport
(A
-
-
Detached Carport
N /A
Covered Deck
3 0
-
N I. A,
-
Uncovered Deck
IA
_
-
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) _Ili
*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:
Wi11 there be a change in use? ❑ Yes
igj No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0 Sprinklers 0 Automatic Fire Alarm N. None
0 Other (specify)
Wi11 there be storage or use of flammable, combustible or hazardous materials in the building? 0 Yes ® No
11 '}'es'. attach list of materials and storage locations on a separate 8-1/2"x 11 "paper including quantities and Material Sakti' 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:'.Applications,}orm>-Application. On LincA2011 Applications Permit Application RCN ised - 11.docx
RCN iscd: August 2011
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Page 2 of 4
PUBLIC WORKS PERMIT INFO :ATION — 206-433-0179 N
Scope of Work (please provide detailed information): N 1A
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 Usc Certificate
�] .. Highlinc
❑ ...Valley View ❑ .. Renton
...Sewer Availability Provided N
❑ .. Renton
❑ .. Seattle
Septic System:
Eh 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
0 ...Right-of-way Use - No Disturbance
0 ...Construction/Excavation/Fill - Right-of-way 0
Non Right-of-way 0
0 ...Total Cut
0 ...Total Fill
cubic yards
cubic yards
0 ...Sanitary Side Sewer
0 ...Cap or Remove Utilities
0 ...Frontage Improvements
0 ...Traffic Control
❑ ...Backflow Prevention - Fire Protection
Irrigation
Domestic Water
0 ...Permanent Water Meter Size...
❑ ...Temporary Water Meter Size ..
0 ...Water Only Meter Size
❑...Traffic Impact Analysis
0 ... Hold Harmless — (SAO)
0 ...Hold Harmless — (ROW)
❑ .. Right-of-way Use - Profit for less than 72 hours
0 .. Right-of-way Use — Potential Disturbance
0 .. Work in Flood Zone
0 .. Storm Drainage
❑ .. Abandon Septic Tank
0 .. Curb Cut
0 .. Pavement Cut
0 .. Looped Fire Line
WO#
wo
wo #
0 ...Sewer Main Extension Public 0 Private ❑
0 ...Water Main Extension Public
Private 0
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
0 .. Utility Undergrounding
❑...Deduct Water Meter Size
FINANCE INFORMATION
Fire Line Size at Property Line
0 ...Water 0 ...Sewer
Monthly Service Billing to:
Name:
Number of Public Fire Hydrant(s)
0 ...Sewage Treatment
Mailing Address:
Day Telephone:
Water Meter Refund/Billing:
Name:
Mailing Address:
City
Day Telephone:
State Zip
City
State Zip
H: Applications AForms-Applicatiots On Line. ;2011 Applicaiionsipermit Applicalion Revised - 8 -1-11.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).
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON. AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING O NER OR AUTHORIZED AGENT:
Signature: A ^
Print Name: ' v V AV
0 til 1 VI jTJ1/1
Mailing Address: Z22-1 1 M A v i tru_ V I e 1k) c7 v
H:`.ApplicalionsAForms-Applications On Linc 2(111 ApplicationsVPenni) Application Rcviscd - 8-0-11.docx
Rc�ivcd: August 2011
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Day Telephone:
Date: 4/1Z-1/0\
(2_01) 6 - I oolZ
nes . k,vIvLtc, Wo 1 sob
City Slate Zip
Page 4 of 4
DESCRIPTIONS
PermitTRAK
ACCOUNT
QUANTITY
PAID
$233.96
D17-0169 Address: 15909 48TH AVE S Apn: 2223049016
$233.96'
Credit Card Fee
$6.81
Credit Card Fee
R000.369.908.00.00
0.00
$6.81
DEVELOPMENT
$216.55
PERMIT FEE
R000.322.100.00.00
0.00
$212.05
WASHINGTON STATE SURCHARGE
B640.237.114
0.00
$4.50
TECHNOLOGY FEE
$10.60
TECHNOLOGY FEE
R000.322.900.04.00
0.00
$10.60
TOTAL FEES PAID BY RECEIPT: R12122
$233.96
Date Paid: Monday, August 14, 2017
Paid By: MARGO CLINTON
Pay Method: CREDIT CARD 214195
Printed: Monday, August 14, 2017 11:04 AM 1 of 1
Y
Cash Register Receipt
City of Tukwila
DESCRIPTIONS
PermitTRAK
ACCOUNT
QUANTITY
PAID
$141.96
D17-0169 Address: 15909 48TH AVE S
Apn: 2223049016
$141.96
Credit Card Fee
$4.13
Credit Card Fee
R000.369.908.00.00
0.00
$4.13
DEVELOPMENT
$137.83
PLAN CHECK FEE
TOTAL FEES PAID BY RECEIPT: R11780
R000.345.830.00.00
0.00
$137.83
$141.96
Date Paid: Thursday, June 22, 2017
Paid By: MARGO CLINTON
Pay Method: CREDIT CARD 112291
Printed: Thursday, June 22, 2017 9:19 AM 1 of 1
SYSTEMS
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
J
17 -u1(e of
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 438-9350
(206) 431-367
Project:
it) I N kL-R rZti <S,
Type of Inspection:
k3iO/ L- 0i NC Fi PIA (-
Address:
/3-" le. -:✓%`
/9
,S.',
Date Called:
Special Instructions:
(0 ( 3C )( F� /
Date Wanted: a.m..
i7-'0""/
—17
Requester:
Phone No:
`2 C) - ep q 3 --373(p
Approved per applicable codes. E] Corrections required prior to approval.
COMMENTS:
f7 Vt.
Inspector:
Date:
1 /S;/7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Di 7-01(o7
Project:
i /Mia/.A RgS°
Type of Inspection:
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:/4i Bi,), t.D/ NG_ rv1 L)Y 81-
Address:/fig; c--
/,5,41(--)91 7C 1 /1'l,4 .3,/
Date Called:
re
Special Instructions:
/34-71-t f t,1•fr ADD ,nvA,'
Date Wanted:/ 7
/z S.
a.m.
•
Requester:
Phone No:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
:/4i Bi,), t.D/ NG_ rv1 L)Y 81-
C'c'b .14/1. t4 r x'13
Inspector:
Date:
— -i�
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedute 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
Di7- 0/ 4.1
Project:
ivj Pt RLL R f ii S P/'L/CE
Type of Inspection:
t:3l11-1-L I NSVi-kTralj
Address:
/-5'90(1'4e-
Atm -5.
Date Called:
Special Instructions:
Date Wanted:
Al --3, / 7
�a_a:
p.m.
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
Uc - L 1 L- 770/ -/
6>K_ (fl i L. IN 3- ) 421-7
Inspector:
Date: 7
REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
C
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
Di7-caloq
Project:
Type of Inspection:
Address:c_.
/67w /id c --)j
Date Called:
Special Instructions:
Date Wanted:
/C' -3/
`/ / 7
Ca.m.
P.m.
Requester:
Phone No:
l+ J Approved per applicable codes. El Corrections required prior to approval.
COMMENTS:
6�— F -i vL1tN6
Inspector:
Date: 76-31-7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
ic%
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) 438-935C
7-7/47
Project:
Type of Inspection:
14.1/91•L S /77fi iif/.Y6>
Address:
/6/ AV4ti
Date Called:
Special Instructions:
Date Wanted:
/t)_../(E9-/7
a.m
p.m.
Requester:
Phone No:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
fM7v1/NE
Inspector:
Date:
/6 _/)ij
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
DI7-9
Project: ������
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Type /of Inspection:
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Address:f, ��
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Date Called:
Special Instructions:
Date Wanted: j ,
/C'/, / /
7
Requester:
Phone No:
]Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
/;7
4CC/ %3.
',,1-L-
/fir kr.' i N5 f'ec (7c/
Inspector:
Date:
/C-, 1;7./ 7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
pi? -c'/ '/
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 438-9350
(206) 431-3670
Proj//Vec ;
IJ/A)LLei
ehI .CII I
Type ofJ 4pection:
1�c."I hibtfc,-
Address:Date
1Ve:q W
'
ATI: --
Called:
Special Instructions:
Date Wanted:,
0 ? P 7
p.m.
Requester.
Phone No:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
C
Inspector:
Date:
,C> ...i37 7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Proj ct:
Ai Niq _CA., IC,tZJ /.) %°('/
Typ f Inspection--.
'
. h'rt> gid-•
Address:
159(X? t{& 71
L)=
Date Called:
Special Instr ctions:
Date Wanted:‘ii `�
`�
/
a.m.
p.
•
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
fG — C'=: ,.,E
Inspector:
Date:
r—Z2 ,!7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Di 7 - 0/6 '%
Proje t:
Type of Ins ection:
Address:
/.0 C169 yL' 71.AtrC S
Date Call d:
Special Instructions:
Date Wante :
22
17
Requeste
Phone No:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
51-A-6/ f-Lbc-e, L -A -T7 c />)
Inspector:
Date:
? /7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
INSPECTION NO.
INSPECTION RECORD
-0(7-6/dg 1
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) 438-9350
Project:
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T e of Inspection:
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Address:
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Date Called:
Date Wanted: 1
fel 2-
7
a.m.
Special Instructions:
Requester:
Phone No:
[] Approved per applicable codes. El Corrections required prior to approval.
COMMENTS:
� A `
/Ler/9-.ter .'spy/-in)L}L
Inspector:
Date
r-2/-, 7
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Project:
EU / 11,,:. i.r: 4 -a
Typrf Inspection:
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Called:
Address:Date
Special Instructions:
Date Wanted:
a.m.
p.m.
Requester:
Phone No:
2 Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspector:
.7
REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Btvd.. Suite 100. Call to schedule reinspection.
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Date: .Z411
City of Tukwila
BUILDING DIVISION
REVIE-ONIS
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HOMES & /RENOVATIONS
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Client Date
Siteaddress Job#
22211 Marine View Drive 5., Des Moines, WA 98198
www.powellrenovations.com
206.824.8001
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22211 Marine View Drive 5., Des Moines, WA 98198
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www.powellrenovations.com
206.824.8001
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Borrower WINKLER, DAVID
Select Appraisal Group, Inc.
SKETCH ADDENDUM File No. 16-0068
Case No. 9326924512
Property Address 15909 48th Ave S
City Tukwila County KING
Lender/Client FIRST TECH FEDEIRAL CREDIT UNION
State WA Zip Code 98188-2787
Address 3555 SW 153RD DR, BEAVERTON, OR 97003
r L
Bedroom m m Bedroom
Second Floor
Main Floor
Bedroom
Bedroom
Utility
Living Room
3 Car Garage
Master
Kitchen
Master \
Bedroom
Sun Room
Sketch by Apex Sketch v5 Standard,'
Comments:
5392,E 6
1772;00
922:`50
(rounded)
5392.63 First Floor
1772.00 8.0 x 55.0 440.00
922.50 45.0 x 21.0 945.00
65.0 x 0.5 32.50
5.0 x 48.5 242.50
8.0 x 42.5 340.00
0.5 x 2.5 x 2.5 3.13
6.0 x 75.5 453.00
3.5 x 72.0 252.00
31.0 x 37.0 1147.00
5.5 x 2,5 13.75
7.5 x 79.0 592.50
0.5 x 3.5 x 3.5 6.13
0.5 x 3.5 x 3.5 6.13
0.5 x 2.5 x 2.5 3.13
0.5 x 2.3 x 1.5 1.69
2.5 x 79.5 198.75
3.5 x 76.7 268.45
0.5 x 1.5 x 1.2 0.90
0.5 x 3.8 x 2.5 4.69
0.5 x 2.0 x 2.5 2.50
1 2210.90
7165 37 Items (rounded) 7165
UAD Version 9/2011 Produced by ClickFORMS Software 800-622-8727 Page 14 of 36
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Seattle & King County OM
PERMIT TO REPAIR ON-SITE SEWAGE SYSTEM
System Type
Owner Name
Bldg. Type
Parcel No
Location
Plat Name
Additonal info:
Other
HENDRIX JANIE L
Single Family
2223049016
15909 48TH AVE S
Const_ Type
Valid By
Lot Number
Permit No
Date Issued
Expires
R
EE0100094
(425)397-7771
ON0143059
01/23/2014
01/23/2016
Installer
HOETH, MICHAEL MI189
Designer: DAVIS,BRAD
5100253
1. The installer must perform all work in accordance with Title 13 (Board of Health Rules and Regulations i13)
2. Issuance of this permit does not constitute an approval of the site or work contemplated or performed.
3. OCCUPANCY OF THE BUILDING AND USE OF THE SEWAGE DISPOSAL SYSTEM ARE PROHIBITED
UNTIL AN AS -BUILT PLAN IS SUBMITTED TO AND APPROVED BY THE HEALTH DEPARTMENT.
Mound Sys.Site Prep
Mound Sys. Bed Prep
Pressure Test
-I 1 -
Designer
Designer
Designer,
Date
Date
Date
Do Not BACKFILL (Cover) system until BOTH Designer and Health Department `(E:A.S.) have approved (OK'd) to BACKFILL.
OK To Backfill
Designer
OK To Backfill
E.H.S.
Final Cover (Approved)
Designer
Corrections Required
oe-
Disapproved
Date
Date
Date
-i�j
ktfil
(See reverse side for more corrections)
I , (Master/Associate) Installer was present at the above property
Time Date
supervising placement of final cover.
I have complied with all the restrictions and recommendations as listed bythe system designer, and certify that either 1, or A Certified Installer
employed by me, was present AT ALL TIMES during the installation.
Name of Master Installer (please print) PI—YC, E - \-4 p > }-i
Signature of Master Installer
5105
Date `t -1— t y
OSS Performance Demonstration Report
AH systems are to be tested with permanent wiring and permanent
power. This form is to be included with the final As -built submission.
Fill out the following boxes according to system type:
Gravity 1, 2. 3, 9 Pump to Gravity 1.2, 3, 4, 9 PD 1,2,3,4.5,6,7. 8, 9
Mound 1,2.3.4, 5, 6, 7, 8, 9 Sand filter 1,2,3.4,5,6,7,8,9,10.11,12,13
Sand filter to Mound l . 2, 3.4, 5, 6, 7, 8, 9, 10, 1 I ,12 .13
1 System Type: Gravity PD Mound Sand Filter = SF/M. SF/PD, SF/Gravity
specify Q t
2 Permit Address 0S -c1 c\'- ¶S S
Installation Permit No. H C)14 03q
Parcel No. ZZ -z 3 ay ti o t
Designer
Installer tri: K e 1-t o e t%
Date system tested/inspected y-t-vy
3 Septic Tank: Size -f ,
Screened Outlet Baffle 0 Yes 0 No
i= -r . i s Atm
4 Pump Tank: Size i s o
Manufacturer Cu Z
Approval No.
Make and Model No.
Water tight Test Satisfactory Yes 0 No
Pump Chamber gals/inch 3 t
Manufacturer Lt) Z Approval No. CCP I-tso
Pump make/model /HP o ST Q zo ('/z 1-I pvoltage tz o
Water tight Test Satisfactory HcYes 0 No
5 Pump System Performance:
Dose Volume (gallons) 5-1.5-- Draw down per cycle (inches) 1.5
Doses per Day i Z Method: Residual Head Squirt Height ,=t out re. ij'
GPM discharge 4
Pump run time ner cycle (min) 1->
6 Timer:
Timed Dosing &Yes 0 No Control Panel make/model 9t1". -07v5 S r, D 1 i x
Time pump ON 9 min. a sec. Time pum s OFF 2 ‘' r s specify time increments
Timed dosing to (circle one) PD, Mound, SF. . i Doi c-.; �t c1
7 Lateral Diameter tori p
Orifice Size E ."; M r"
Orifice Spacing i 2 "
Orifice Orientation: N A,
Manifold Diam. I"
Check valves (manifold) 0 Yes allo
0 Yes [ No
0 Yes GdVo
0 Yes pc No
Flow control valves
Anti -siphon device
Orifice shields
Manifold Length
Monitoring ports in place Yc5
Lateral Clean -outs in place `+(5
Gravelless chambers 0 Yes QtNo
Alarm location ..: co ro,4-01 pa
4
8 System drains between cycles 0 Yes 0 No Variation in orifice discharge rate over entire system < 15% Yes No
ards on the design 0 Yes 0 No
._......-- r
Laterals
1
2
3
4
5
6
7
8
Lateral Length
Orifice Spacing
--�
_.L
(N.}
No. of Orifices
1✓ t 1
Residual Mead
As the Installer of record I have verified a
the site. Licensed Installers Signature
in box #8 and it accurately represents the work that was performed at
Date Li—S — ty
9 I have inspected the installed OSS and conducted a performance test in accordance with the current DOH
design standards and this system has passed the performance test and As -built inspection. All information
accurately represents what 1 obsery :•.t the s'te.
0111111
Desi ner/Engineer Signature
1 request final inspect'
Note: failure to supply adequate information to
and disapproving the installation.
All Sand Filters or Sand Filters to Mounds see page 2
Performance Test version 6/99 REV 12/23/99 Page 1 of 2
nate system performance is grounds for rejecting the performance test
Tracking Number
Print Date /2.23.99
Performance Demonstration Report Form
Page 3 for Subsurface Drip Systems
Pack bed/ drip — Sandfilter/ drip ATU/drip
PRODUCT TYPE
X Other
Geoflow Netafim
Other
All dripline components are from the same manufacturer and are compatible with the product line
Used. Verified by Designer/PE Master Installer
INSTALLATION
Number of Driplines is
Dripline Spacing (2 -ft min) is 2.9
Dripline Depth (inches) is t, - $
Cover Depth (inches) is -
1'1
Total lineal feet is viloi crS
Orifice Spacing is 12'`
Number of noes �I
lu.t-c«ly
COMPONENTS
Air/ Vacuum Relief Valves: #
Flow Meter: L (( S
Flush Valves: Automated I
Chemical Injector Port 1-
Pressure gauge .�
Filter: J
y
Diameter 3 `i
Manual or Continuous
Type/size t �PiSc
DOSING
Number of doses/ day 12 Time pump ON i•51";.4 Time pump OFF Z kw 5
Pump Make and Model p 5I P Z a
Control Panel Make/ Model R' o - ,s T -t - tr
TESTING/ INSPECTION
Initial operating pressure of system (PSI) (o 0
Flush line pressure (PSI) 3 Z
Initial measured system flow rate (GPM) fo • 0
Total Flow for system (GPM) 10.0
System Water Tight: YES t- NO
As the installer of record I have verified all data in above and it accurately represents the work
that was performed at the site.
Licensed Installers Signature Date
1 have performance tested this system in accordance with the current Guideline for use of SSDS
and this system has passed the performance test and As -built inspections. All information
supplied accurately represents what was observed at the site.
Designer Signature (,'
Date
-�_ 1t
Public Health Ul
Seattle & King Count
REPORT OF \VI:V1:ATER TANK .af3-\\1)O\\1FAT
Return completed form to Public Health — Seattle & King County, Environmental Health Division,14350 SE Eastgate Way,
Bellevue, WA, 98007, Tel. (206 296-4932. Faxed co ies will not be accepted due to data entry purposes.
Ia1 +1 el OI i lo` I DATE: / is/ iy
PARCEL (APN): I
Instructions for completing form: This form is to be completed by any persons permanently removing a
septic tank, seepage pit, cesspool, or other on-site sewage system wastewater tanks from service.
Complete and submit this report to the health officer within thirty (30) days of the abandonment.
Authority: Chapter 13.04.054, the Code of King County Board of Health, Title 13.
General Information (Please print):
Name of Owner/Occupant of Property: --S �^ ` c k -at "c c- x
Address: i sa °°\ `t $ Yom- s .
Wastewater Tank Data:
Type of Sewage Tank: 6` Septic Tank — Pump Tank — Holding Tank Other:
Number of Compartments Pumped: v - e
Number of Gallons Pumped: 151D
Checklist Item
Septage removed by an approved pumper?*
Tank lid removed or destroyed?
Tank void filled with compacted soil or
gravel?
Yes No Not Applicable Comments
A
*OSS Pumper Name: K r 11.5
King County Certification Number:
Reason for wastewater tank abandonment:
_ Property being served by public sewers A Property being served by replacement tank
Structure being demolished
Comments:
Report of Wastewater Tank Abandonment
Revised 11/9/2012
INSTALLERS BACKFILL NOTIFICATION
REQUEST FOR FINAL INSPECTION
TO: -Gur1
(Designer)
Seattle -King County
Department of Public Health
Environmental Health Division
Name of owner j :t' i s 1-1 :I r f
Site address \ Selo° `-t$ Pkvc S
(as appears on installation permit)
Installation Permit # O i- U iV 3 o rt\
( lake ssociate Installer)
(signature of installer)
was present at this site placing or supervising placement of final cover on the date indicated (please
check appropriate box).
Date Backfilled
(placement of final cover)
Instructions:
Certified Installer:
( I ) You must place or be physically present on the site to supervise placement of final cover
material on the sewage disposal system;
(2) This form may be used to certify that you have placed or supervised final cover placement (or
you may use the designated space at the bottom of the installation permit) and to notify the
designer that system is ready for final inspection;
(3) Routing instructions: upon completion, this form is to be forwarded to the designer.
/forms/sewform35
EXTENDED MAINTENANCE AGREEMENT
This agreement is intended to facilitate quality control assurance for onsite sewage
systems. By maintaining a high level of design and construction standards most of the causes of
system failure can be eliminated. System usage and maintenance are the final items that will
determine system performancerTherefore, the following is offered.
This agreement is made between NW Design and Property Development, LLC
("Provider") and property owner ("Owner"). Provider makes no warranties, expressed or
implied.
A. PARTIES
1. Provider:
NW Design and Property Development, LLC
PO Box 1179
Lake Stevens, WA 98258
1-877-397-7771
Owner:
Name: Janie Hendrix
Mailing address: 15909 48th Ave S, Tukwila WA 98188
Phone:
Email:
System Address (Where sewage originates): 15909 48th Ave S, Tukwila 98188
Type of System: FAST .75 ATU to SSDS
Tax Account Number: 222304-9016
This agreement shall be in effect for a period of thirty -30- days after written notification
of cancellation from either party to the other party. This agreement is valid from 10/29/2013 to
10/29/2015. Inspections shall occur 45 days after start-up, then every 6 months thereafter. The
cost for each inspection shall be $260.00 per visit plus current King County filing fee.
Inspections will be made per RS&G guidelines and current county requirements.
Transferability: Provided all fees and costs are paid current and Owner is not otherwise in
default under any of the terms of this Agreement, this agreement is transferable from an Owner
to a grantee of the property with the system address listed above.
The "New Owner" must sign a new Extended Maintenance Agreement within thirty -30-
days of the transfer of the real property, otherwise the transfer of the rights under this Agreement
are void. It is the responsibility of Owner to notify Provider of said title conveyance.
B. Operation & Maintenance:
Owner agrees to pay a fee for each site inspection authorized by Owner. Owner will be
charged standard rates, as determined by Provider, for any and all service calls and agrees to
pay all fee(s), according to Provider's standards rates for those services authorized by Owner.
1 of 4
Prior Agreements: This Agreement contains all of the agreements of the parties with
respect to any matter covered or mentioned in this Agreement and no prior agreements or
understanding pertaining to any such matters shall be effective for any purpose. No provision of
this Agreement may be amended or added to except by an agreement in writing signed by the
parties hereto or their respective successors in interest. This Agreement shall not be binding on
any party unless fully executed by all parties.
Access: Owner shall not inhibit access to any maintenance points (Examples of
maintenance points are: septic tank and pump tank man ways, inspection ports, manifold valve
boxes. and control panel. This list may not be inclusive). Any encroachments that inhibit access
\kill preclude said item to be inspected and will be recorded on reporting documents, Provider
reserves the right to determine what constitutes an inhibition of access.
By signing this Agreement, the parties agree to all its terms and conditions.
PROVIDER: DATE
NW Design and Property Development, LLC
By:_ `'$rad R. Dom— ' _10/29/2013
(Date)
Its:
OWNER:
r -
Yy
(Print name)
4 of 4
I
(Date)
RETURN ADDRESS
Janie Hendrix
15909 q?Ave 5.
TuKwila WA 98188
111111111110111
20 131212000848
3 FORGET OSS 79.00
PAGE -001 OF 008
12/12/2013 14:34
Please prim neatly or type information
Document Title(s)
Notice of On -Site Sewa3e System Operation and
Mainbenarlce getuiremenE5
Reference Number(s) of related documents
Grantor(s) (Last, First, and Middle Initial)
Hendrix 1 Janie l..
Grantees(s) (Last, First, Middle taitial)
THE PUBLIC
Additional Reference se's on page
Additional grantors on page
Additional grantees on page
Legal Description (abbreviated form: i.e. lot, block, plat or section, township, range, quarter/quarter)
SE - 22- 23 --9
Assessor's Property Tax Parcel/Account Number
2223049 - 901(
Additional legal is on page
Additional parcel 6's on page
The Auditor/Recorder will rely on the information provided on this form. The staff will not read the documents to verify the accuracy or
completeness of the indexing information provided herein
Eases Office 14350 SE gistgate Way
Bellevue, WA 98007 •
Telephone (206) 296-4932 Fax 296-4919
OM: " Warms,1,'.�
mer: also send copy to, Masterinsta
Phone.#-(
' FAX # y,T
DESIGNER'S OSS PRE -INSTALLATION INSPECTION REPORT
(FOR STUB -OUT RELEASE)
Be Completedby the Designer:
e Design Application Activity Ntitnber HD000M0 Building -permit #la'c'Pools
knew) .
cord ID Number I O N I° I\ I t\ j 2 I L 1(t2 1 1
duras 5"9 0 °� , y �` '�«-' S Name
Name
.1 c r
appears es site assign app&eahien)
rcel # L11:40.00-02
J1=. 0.00-0r -
It V
Lot # Block # Division #
zigner's'PE's :Name D 0,..:11
Leasep) (Not CompanyN)
" aster Installer's Name .v --t ri o-t.st+,
j
Subdivision #. or risme
or State PE # S o oz -r3
>ecify the type of OSS to be Mailed Fc•S'} ATS 4).:.
•
•
esigner's pre -installation inspection.requested on ,20
oes the approed design specify that a pre -construction meeting is required?
i,,,,jj Yes: Meeting conducted en ,20 No
Teter Supply
Pi:,blic: water service line to the parcel/property line is installed, operational, and approved.
i Individual Private WeLUSprict�
;;source Location conforms with design
source construction report lwell tog) is satisfactory
source, meets minimum water weatitv'requuements *
water quality tests results are in compliance bacteria nitrate arsenic *
1n 1— 157 , 20 11 ,I conducted a pre -installation inspection on the above site
property). Based upon this inspection, the site complies with the criteria of the approved design and Title 13.
atlation Conditions: •
• .
Installation Must not be attempted on this site during wet conditions.
►then:
Applies to designs submitted after 4/19/99. •
1?or. Health Department Use Only
remarks
1,7
vilechdatalfo ms\sewagelfocm 77 ' Page 1 of 1
revised 10nro9, Rev REV1 UV60o
Date Received
Appr000rnere
Site/takes:
X IX
FFI = -CQ�
Site Design:Application Form for Individual On -Site Sewag
Public Health - Seattle and King County )r
(Submit 5 copies of application vAth 4 copies of plans) 2
��j�nQ
1 S c o a `18 C` Fi n e S. i Ny� 7 ATTACH A DETAILED ROUTE
t •.
LIL® NAP FOR LOcATMG THE PROPERTY
Name and address of property
'mac1-� elt- 6 r s‘x
Name I
Last
Designer
0, e as 4?Q
4•0 -
Street
Street Address I S 9 0 9 92 s`' (\ve
j ci r l e, 1 City -Zip Code i A.►; I6, 1818`) 1 Phone jzoko- zzto'
F st
f a Street Address I +'3 t k \-t
1 C Zrp Code (..K 4012s81 Phone 1qzs- kctd-
THIS IS NOT A PERMIT 09
PROPERTY INFORMATION: Legal Description Attached'
1.
Parcel # (APN) 12 l Z 12131 v 1491'01 k 161 Section: 12121 Township: 121171 Range:1 0141 -
Subdivision Name: 1 1 Lot 1 1 1 Block 1 1, 1 1
Property Size 1 19 1 is 1 0 1 v 1 q sq. tt Acreage: 1-. z I Fhoritria. Urban Anna
Distance from property line to nearest sewer. 1 1 Sj c� 1 v •..az
6.aNFa11I''`.
Water Supply U (IP) I = Individual r. Group A Supply o Group B supply
Public Water Supply Name: 1 1ko\ 1 ID# l
Sensitive Area: U (Y?N) If yes, specify II (L.W,O) L = Landslide W = Wetlands 0 = Other
lq7
1 1 —
1
SYSTEM INFORMATION:
New System L_.. I Repair Design 124 Correction of OSS Failure? Ill Y?N Detailed Plans Attached (4 sets) Y?N a,
Type of Building I 1 1 S1 F1 SF = Single Family MF = Multiple Family COMM = Commercial INST , NST Insbtubonai
Type of Sym Proposed: 1 1 01-1 1 U I G = Gravity GP = Gravity with pump M = Mound
PD = Pressure Distribution HT = Holding Tank CT = Composting Toilet E = Experimental 0 = t‘Aicsu FA
Dates Soils Logged: 1 t 1 O 11 t 1 c) I c 131 sou Logs Date Attached oisi moo U y?N 7 s +n
Depth to Watertabte or Restrictive Layer. 1 31 (L.1 ;cries
SSD
Maximum Slope in 0rainfietd/Reserve Area 1 151 %
CALCULATIONS:
Number of bedrooms: 1 S 1 Total Gallons/Day (450 rnirlmum): 1 (ol 9 1 01 Gal. Soil Texture Type
9+ Rate: 1 J. l Gang tvdey (t A -s) 1 �j 1
on Area: 1 ` I 1 13 I el Sq. it. Trench Width )1_212.1 inches
Total Drainfield Length: 1 816 1 S 1 Ft. septic Tank Size: 1— I N1 RI —1 Gal. Garbage Grinder it! f rN
Pump Chamber Sae (if needed) 1 W 1 Z 1> 1 OI Gal. Trench Depth (min rax): I 1 (s) 1/ 1 1 8 1 Inc has _
Ilildgemaiiscaretoor* methe !to,CM* bOddiiea li:3Rgraill"4 ,-,r•'4:ebonynydunoA6 In Ws
bad b wagon day Wpm% sidtr appimporL
Designers : tit
i W V 0 Z5
kW= a°"�mpYar'oelreq
,' KC. ID# 1 1 1. 1 1 1 Date: tits-Zko-13
FOR HEALTH DEP • = USE ON . = MARE EWAl : A ACOUtitYCEREFE0 MALIAR
OTHERMSEZ
APPROVED (date): if' '1--f / . $Y; �PilL v �
A „ IGNED
0 a ttSFRVICE CONTRACT
ISR RECORDED RED A STUBNOTICE Uu I KR SC
fI s ALOFTr68ESENAPPLlG eA YaiORieItl1ATI0p - jlpp or oi0T 7lriliE'
TOMOO CONSTRUCTION MO EDISPOSAL sSMnumANY ones sf�vEMENSONOESTYE ' CE
SNAIL ANA SURANCE,EOME Orta Ma0Evg FORnEtintmu.eEIS2M.
res APPLICATION EXPIRES MVO YEARS OWN DATE OF APPROVAL
DISAPPROVED (date): BY: 0V 0 1 2013
See attadted s'de Odder" Street
Arty penin allayed br ark deasbl artful order dthe *IM Orte h it 8e a loner aFP brappeal b the Heat anger
mister dipadeo date die atom sxeot (Me t3,ICC.B.odrt.Char 1112 - Serape R�pr ), a11�STG'TE PUBLIC HEALTH
Comments
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id111111111111111111111161111;111111111111111111111111114111111111111iillt III liriffill111111111 OM!
LEGa_ i IESCRIPTION
Owner. O ick _
Builder
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Bullder 7A''7cf_
[AAA- (Al 4-5--)„,a.Z
AL.MESS OF PROPERTY ' / c'er
SEATTLE -KING COUNTY DEPARTMENT OF PUBLIC HEALTH
DIVISION Of SANITATION
904 Public Safety Building
AS-BIIILT SEWAGE DISPOSAL PLAN
(Submit in Triplicate)
Address P6' R/»C 6 1(63=)
Address
A
PERMIT NO. / E'3
..._c'.c71 • 9rf/ Phon' </E
Designer..D)'An .4 - C7)4.r47✓1 Address S.Sxly �+C"i.7Jc . Jr► -7L
Installer...U. .-4.4ik-(`"-7 YLbs. Address /i4-(-77 .�_s` /.9t`t Phone ,.- Y3 -ef/94
1 hereby certify thea ompanying drawing Is .an accurate representation of the system installed at the listed address. I further certify ail recommen-
dations and restrictions. 'concerning pluMblv pub elevatons, maintenance of grades, filis, surface drains, etc.) listed by me on my approved site plan•(or
latest r,oproved revision t'.rc of) dated...././7 . . have been complied with. 1 further certify that this system meeta au requirements of
the R..•es and Regulations established under King County Resolytio,Tif�/222873/!
or�City of Seattle Ordinance No. 90181 whichever is ac^ -able.
. L t. ,...1 CA/�y l • /' "/ ;S'
111121431.3411 OR 01.11.411413 -' c
Phone
Phone
erwrlrle*TE we.
Dab Accepted ... /. /..^ 2—)
�
Signature of Sanitarian.. Q`1
Remarks:,
TO BE FILLED IN BY HEALTH .DEPARTMENT ONLY
Oat* Not Accepted . .
RECEIVED
NOV 2
V
S!J_UTHWES' ;_;TRICT
HEALTH ATER
INSTRUCTIONS: You may use the reverse side of this form for the drawing or attach separate sheet. Use a scale which will permit the greatest retail and
still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Overloa: ng the septic t3^.k or disturbance of
may seriously impair satisfactory operation. Points to rememb,--
1. Have your tank checked periodically to see if pumping is necessary (21-3 years).
2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excevate,`flll, place a structure, driveway or patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not harm the a_tior of the septic tart and disposal field.
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rPublic Health - Seattle & King County
Application for Health Department Approval of Building Permit
For houses or structures served by an on-site sewage (septic) system (OSS)
Office Address -14350 SE Eastgate Way, Bellevue, WA 98007
(206) 477-8050 Fax: (206) 296-9792 Refer to fee schedule for current fee
Application and all support documents must be submitted in TRIPLICATE - 3 complete
In addition, your application sets must in� — sets
❑ A detailed route map and directions to property;
❑ Floor plans showing what is changing in the building or on the p
The maximum size paper accepted is 11" x 17"
❑ An attached completed CHECKLIST FOR HEALTH DEPARTM
REVIEW OF APPLICATION FOR BUILDING PERMIT
ik_..W,+
Health Department Use Only
Record,I..D. Number
ON N yrdam`'` r 1141)/
l60,a lg /
Property Information
Health Dept. Use Only
T - Guide Page/Loc.
REVIEWED FOR
...111a
APPROVED
3NTAUG112017
E COMPLIANCE
Address of Property 1(51 0414? -4"" AV.c .5
City IAA lot
Applicant's Name kAAVgo G I l yl j--ayl
Applicant's Mailing Addres" 22-.11 AAatviv►,v iGw by
Owner's Name r'tVid Vi inlG1.Gv
Age of House Distance to nearest public sewer
Existing Square footage of house (o 10 Number of existing bedrooms
Square footage to be added 42„ Number of bedrooms being added
Description of proposed changes qdA i inol 17otA.)A.tv lotJ.t)
City of Tukwila
BUILDING DIVISION
Parcel No (APN): 12 2.
Zip code ,t;. St)
Day Phone ( 20(.0) -71 g - I 012-
City
1ZCity 1746,Moivws Zip
Day Phone (
2131019 ill pH
La) Iqg
5
Is property in an
incorporated city?
2 Yes [] No
Type of On -Site Sewage System Serving Property: Fa Sfi -1 g
Additions or repairs to sewage system (give dates and describe briefly)
Ac 11 net-.-l=swi sslECEIVED
CITY OF TUKWI A
AUG 07 2017
Describe or attach any drainfield easements, covenants or notices on title, which may impact the property
N/A PERMIT CENTER
Water Supply Information i-li grinI t Yu. vJJ aul'. v vicA-P9fIR
❑Group B Water Supply Name o'it Water System LTR#
(2 or more connections) State ID #
Group A Less Than 1000
❑ Group A More Than 1000
❑Private (well, spring, etc.) attach copies of well log, well covenants, chemical/bacteriological sample reports.
For Health Department Use Only
pproved 7/7/17 Date By:
Disapproved Date By:
❑ Hold Date By:
Comments/Conditions:
Released Il:1 Date
e
I(,ec
JUL, 17 2017
E s FGA rE
,ENVIRNMENrAL
HEALTH
Any person aggrieved by any decision or final order of the Health Officer may file a written application for appeal to the Health Officer within 60 calendar days of
the decision. (K.C.B.O.H. Title 13, Chapter 13.12 — Sewage Review Committee) FORM_9_D_Rev 12.30.10 — Previous Versions are Obsolete
CHECKLIST FOR HEALTH DEPARTMENT REVIEW OF APPLICATION FOR BUILDING PERMIT
(For buildings not served by public sewer)
The following checklist is a guide to assist the applicant in submitting a complete application. A properly prepared
application must include this checklist below along with any additional details and specifications required by applicable
provisions of the King County Board of Health -- Title 13. Note: For non -applicable items put NA in the "NO" column.
SITE ADDRESS: +-moi A V,C_ PARCEL NUMBER (APN)
7
2
_
0
4
1
Cv
OLT PLAN0
Yes
No
APPLICATION FORM
t
A copy of an approved as -built diagram is provided/attached
A 1 "=20' scalel "= 30' scale is used. The parcel plot plan is provided on paper that is 11" x 17" or
smaller.
Application indicates that public sewer service is not available within 200 feet of the subject property.
The Application for Health Department Approval of Building Permit form is complete; Data on all
copies must is legible.
Entries on the plot plan are legible
Application is submitted in triplicate, and accompanied by the appropriate fee.
A North arrow is indicated on the plan
Detailed reference maps for locating the property are provided (vicinity, location and routing to site).
Property and easement lines are shown, (specific lengths are indicated)
There is access for field inspection by health department.
The application indicates if the owner needs to be present due to access issues (e.g. guard dog, locked gate, etc.).
Direction(s) of surface drainage is/are shown
Application sets are properly collated
The plans show existing structures present on the site, including all out buildings
OLT PLAN0
Yes
No
PARCEL PLOT PLAN
t
A copy of an approved as -built diagram is provided/attached
A 1 "=20' scalel "= 30' scale is used. The parcel plot plan is provided on paper that is 11" x 17" or
smaller.
A same scale (i.e. matching the as -built diagram scale) transparent overlay is provided showing the
proposed construction/addition
Entries on the plot plan are legible
A North arrow is indicated on the plan
Property and easement lines are shown, (specific lengths are indicated)
Direction(s) of surface drainage is/are shown
The plans show existing structures present on the site, including all out buildings
Plan shows the location of existing wastewater tank(s) — (e.g. septic tanks, pre-treatment tanks,
dosing/pump tanks, containment vessels)
Plan shows (ifpresent) the location of existing sand filter(s)
Location of the primary sewage disposal area (e.g. drainfield, mound, up -flow sand filter) is shown__
Location of the designated reserve sewage disposal area is shown
Location of other septic components are shown (e.g. tightlines, d -box, pressure lines)
Existing Horizontal Separations (e.g. the proposed addition setback to sewage system components)
The above scaled plot plan depicts the accurate location(s) of the following:
driveways and parking areas
wells, other water sources — show a 100' radius for each well location
abandoned wells
water supply lines
drainage features (e.g. footing drains, curtain drains, drainage ditches)
cuts, banks, areas of filled terrain
retaining walls
surface water, streams, bodies of water
seasonal water
11124/-11a
111 1/G1 tin .1 11'1L` 1\ 1 .1ia-D U11.. 1 IiL' I. VIt.L
Yes
No
t
A copy of an approved as -built diagram is provided/attached
A same scale (i.e. matching the as -built diagram scale) transparent overlay is provided showing the
proposed construction/addition
f Vl laxil\ 1\L`LCf A. Ala./ LVt, V111L'1r 1 a
Yes
No
If applicable/existing, other recorded documents relating to the sewage system and water supply are
referenced.
BA Checklist Print Date 3/05/07
Public Health LAI
'
Seattle & King County
6/16/2017
OPERATION / PERFORMANCE MONITORING REPORT
Environmental Health Division. 14350 SE Eastgate Way. Bellevue. WA 98007. Tel. (206) 477-8050
Inspection Type: ROUTINE - Correction Status: No corrections needed
Tax ID: 2223049016
Inspection Date: 06/15/2017
GENERA L SYSTEM TYPE: ATU-Drip
Site Address: 15909 48TH AVE S
City: TUKWILA
Mail Address: 15909 48TH AVE S City: TUKWILA, WA Zip: 98188
OSM Company: Evergreen Onsite
Submitted 06/16/2017 by:
COMMENTS & GENERAL INSPECTION NOTES
No Deficiencies Noted
OSM Name: Mark Christiansen (092) OSM TeI#: 425-397-777]
The 1750 Gallon Septic Tank and the 1750 Gallon Pump tank were not in need of a pumping at the time they were inspected. The inlet and outlet
baffles were intact and in good condition at this service. The Effluent Pump was in proper working order and pumping down at an acceptable
rate. The ATU (FAST) unit was found to be in proper working order and not in need of a pumping at this time. The Salcor UV was in proper
working order at this inspection. The Alarm was tested and in proper working order at this time. The Drainfield area appears to be in good
condition with no apparent signs of ponding, surfacing, sponginess, or mechanical damage at this time. The system is in proper working order at
this time and no recommendations were made for immediate service or repair at this time. Continuing routine service and maintenance will prolong
the life of the system.
GENERAL SITE & SYSTEM CONDITIONS
The General Site and System Conditions were:
Risers and lids secured:
OSS Working Properly
Pre -failing Signs
Record Drawing Modified
Record Drawing New
(;c HHI—e I JON
YES
YES
NO
LTR#_
NO
NO
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
ero.rc rea men Uni : ATU- Br.M
Manufacturer: Bio-MIcroblcs, Inc. Model: MicroF
-FAST,M. f- to _Br. -M .. ,I .-M .Filer ^7'
This component was:
Fully Inspected
All Components accessible for maintenance, secure and in good condition: j
R c. V;'. G'1 ` YES
^
If a dye test was performed, did the dye surface? (N/A if no dye test)•
II N/A
— - ' _ `? jjj NO
A PPt�pp C�VED d NO
Effluent leaking onto the surface of the ground from any component? (If yes, explain in comments))
Improper encroachment (roads, buildings, etc.) onto component(s):4.
Component settling problems observed:
AUGNO
tiU f /
I
YES
Subsurface components adequately covered i
Period average daily flow (gallons per day)
Site maintenance required (e.g. Landscape maintenance) If yes, describe in comments
Unit audio/visual alarms functioning:
A t JI3 0
i' 7
NO
Occupant compliance problem (occupant not operating the system properly). If YES describe in rotes
Vent(s) and observation ports clear from obstructions:
NO
Structures connected to onsite sewage system occupied. If NO explain in comments: !
City of "Fur l-
YES
Alterations made to the OSS (valves adjusted, timer settings modified, ports installed, etc.) (If YE$, B' l ( ° ft�� ^.
riaerrlha in nnfasl•_.._. ihl_:z �+�r s'',�tr,).:
1
NO
Risers and lids secured:
OSS Working Properly
Pre -failing Signs
Record Drawing Modified
Record Drawing New
(;c HHI—e I JON
YES
YES
NO
LTR#_
NO
NO
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
ero.rc rea men Uni : ATU- Br.M
Manufacturer: Bio-MIcroblcs, Inc. Model: MicroF
-FAST,M. f- to _Br. -M .. ,I .-M .Filer ^7'
This component was:
CITY OF I Urk
YY ILAy Inspected
Aerobic Mechanism appears to be functioning per manufacturers specifications:
YES
Cleaned filter element:
/
N1'YES
Unit audio/visual alarms functioning:
A t JI3 0
i' 7
I YES
Vent(s) and observation ports clear from obstructions:
YES
Vigorous boiling is occurring:
YES
YES
Effluent is visually clear:
PERMIT CENTER
The effluent smell is a damp, earthy odor (N/A = not observed):
YES
pH level within normal operating range (6-9): (Enter N/A if not performed):
Field samole Performance results within ooeratinnal limits /Enter N/A if.,,. --,--..,,.
IL a■
N/A
_ _ .
r
/1
ReportlD: 601306
N/A
View inspection reports online at www.onlinerme
The first compartment settling zone sludge accumulation is greater than 18 inches or is within 6 inches
of the connection point between the settling zone and treatment zone. (If Yes, pumping needed):
NO
The second compartment treatment zone sludge accumulation is less than 3 inches from the FAST unit
(If Yes, pumping needed):
NO
Pumping needed:
Disinfection: Ultra Violet, Manufacturer= Salcor Engineering - 3G
Manufacturer: Salcor Engineering Model: 3G
NO
This component was:
Fully Inspected
UV bulb cleaned:
NO
UV bulb replaced:
NO
A modification/repair was completed on the component (If yes, provide detail in comments):
NO
TANK: Pump Tank 1750 gallon concrete
NO
This was:
component
Fully Inspected
Pump 1: Cycle Count (override in parentheses - if present):
Compartment 1 Scum accumulation (Inches, if other specify):
0
Pump 1: Timer setting adjustments were required (if yes indicate new timer settings below - state
reason in comments):
Compartment 1 Sludge accumulation (Inches, if other specify):
0
Pump 1: New gallons per dose (override in parentheses - if present):
Pumping needed:
NO
Pump 1: New off hours (override in parentheses - if present):
A modification/repair was completed on the component (If yes, provide detail in comments): NO
ump: Effluent Pump, Manufacturer= Orenco - PF200511
Manufacturer: Orenco Model: PF200511
This component was:
Fully Inspected
Controls functioning:
YES
Pump Vault Filter cleaned (N/A = not present):
N/A
Tested gallons per minute flow:
proprietary
A modification/repair was completed on the component (If yes, provide detail in comments):
Panel: Control - 1 Pump
NO
Manufacturer: SJE Rhombus
This component was:
Fully Inspected
Panel functioning (including alarm):
vEs
Pump 1: Arrival on minutes (override in parentheses - if present):
proprietary
Pump 1: Arrival off hours (override in parentheses - if present):
proprietary
Pump 1: Arrival gallons per dose (override in parentheses - if present):
YES
Pump 1: ETM hours (override in parentheses - if present):
YES
Pump 1: Cycle Count (override in parentheses - if present):
32
Pump 1: Timer setting adjustments were required (if yes indicate new timer settings below - state
reason in comments):
NO
Pump 1: New gallons per dose (override in parentheses - if present):
28
Pump 1: New off hours (override in parentheses - if present):
YES
Pump 1: New on minutes (override in parentheses - if present):
YES
A modification/repair was completed on the component (If yes, provide detail in comments):
Drainfield (disposal): Drip Irrigation
NO
Manufacturer: Netafim
I his component was
Fully Inspected
Drip system flushed
YES
Filters function properly:
YES
Drip system auto -flush working properly:
YES
Surface water, downspouts diverted away from drainfield: _ _
YES
Supply line air release valves functioning properly (N/A = not present):
YES
Pre -filter pressure reading Before Cleaning:
32
Evidence of vehicular traffic or livestock over drainfield:
NO
Post -filter pressure reading Before Cleaning:
28
Return line air release valves functioning properly (N/A = not present):
YES
Check valves in system functioning properly:
YES
Pre -filter pressure reading After Cleaning:
Post -filter pressure reading AfterCleaning:
172030
Flow meter reading (in gallons):
34
Effluent Discharge Meter Reading:
Root inhibitor cartridge replacement date:
Post Regulator Pressure Gauge reading PSI (if present):
Dripline flushes properly
YES
A modification/repair was completed on the component (If yes, provide detail in comments):
NO
ANK: Septic Tank - 2 Compartment 1100 gallon - POOL HOUSE
This was:
component
Not Inspected
Effluent level within operational limits (if NO explain in comments):
All required baffles in place (N/A = No baffles required):
Effluent Filter Cleaned (NIA = Not Present):
—
Compartment 1 Scum accumulation (Inches, if other specify):
Compartment 1 Sludge accumulation (Inches, if other specify):
Compartment 2 Scum accumulation (Inches, if other specify):
Compartment 2 Sludge accumulation (Inches, if other specify):
Pumping needed:
A modification/repair was completed on the component (If yes, provide detail in comments):
ReportlD: 601306
View inspection reports online at www.onlinerme.com
Page 2 of 3
This report indicates certain characteristics of the onsite sewage system at the time of 'sit. In no way is this report a guarantee of operation or future performance.
ReportlD: 601306
View inspection reports online at www.onlinerme.com
Page 3 of 3
Not Inspected
This component was:
Component appears to be functioning as intended:
A modification/repair was completed on the component (If yes, provide detail in comments):
1 rainfield (disposal): Gravity POOL NOUSE
Not Inspected
This component was:
Component settling problems observed:
Surface water, downspouts diverted away from drainfield:
Load test performed with satisfactory results (N/A = Not Performed):
Evidence of vehicular traffic or livestock over drainfield:
Observation ports present and accessible:
A method, such as aeration, was used to reduce clogging of the biomat in this component (If yes,
provide detail in comments):
A modification/repair was completed on the component (If yes, provide detail in comments):
This report indicates certain characteristics of the onsite sewage system at the time of 'sit. In no way is this report a guarantee of operation or future performance.
ReportlD: 601306
View inspection reports online at www.onlinerme.com
Page 3 of 3
Select Appraisal Group, Inc.
SKETCH ADDENDUM File No. 16-0068
Case No. 9326924512
Borrower WINKLER, DAVID
Property Address 15909 48th Ave S
City Tukwila County KING
State WA Zip Code 98188-2787
Lender/Client FIRST TECH FEDERAL CREDIT UNION Address 3555 SW 153RD DR, BEAVERTON, OR 97003
Main Floor
FP
0
0
Bath
E
0
2
v
m L
8)
rD
Utility
Living Room
9
Bonus Room
5.
Strs
Fp
9
2.5'
42.5'
s t
Bedroom m m Bedroom
Bedroom
42.5'
Bedroom
Strs
41'
Second Floor
3 Car Garage
Sketch by Apex Sketch v5 Standard'.
Comments:
8.5'
ai'
RECEIVED
CITY OF TUKWiLA
JUN 22 2017
PERMIT CENTER
GLA1
GLA.
GA
5392.63.
1772.00
922.50
5392.63
1/72.00
922.50
First Floor
8.0 x 55.0
45.0 x 21.0
65.0 x 0.5
5.0 x 48.5
8.0 x 42.5
2.5 x 2.5
6.0 x 75.5
3.5 x 72.0
31.0 x 37.0
5.5 x 2.5
7.5 x 79.0
0.5 x 3.5 x 3.5
0.5 x 3.5 x 3.5
0.5 x 2.5 x 2.5
0.5 x 2.3 x 1.5
2.5 x 79.5
3.5 x 76.7
0.5 x 1.5 x 1.2
0.5 x 3.8 x 2.5
0.5 x 2.0 x 2.5
Net LIVABLE Area
(rounded)
1
7165 37ltems (rounded)
440.00
945.00
32.50
242.50
340.00
3.13
453.00
252.00
1147.00
13.75
592.50
6.13
6.13
3.13
1.69
198.75
268.45
0.90
4.69
2.50
2210.90
7165
UAD Version 9/2011 Produced by ClickFORMS Software 800-622-8727 Page 14 of 36
bF7 0 lb9
July 06, 2017
City of Tukwila
Department of Community Development
MARGO CLINTON
22211 MARINE VIEW DR S
DES MOINES, WA 98198
RE: Correction Letter # 1
DEVELOPMENT Permit Application Number D17-0169
WINKLER RESIDENCE - 15909 48 AVE S
Dear MARGO CLINTON,
Allan Ekberg, Mayor
Jack Pace, Director
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 DEPARTMENT: Allen Johannessen at 206-433-7163 if you have questions regarding these comments.
• (GENERAL NOTE)
PLAN SUBMITTALS: (Min. size 11x17 to maximum size of 24x36; all sheets shall be the same size. New revised
plan sheets shall be the same size sheets as those previously submitted.)
(If applicable) "STAMP AND SIGNATURES" "Every page of a plan set must contain the seal/stamp, signature of
the licensee(s) who prepared or who had direct supervision over the preparation of the work, and date of signature.
Specifications that are prepared by or under the direct supervision of a licensee shall contain the seal/stamp,
signature of the licensee and the date of signature. If the "specifications" prepared by a licensee are a portion of a
bound specification document that contains specifications other than that of an engineering or land surveying
nature, the licensee need only seal/stamp that portion or portions of the documents for which the licensee is
responsible." It shall not be required to have each page of "specifications" (calculations) to be stamped and signed;
Front page only will be sufficient. (WAC 196-23-010 & 196-23-020)
(BUILDING REVIEW NOTES)
1. Slab -on -grade insulation shall be placed on the outside of the foundation or inside of the foundation wall.
Insulation shall extend downward from top of the slab for a minimum distance of 24 inches or downward to at least
the bottom of the slab and then horizontally to interior or exterior for a total of 24 inches. Above grade insulation
shall be protected. A two-inch by 2 -inch (maximum) pt. 2x may be placed at the finished floor elevation for
attachment of interior finish materials. Exterior insulation shall be protected. Show proposed method for providing
exterior insulation for the floor slab. (2015 WSEC R402.2.9)
2. Show cross section for floor, wall (2x6), and ceiling showing framing sizes and show insulation per current 2015
energy codes. Show R value for the exterior window. The exterior wall appears to be stucco. If so specify and
indicate method for application and tying into existing.
3. All permit plan sheets shall be a minimum of 11x17 sheets. (see note above)
Note: In response to these corrections for this permit -plan -review, other corrections may be needed.
PW DEPARTMENT: Joanna Spencer at 206-431-2440 if you have questions regarding these comments.
• 1) Since the property is still on septic system applicant shall submit plans for review and approval to King County
Wastewater Program Environmental Health Dept., 14350 SE Eastgate Way, Bellevue, WA 98007, phone 206-477-
8050. Their office hours are Mon-Tues-Wed-Fri-8:00am-4:pm, Thursday-9:00am-4:00pm.
2) Submit copy of King County approval, email ok.
6300 Southcenter Boulevard Suite #I00 • Tukwila Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
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.
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 206-431-3655.
Sincerely,
Bill Rambo
Permit Technician
File No. D17-0169
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: D17-0169 DATE: 08/07/17
PROJECT NAME: WINKLER RESIDENCE
SITE ADDRESS: 15909 48 AVE S
Original Plan Submittal
X Response to Correction Letter # 1
Revision # before Permit Issued
Revision # after Permit Issued
DEPARTMENTS:
AIAJC�-��7
Building Division 11
33 kW& a�
Public Works
Fire Prevention
Structural
Planning Division
Permit Coordinator
Fl
a
PRELIMINARY REVIEW:
Not Applicable n
(no approval/review required)
REVIEWER'S INITIALS:
DATE: 08/08/17
Structural Review Required
DATE:
APPROVALS OR CORRECTIONS: DUE DATE: 09/05/17
Approved
Corrections Required
n
Approved with Conditions n
n Denied
(corrections entered in Reviews) (ie: Zoning Issues)
Notation:
pt Sw
sm,6..i el
REVIEWER'S INITIALS: DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg D Fire ❑ Ping ❑ PW ❑ Staff Initials:
12/18/2013
PLAN REVIEW/ROUTING SLIP
PERMIT NUMBER: D17-0169 DATE: 06/22/17
PROJECT NAME: WINKLER RESIDENCE
SITE ADDRESS: 15909 48 AVE S
X Original Plan Submittal
Response to Correction Letter #
Revision # before Permit Issued
Revision # after Permit Issued
DEPARTMENTS:
wilding Division
Public Wor�Leit 1
bTfr 41
Fire Prevention
Structural
(19-A-17
Planning Division
ElPermit Coordinator
mo
PRELIMINARY REVIEW:
Not Applicable
(no approval/review required)
REVIEWER'S INITIALS:
DATE: 06/27/17
Structural Review Required
DATE:
n
APPROVALS OR CORRECTIONS:
Approved Approved with Conditions
Corrections Required Denied
(corrections entered in Reviews) ' (ie: Zoning Issues)
DUE DATE: 07/25/17
n
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only f,, I
CORRECTION LETTER MAILED: 1-40 ` -7
Departments issued corrections: BldgV--Fire 0 Ping ❑ PW
Staff Initials:
u4/7_
12/18/2013
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.ci.tukwila.wa.us
REVISION SUBMITTAL
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: 11 f 2_011
Plan Check/Permit Number: D17-0169
❑ Response to Incomplete Letter #
RECEIVED
® Response to Correction Letter # 1 CITY OF TUKWILA
❑ Revision # after Permit is Issued AUG 0 7 2017
❑ Revision requested by a City Building Inspector or Plans Examiner
PERMIT CENTER
Project Name: Winkler Residence
Project Address: 15909 48 Ave S
Contact Person:OlV 10 G t 1 vi -173111 Phone Number: (2_041 113 _ 1017—
Summary of Revision: J
b 1 at? JO a 'A L i ✓1 1 Vl, l a.I4 17 4 i VIntilAtA (pi -5)
�vo�SGAL.krovl 106tuAc.ci, 12-vMt.* L utv11L vtouv1
exr/24-irn1 wiViziol4J (pi. 1—t00
3) ova f I xl-r ShLe-1—s
VW
l-41 a l-I-aGVli of A V OVJZt4 1itvvl--v'aI Al 1GC &CtIV1Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
_a a
Received at the City of Tukwila Permit Center by:
Entered in TRAKiT on
1—
\applications\forms-applications on line\revision submittal
Created: 8-13-2004
Revised:
POWELL RENOVATIONS LLC
Safety & Health Claims & insurance
Washington State Department of
% Labor & Industries
Page 1 of 2
Workplace Rights Trades & Licensing
POWELL RENOVATIONS LLC
Osmer or
Pnnc.ipals
POWELL, TODD
EASTMAN, PARTNER/MEMBER
POWELL, BROOKS
BENTON, PARTNER/MEMBER
PETRICH, ANNMARIE, AGENT
(End: 09/03/2015)
Do flg i
POWELL RENOVATIONS LLC
WA UB! No.
602 710 373
22211 MARINE VIEW DRIVE S
SEATTLE, WA 98198
206-824-8001
KING County
Dub nook. type
Limited Liability Company
Governing ocrsdre
BROOKS
POWELL
TODD POWELL,
License
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor Active.
Meets current requirements.
Lac pe eS
GENERAL
L,ceiSe ..
POWELRL939PE
Effect -Re — expiration
10/05/2007— 10/05/2017
Bond
DEVELOPERS SURETY & INDEM CO
Bond of i.,0,,n t. 00.
748809C
$12,000 00
Received by L Effective date
10/05/2007 10/01/2007
Expiration date
Until Canceled
Insurance
Wesco Insurance Co $2,000,000.00
Fo'rc'e 00.
WPP102159705
Received iriry L.&I Effective e d at<
01/19/2017 01/15/2017
E Ipoeuon date
01/15/2018
Help us improve
haps://secure.lni.wa.gov/verify/Detail.aspx?UBI=602710373&LIC=POWELRL939PE&SAW= 8/17/2017
POWELL RENOVATIONS LLC
Insurance history
Savings
No savings accounts during the previous 6 year period.
Lawsuits against the bond or savings
Cause no.
11-2-24368-1 KNT
Complaint filed by
JOHN & NANCY SAVAGE
Complaint date
09/30/2011
Open
Complaint against bonds) or savings
748809C
Complain E mount
$0.00
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.
License Violations
No license violations during the previous 6 year period.
Workers' comp
Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums.
L&I Account ID Account is current.
145,311-00
Doing business as
POWELL RENOVATIONS LLC
Estimated workers reported
Quarter 2 of Year 2017 "11 to 20 Workers"
LAI account contact
TO / GARY HONC (360)902-4823 - Email: HONC235@Ini.wa.gov
Public Works Strikes and Debarments
Verify the contractor is eligible to perform work on public works projects.
Contractor Strikes
No strikes have been issued against this contractor.
Contractors not allowed to bid
No debarments have been issued against this contractor.
Workplace safety and health
Check for any past safety and health violations found on jobsites this business was responsible for.
Inspection results date
09/12/2013
Inspection no.
316860121
Location
10533 174th Ave Se
Newcastle, WA 98059
Violations
Page 2 of 2
VVashtngton State Dept, si L.abor 8 Indusai- Use ut th
is subicect
he laws of th stale of Washington
Help us improve
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602710373&LIC=POWELRL939PE&SAW= 8/17/2017