HomeMy WebLinkAboutPermit S16-0008 - SIGONA AUTO - BUILDING MOUNTED SIGNThis 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.
S16-0008
SIGONA AUTO
14101 INTERURBAN AVE S
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
12, 13, 14
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.
SIGONA AUTO SALES
14101 INTERURBAN AVE S.
S16-0008 (EXPIRED)
1 PERMANENT BUILDING MOUNTED
SIGN
Parcel No:
Address:
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Web site: http://www.TukwilaWA.eov
PERMANENT SIGN PERMIT
3365900891 Permit Number: 516-0008
14101 INTERURBAN AVE S
Issue Date: 3/4/2016
Permit Expires On: 8/31/2016
Owner:
Name: TUKWILA INTERURBAN INVEST
Address: PO BOX 88636 , TUKWILA, , 98188
Contact Person:
Name:
Address:
EDWIN MWAIHA
Contractor:
Name: OWNER AFFIDAVIT IN LIEU OF
CONTRACTOR
Address:
License No:
Business:
Name: SIGONA AUTO SALES
Address: 14101 INTERURBAN AVE S , ,
Phone:
Phone:
Expiration Date:
DESCRIPTION OF WORK:
(1) 36SQ FT BUILDING MOUNTED SIGN
"SIGONA AUTO SALES"
Fees Collected: $260.40 Zoning: RCM
Types of Sign:
1. BUILDING -WALL
EXPOSED BUILDING FACE:
SIGN AREA (SQ FT):
Planning Division Authorized Signature:
Electricity Provided by: PUGET SOUND ENERGY
884.8
36
I hearby certify that I have read and examined thi 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.
Signature:
Print Name:
ACCEPTANCE BY EMAIL
IS SIGNATURE FOR
PERMIT AND CONDITIONS
Date:
THIS PERMIT SHALL BECOME NULL AND VOID IF THE WORK IS NOT COMMENCED WITHIN 180 DAYS FROM THE
DATE OF ISSUANCE, OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS FROM THE
LAST INSPECTION.
Sign permit inspections are conducted once a month. This allows approximately 30 days for the sign to be
manufactured and installed. Please let us know if more time is needed.
If payment for the job is pending final inspection approval, please provide the sign permit information by email
to teri.svedahl@tukwilawa.gov or call 206-431-3670 and we will complete the inspection within
five (5) business days.
Electrical permits and inspections occur independent of this permit.
FINAL INSPECTION APPROVAL: DATE:
4
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-3670
PERMANENT SIGNS
Building Mounted And
Freestanding
PERMANENT SIGN PERMIT APPLICATION
FOR STAFF USE ONLY
Planner :
File Number : 5 / 4 _ xj
Needs Electrical : Yes / No
Associated File Numbers :
Zoning of Site: h ,-Commercial/Industrial
Residential
Number of Building Mounted Signs included in application:
Number of Freestanding/Monument Signs included in application:
RECEVED
��.) 16:
Community
Development
Other signs included in application (Dynamic / Canopy /Awning / Other):
Text on sign will read:
Name of Tenant:
(Q t)rU fk a} i) SC�2
WWLA • S;younoaut to • Corr)
X S% L1oro( RAO t -(
aa65" 2 Sba-A
Address of Tenant / Business:
Contractor:
1�-►t0 t+Jit-,P1JA (Ay.) S 1JKvoiV { vvW
Contractor State License #:
Contractor's City of Tukwila Business License #:
Contractor Address:
Contact Name for Permit: , ,n) WW114-0
Contact Address:
Contact E-mail:
Contact Phone:
LA )_ +R 09,,.) I YPH v' SI I 1 rb fl A) wa 9,s? co 2
c,&(-‘4 Lid -0 Co_ fru(;) uon
ao b Si (Z t?I
I HEREBY CERTIFY that the information contained in this application and the materials furnished to the City by me are true. I
understand that if I provide incorrect information on this application or submit plans that are not correct, it could delay issuance of a
permit or, if the permit has been issued, be cause for the City to revoke the sign permit.
Signature of Owner or Authorized Agent
6
APPLICATION CHECKLIST - REQUIRED
o Valid Tukwila business license number for the sign
contractor
o One copy of a valid Washington State contractor's
license, or owner's affidavit
o Completed and signed application
o Payment of application fee
(Listed in current Fee Schedule)
o Method of illumination — Separate electrical permit
required through building division
o Two (2) copies of a dimensioned and scaled site
plan
o Two (2) copies of drawings of proposed signs
with area calculations
o Two (2) copies of elevations of building walls
where signs will be located indicating the
location and dimensions of the exposed
building face used to calculate the sign area.
INSPECTIONS
Sign permits are NOT scheduled through the automated permitting line
Sign permit inspections are typically completed in groups once a month, allowing approximately 30 days for the
sign to be manufactured and installed. Please let us know if you require more time.
If payment of the job is pending inspection, please email Teri Svedahl directly at
Teri.Svedahl@TukwilaWA.gov with the permit information and we will complete the inspection within 5
business days:
It is the responsibility of the installer to obtain the electrical permit and inspections from the City of
Tukwila BUILDING DIVISION Permit Center at (206) 431-3670. The electrical inspector will need access
to complete the Electrical portion of the inspection.
GENERAL
The issuance of some signage within the City may require a permit from the Washington State Department of
Transportation (WSDOT). It is the applicant's responsibility to obtain all required permits from the appropriate
government agency. For information on permits that may be required from WSDOT call (360) 705-7296.
The issuance of a sign permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of this code or of any other ordinance of the City. Permits presuming to give authority to violate
or cancel the provisions of this code or other ordinances of the City shall not be valid. The issuance of a permit
based on construction documents and other data shall not prevent the Director of Community Development
from requiring correction of errors in the construction documents and other data (TMC 19.12.020 (C)). Pursuant
to TMC 19.12.150, sign permits shall be valid for 180 days from the date of issuance of the sign permit. The
Director of Community Development may approve one extension of up to 30 days if a written request is
submitted to the City BEFORE expiration of the 180 day period.
o
Worksheet for Building -Mounted Signs in Commercial/Industrial
Zones
The City's sign code permits a variety of building mounted signs, including wall signs, signs on awnings, canopy signs and
projecting signs. This sign permit application can be used to determine the total number of building mounted signs permitted
for your business. The application also provides the specific code standards for the common types of building mounted signs;
see TMC 19 Sign Code for details. Please note that you may not qualify for all signage types outlined in this application.
Wall Sign
Each public entrance is eligible for either a flush mounted wall sign or an awning face sign.
In some cases an additional wall sign maybe permitted on walls that do not have entrances, see Section 2 of this application.
Use the table below to determine the maximum permitted sizer of your wall sign:
Maximum Sign Area
AREA = (L x H) of Exposed Building Face
(EBF) in square feet =
Permitted Sign Area
0-500
EBF x.05 or 20 square feet, whichever is larger
501-1,500
(EBF -500) x .04 + 25 square feet
1501-3,000
(EBF -1,500) x .03+ 65 square feet
3,001-5,000
(EBF -3,000) x .02+ 110 square feet
Over 5,000
150 square feet maximum
Wall Sign Worksheet
*To meet requirements, please refer to the information and tables provided in this document
1 This table is inapplicable if your site is covered under an approved Master Sign Program and an increase in sign area was
granted.
Sign #1
Sign #2
Sign #3
Reserved
for City
Use
For more detail see the Sign
Code Language,
TMC 19.20.050 A.
(use add'l sheet
if needed for
add'l signs)
Wall Area
�gg S
4- `1'
The size of the sign is based on
the area of the wall fronting the
tenant space where the sign will
be located, see 19.08.110.
Maximum
Sign Area
Lam- 39) s
Calculate the maximum sign
area allowed for the wall from
the table above.
Proposed
Area of
Sign
_c-\1(4. _
3Gscv C -angles.
7 C
EVE ®
Calculate the area by drawing
one box around the entire sign
face or copy using 90 degree
Sign Copy
Community
Development
1 6 `
List what the sign will say
(for example: name of business).
.S%Cio!`�A'�0 Spm
3
Lo • 5 4 «3 • (4)-n
1 This table is inapplicable if your site is covered under an approved Master Sign Program and an increase in sign area was
granted.
Incentive Signage Provision
Businesses may be permitted additional flush -mounted building signage on walls fronting their tenant spaces that do not
qualify for the signage described in Section 19.20.50.A, under the following circumstances:
a. The business or use may not have any other building -mounted signage oriented in the same direction as the incentive
sign.
b. Architectural interest must be provided through at least one of the following methods:
1) At least 50 percent of the wall area between the height of two and seven feet must be transparent with either an
unobstructed view into the business or use, or a display window with a depth of at least three feet.
2) Architectural detailing consistent with the building design using changes in color, materials, texture and
variations in the wall plane.
3) Artwork such as mosaic, mural or sculptural relief over at least 50 percent of the wall surface.
4) One or more trellises covering at least 50 percent of the wall area between the height of two and seven feet,
planted with climbing vines and other plant materials in a planting bed at least two feet in width and provided
with permanent irrigation.
5) The allowable area of the sign is 50 percent of that calculated in "Table 22 — Allowable Message Area for
Permanent Wall Signs in Commercial and Industrial Zones."
2 See table on front side — "maximum sign area"
rte; R
Lf`ir riccir `1 uo /o 4 n .�
�`
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-367o FAX (206) 431-3665
Permit Center/Building Division
206 431-3670
Public Works Department
206 433-0179
Planning Division
206 431-3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON)
) ss.
COUNTY OF MNG
s it ax. 8 'V L.
16
Community
Development
[please print name]
, states as follows:
PERMIT NO: s f &vnr,C9
1. I have made application for a permit from the City of Tukwila, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington, a copy of which is printed on the reverse side of this Affidavit. I have
read or am familiar with RCW 18.27.090.
3. I understand that prior to issuance of a permit for work which is to be done by any contractor, the
City of Tukwila must verify either that the contractor is registered by the State of Washington, or that
one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,
I consider the work authorized under this permit to be exempt under number _, and will therefore
not be performed by a registered contractor.
5. I understand that the licensing provision of RCW 19.28.161 through 19.28.271 shall not apply to
persons making electrical installations on their own property or to regularly employed employees
working on the premises of their employer. The proposed electrical work is not for the construction
of a new building for rent, sale or lease.
I understand that I may be waiving certain rights that I might otherwise have under state law in any decision
to engage an unregistered contractor to perform construction work.
LAURIE A. WERLE
NOTARY PUBLIC
STATE OF WASHINGTON
COMMISSION EXPIRES
MAY 29, 2018
,1N c.nvJP, 1-lf ( <L&-7.;
Owner/Owner's Agent*
Signed and sworn to before me this
day of , 20lp
Y PUBLIC in and for the State of Washington
Residing at
//7 ✓ / , County
Name as commissioned: jivo
My commission expires: 05*
18.27.090 Exemptions. The registration provisions of this chapter do not apply to:
1. An authorized representative of the United States
government, the state of Washington, or any incorporated
city, town, county, township, irrigation district, reclamation
district, or other municipal or political corporation or
subdivision of this state;
2. Officers of a court when they are acting within the scope
of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their own
business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground mine
or mineral deposit when performed by an owner or lessee;
5. The sale of any finished products, materials, or articles of
merchandise that are not fabricated into and do not become
a part of a structure under the common law of fixtures;
6. Any construction, alteration, improvement, or repair of
personal property performed by the registered or legal
owner, or by a mobile/manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW who shall
warranty service and repairs under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site or
reservation under the legal jurisdiction of the federal
government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them into, or consuming
them in the performance of, the work of the contractor;
9. Any work or operation on one undertaking or project by
one or more contracts, the aggregate contract price of
which for labor and materials and all other items is less
than five hundred dollars, such work or operations being
considered as of a casual, minor, or inconsequential nature.
The exemption prescribed in this subsection does not apply
in any instance wherein the work or construction is only a
part of a larger or major operation, whether undertaken by
the same or a different contractor, or in which a division of
the operation is made into contracts of amounts less than
five hundred dollars for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in this
subsection does not apply to a person who advertises or
puts out any sign or card or other device which might
indicate to the public that he or she is a contractor, or that
he or she is qualified to engage in the business of
contractor;
10. Any construction or operation incidental to the
construction and repair of irrigation and drainage ditches
of regularly constituted irrigation districts or reclamation
districts; or to farming, dairying, agriculture, viticulture,
horticulture, or stock or poultry raising; or to clearing or
other work upon land in rural districts for fire prevention
purposes; except when any of the above work is performed
by a registered contractor;
11. An owner* who contracts for a project with a registered
contractor, except that this exemption shall not deprive the
owner of the protections of this chapter against registered
and unregistered contractors. The exemption prescribed in
this subsection does not apply to a person who performs
the activities of a contractor for the purpose of leasing or
selling improved property he or she has owned for less than
twelve months;
12.* Any person working on his or her own property,
whether occupied by him or her or not, and any person
working on his or her personal residence, whether owned
by him or her or not but this exemption shall not apply to
any person who performs the activities of a contractor on
his or her own property for the purpose of selling,
demolishing, or leasing the property;
13. An owner* who performs maintenance, repair, and
alteration work in or upon his or her own properties, or
who uses his or her own employees to do such work;
14. A licensed architect or civil or professional engineer
acting solely in his or her professional capacity, an
electrician certified under the laws of the state of
Washington, or a plumber certified under the laws of the
state of Washington or licensed by a political subdivision of
the state of Washington while operating within the
boundaries of such political subdivision. The exemption
provided in this subsection is applicable only when the
person certified is operating within the scope of his or her
certification;
15. Any person who engages in the activities herein
regulated as an employee of a registered contractor with
wages as his or her sole compensation or as an employee
with wages as his or her sole compensation;
16. Contractors on highway projects who have been
prequalified as required by RCW 47.28.070, with the
department of transportation to perform highway
construction, reconstruction, or maintenance work;
17. A mobile/manufactured home dealer or manufacturer
who subcontracts the installation, set-up, or repair work to
actively registered contractors. This exemption only applies
to the installation, set-up, or repair of the
mobile/manufactured homes that were manufactured or
sold by the mobile/manufactured home dealer or
manufacturer;
18. An entity who holds a valid electrical contractor's
license under chapter 19.28 RCW that employs a certified
journeyman electrician, a certified residential specialty
electrician, or an electrical trainee meeting the
requirements of chapter 19.28 RCW to perform plumbing
work that is incidentally, directly, and immediately
appropriate to the like -in-kind replacement of a household
appliance or other small household utilization equipment
that requires limited electric power and limited waste
and/or water connections. An electrical trainee must be
supervised by a certified electrician while performing
plumbing work.
* Per Washington State Department of Labor and Industries lessee has
been interpreted to be equivalent to owner for purposes of exemptions.
City of Tukwila
6200 Southcenter Blvd, Tukwila, WA
1 Finance Department
1603401-1 02/03/2016 BR1 T102
Wed Feb03,2016 12:56PM Trans#43-43
Name: SIGONA AUTO LLC SIGONA A
43 $67.00 BUSLCN - Business Licenses
Customer#: 00067629
Activity#: 00025438
1 ITEM(S): TOTAL: $67.00
Cash PAID $67.00
www.tukwilawa.gov 206-433-1835
3usIness Access (road/strut leading to business) is :
0 Concretesphalt 0 Gravel 0 Dirt
:Ioor Space Size? :Parking Spaces? !Opening Date
XVG.‘ sc„C-k- 6 03\otIrkD tS
DESCRIPTION OF BUSINESS (In detail, list services and/or type of products sold or stored.)
',c) Sim►—c
In Your Business:
Will retail sales be conducted?
Outside Contractor, not located in Tukwila?
Will marijuana be used/sold on premises?
gov
2016 Business License Application
FILL OUT THIS FORM IN ITS ENTIRETY
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
(TION ONLY, not a license to conduct business.
RIOR to conducting business, ALL LICENSES EXPIRE DECEMBER 31
Name Change
Suite #
0 Address Change
:Address
0 Usage Change 0 UBI # Change
Mailing Address (if different than business address)
City
fl ?ir)
Corporate Email 1
S1-1ctaLtb.% � toJ11
Own tship Status IJ Iividual/
Suite #
StV. f Lf'6 _
IST ._ s21P
v�; q "g0o2
;Corporate Phone #
SolPrprietor ❑ Corporation
❑ Partnership 0 Non -Profit 501C3 0 GovernmeLC
Last known USAGE of location:
Prior City of Tukwila Bus License #
'WA STATE Contractor's License #
Is your home used as your business address?
Will alcohol be served/sold on premises?
Sign Installer/Manufacturer
Will you do door to door sales/peddling?
Any amusement devices on premises?
Do you drive a Taxi/Limosine/Comm Vehicle?
Are you operating a business on the property
of another business? Ex: Food Truck, Coffee Stand, other
azardous Materials
Do you use/store/discharge flammable, hazardous, or bio -hazardous materials? Yes No_'
Yes No
v
-REQUIRED
Any gambling on premises?
Will admission fees be charged?
Do you collect parking fees?
WAATATE UBI # REQUIRED
Yes
o3 Lfgcl
If yes, please complete Home Occupation Affidavit.
If yes, have you applied for a liquor license?
If yes, please complete Sign Affidavit acknowledging Title 19 Sign Code.
If yes, please complete a Peddler'a License application.
If yes, please complete Amusement Device application.
How many do you have?
Where are they parked?
What length(s)
If yes, you need to provide a letter of permission from the property owner and a
map/dia : ram as to where you will be situated on the • roperty.
If yes, attach list of Type AND Quantity.
(If yes, please attach list and describe.)
Is your business activity or any portions of your building/space different than the previous use? Yes No
Are you presently doing or planning to do any: Construction, Remodeling, and/or Installation of Commercial Storage Racks? Yes No ✓
Contact the Permitting Center 206-431-3670, PRIOR TO STARTING ANY Remodeling/Construction or installation of Storage Racks.
ist all Owners/Partners/,Officers (please attach separate sheet if needed)
lame 1:
r
to tY t`'1 _t 1..
lome Address
lame 2:
'Title: Driver's License q REQ Issuing State
tc,
:City, ST & ZIP CI Phone: Work / Cell / Home Date of Birth REQ
_l___
Issuing State
lome Address
eTe; !Driver's License It REQ
;City, ST & ZIP
i Phone: Work / CeII 7 -Home ;Date of Birth REQ
City of Tukwila
6200 Southcenter Blvd, Tukwila, WA
1 Finance Department
1603401-1 02/03/2016 BR1 T102
Wed Feb03,2016 12:56PM Trans#43-43
Name: SIGONA AUTO LLC SIGDNA A
43 $67,00 BUSLCN - Business Licenses
Customer#: 00067629
Activity#: 00025438
1 ITEM(S): TOTAL: $67.00
Cash PAID $67.00
www.tukwi1awa.gov 206-433-1835
gov
2016 Business License Application
FILL OUT THIS FORM IN ITS ENTIRETY
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
LTION ONLY, not a license to conduct business.
RIOR to conducting business. ALL LICENSES EXPIRE DECEMBER 31
Name Change
Suite #
ZIP
bLf
51so ,IISkkP. errvA� .too aO_G s g6a '
3usiness Access (road/street leading to business) is :
0 Concretesphalt 0 Gravel 0 Dirt
:loon Space Size? Parking Spaces? ; Opening Date
i\tl & 6 03\o11aD ts
DESCRIPTION OF BUSINESS (In detail, list services and/or type of products sold or stored.) -REQUIRED
0 Address Change
(Address
0 Usage Change 0 UBI # Change
Mailing Address (If different than business address)
1 kepA.. NMI") l nl
:City
'Corporate Email jj
Ss. i>netuu X111 (9M
EOwn (ship Status U lhtiividual/ Sole Proprietor 0 Corporation
0 Partnership 0 Non -Profit 501C3 0 Governmee[r t.LC
Prior City of Tukwila Bus Ucense # ;Last known USAGE of location:
Suite #
- 14,6
1ST ;ZIP
iCorporate Phone #
WA STATE Contractor's Ucense #
kvLS o 5 r-
In Your Business:
Will retail sales be conducted?
Outside Contractor, not located in Tukwila?
Will marijuana be used/sold on premises?
Is your home used as your business address?
Will alcohol be served/sold on premises?
Sign Installer/Manufacturer
Will you do door to door sales/peddling?
Any amusement devices on premises?
Do you drive a Taxi/Limosine/Comm Vehicle?
Are you operating a business on the property
of another business? Ex: Food Truck, Coffee Stand, other
Any gambling on premises?
Will admission fees be charged?
Do you collect parking fees?
WA TATE UBI # REQUIRED
Yes
No
If yes, please complete Home Occupation Affidavit.
If yes, have you applied for a liquor license?
If yes, please complete Sign Affidavit acknowledging Title 19 Sign Code.
If yes, please complete a Peddler'a License application.
If yes, please complete Amusement Device application.
How many do you have?
Where are they parked?
If yes, you need to provide a letter of permission from the property owner and -a
map/diagram as to where you will be situated on the property.
What length(s)
azardous Materials
Do you use/store/discharge flammable, hazardous, or bio -hazardous materials? Yes No,L
fanning & Building Information .*s
If yes, attach list of Type AND Quantity.
(If yes, please attach list and describe.)
Is your business activity or any portions of your building/space different than the previous use? Yes N
Are you presently doing or planning to do any: Construction, Remodeling, and/or Installation of Commercial Storage Racks? Yes No V
Contact the Permitting Center 206-431-3670, PRIOR TO STARTING ANY Remodeling/Construction or installation of Storage Racks.
ist all Owners/Partners/Officers (please attach separate sheet if needed)
Driver's License # REQ
Issuing State
lame 1:
Title:
tome Address
lame 2: `Title:
City, ST
Phone:;Work / Cell / Home
�'�'� D-3 -5�
lome Address
City, ST & ZIP
Date of Birth REQ
Driver's License # REQ Issuing State
;Phone: Work / Cell / Home
Date of Birth REQ
City of Tukwila
6200 Southcenter Boulevard
Tukwila, WA 98188-2544
206-431-3680/licensing@tukwilawa.gov
FAX: 206-433-1833
2016 Business License Application
~FILL*OUTTHIS"FORM IN°ITS`ENTIRETY`" x" "'"
INCOMPLETE APPL+ICA TION'S,WILLNOTBE PROCESSED
4.4as a, ,,8
This is 'an APPLICATION ONLY, not a license to conduct business.
Yon must obtain a business license PRIOR to conducting business. ALL LICENSES EXPIRE DECEMBER 31
Business License: s! ew 0 Renewal 0 Name Change 0 Address Change 0 Usage Change 0 UBI # Change
usinesslnform'atio Y : `°•A " " f II n Y ..
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3usiness Name (Legal)
p, 'r Mailing Address (if different than business address)
NBA (Doing Business As)'Addr/f�e'sss Suite #
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3usiness Address Suite # ;City ST ZIP
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:ity _,_ ST. ZIP Corporate Email Corporate Phone #
Email (to receiverenewal information) Bus Phone # f ;Ownetship Status U IMiividual/ Sole Proprietor 0 Corporation
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3usiness Access froad/strea leading to business) is : Prior City of Tukwila Bus License # Last known USAGE of location:
❑ Concrete ,2 Asphalt ❑ Gravel ❑ Dirt
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-loor Space Size? Parking Spaces? Opening Date `WA STATE Contractor's License # # WA TATE UBI REQUIRED
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DESCRIPTION OF BUSINESS (In detail, list services and/or type of products sold or stored.) -REQUIRED
In Your Business: Yes No Yes No
Will retail sales be conducted? Any gambling on premises?
Outside Contractor, not located in Tukwila? "9(' Will admission fees be charged?
Will marijuana be used/sold on premises? ///X Do you collect parking fees? X
Is your home used as your business address? y If yes, please complete Home Occupation Affidavit.
Will alcohol be served/sold on premises? 7( If yes, have you applied for a liquor license?
Sign Installer/Manufacturer NZ If yes, please complete Sign Affidavit acknowledging Title 19 Sign Code.
Will you do door to door sales/peddling? ` ! If yes, please complete a Peddler'a License application.
Any amusement devices on premises? )( If yes, please complete Amusement Device application.
Do you drive a Taxi/Limosine/Comm Vehicle? )( How many do you have? What length(s)
Where are they parked?
Are you operating a business on the property of If yes, you need to provide a letter of permission from the property owner and a
of another business? Ex: Food Truck, Coffee Stand, other f' map/diagram as to where you will be situated on the property.
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Do you use/store/discharge flammable, hazardous, or bio -hazardous materials? Yes No If yes, attach list of Type AND Quantity.
iannln ' nformation
Is your business activity or any portions of your building/space different than the previous use? Yes No� Of yes, please attach list and describe.)
Are you presently doing or planning to do any: Construction, Remodeling, and/or Installation of Commercial Storage Racks? Yes No V "
Contact the Permitting Center 206-431-3670, PRIOR TO STARTING ANY Remodeling/Construction or installation of Storage Racks.
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Owners/Partners/Officers (pleaseeRT4 separate ()f nee e) x r
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lame 1: 'Title: a. "� ~rte 'Driver's License# REQ Issuing State
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lome Address ;City, ST & ZIP CI- ' (-)3 ' ;Phone-: Work / Cell / Home Date of Birth REQ
lame 2: Title: ;Driver's License # REQ Issuing State
tome Address City, ST .& ZIP • Phone: Work / Cell / Home Date 4 -Birth -Ft -EC/
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Business` License Fee
Licenses are valid JANUARY 1 through DECEMBER 31 (Licenses are not pro -rated and expire Decem aer 31.)
Number of Owners: F/T { P/T
the business)
and owners.)
(per WA State Dept. of Labor & Industries)
worked for 1 month, then multiply by 12.
worked in Tukwila.
hours, not including special event hours.
5% per month, up to a maximum of 25% of
in previous year as well, you must pay
have questions. 206-431-3680.
Number of Managers: FIT PIT
Number of Employees: F/T P/T (includes family members who work at
Total: F/T PIT
A. \CVXc:•.ti r Total Number of hours worked in a 12 month period
(Determine the hours worked by ALL employees — full & part-time, managers
o One Full -Time Equivalent (FTE) Employee = 1,920 hours
• New businesses need to estimate number of hours to be
e If business is located outside Tukwila, report only those hours
• Minimum working hours at Southcenter Mall is 3,848 annual
B. Multiply line "A" by $0.034896 (If less than $67, pay $67 minimum)
C. Business License Fee, enter amount from line "B"
D. Penalty - if business is already in operation.
• IF ALREADY IN OPERATION, you must pay an additional
the license fee per TMC 5.04.050 Late Acquisition. If operating
the license fee for that year also. Please contact us if you
E. 6I TOTAL DUE
Please make checks payable to "City of Tukwila" (All Fees Paid are Non -Refundable)
EXEMPTION: Any organization that files for a non-profit exemption will be required to submit to the City a copy of its current IRS 501(c)3 determination letter
issued by the Internal Revenue Service to be exempt from the business license fee.
1 certify the Information contained herein Is correct 1 understand that any untrue statement is cause for revocation of my license.
Print Name Title/Position
Email Address
.ntact Phob Number
(1' ? S c1-
Signature
sBusmess License', e. In ormation is Ka ? "i; '_,.,.. Y._ `.oxo ; •
1. The license fee is a combination of the business license fee and the revenuer generating regulatory license (RGRL) fee. The license fee
based on the number of employee hours on the four quarterly reports submitted to the Washington State Department of Labor and
Industries (L&I) from the previous year. The work figure used by L&I is 1,920 hours per year for a full-time employee. In addition to the
annual employee hours reported on the L&I report, you must include employee hours for sole proprietors, owners, managers, partners
and any officers, agents or personal representatives acting in a fiduciary capacity. It is the responsibility of the employer to determine the
number of hours worked within the city. Enter the number of employee hours worked on Line "A". Multiply (Line "A") the total number of
employee hours worked in Tukwila by $.034896 to determine the total amount due (Line "B"). The minimum fee for any license is $67.00,
which covers 1,920 hours worked in Tukwila. If the amount calculated is less than $67.00 enter $67.00 on Line 3. If the amount calculate
is greater than $67.00, enter the greater amount on Line "C". Employers without a full year history would need to estimate the number of
employee hours that will be worked in the 12 month period.
2. New Businesses — The business license fee for a business that did not submit reports for each of the last 4 quarters to L&I shall t
based on the estimated number of employees of that business. The business shall provide its estimate of the average number
employee hours worked in a 12 month period. If the City determines the number of FTE employees was under -reported at the time ,
application or renewal by an error factor of more than 15%, the business shall pay the balance of the applicable license fee together with
penalty of 20% of such balance due. The business shall also reimburse the City for any accounting, legal, or administrative expense
incurred by the City in determining the under -reporting or in collecting the additional amounts. Any person who submits a license fE
payment by check to the City pursuant to the provisions of this chapter shall be assessed an NSF fee set by the Finance Director if tf
check is retumed unpaid by a bank or other financial institution for insufficient funds in the account or for any other reason.
3. Outside Contractors or Consultants - Onl re • ort those hours worked in Tukwila for the current ear, Janua — December.
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Processed by: Customer #: c7� 7 2 Activity #:
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T7T Inn 9107/m/Z.ol 21700 T- Tot209T
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