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HomeMy WebLinkAboutPermit D18-0237 - PATEL RESIDENCE - WINDOWPATEL RESIDENCE 4458 S 160 ST D18-0237 Parcel No: Address: Project Name: City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Inspection Request Line: 206-438-9350 Web site: http://www.TukwilaWA.gov DEVELOPMENT PERMIT 8108600441 Permit Number: D18-0237 4458 S 160TH ST PATEL RESIDENCE Issue Date: 9/24/2018 Permit Expires On: 3/23/2019 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: CHRISTIANA TRUST 440 S LASALLE ST STE 2000 , CHICAGO, WA, 60605 MAHAMMED PATEL 4458 S 160 ST, TUKWILA, WA, 98188 OWNER AFFIDAVIT - PATEL Phone: Phone: Expiration Date: DESCRIPTION OF WORK: NEED PERMIT FOR WINDOW Project Valuation: $1,850.00 Type of Fire Protection: Sprinklers: Fire Alarm: Type of Construction: VB Electrical Service Provided by: TUKWILA Fees Collected: $286.83 Occupancy per IBC: R-2 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: 2017 2017 2017 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: 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: Date: 0712-1)1r This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PERMIT CONDITIONS: 1: ***BUILDING PERMIT CONDITIONS*** 2: Work shall be installed in accordance with the approved construction documents, and any changes made during construction that are not in accordance with the approved construction documents shall be resubmitted for approval. 3: All permits, inspection record card and approved construction documents shall be kept at the site of work and shall be open to inspection by the Building Inspector until final inspection approval is granted. 4: All construction shall be done in conformance with the Washington State Building Code and the Washington State Energy Code. 5: 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. 6: 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. 7: 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). 8: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center. 9: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 1700 BUILDING FINAL** 0409 FRAMING 0606 GLAZING CITY OF TUKW Community DevelopAndDepartment Public Works Department Permit Center 6300 Southcenter Blvd, Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Building Per0 No. b 1 -- Project No. 41 Date Application Accepted: 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: 4414 5 3. 5 16 a779 s -r_ Tenant Name: PROPERTY OWNER Name: 1'10- -1 j9 -mo Ps') 2 1) .1-P fr Tom- , Address: /6 030 57 Xt V C- •.s City: 'TU 64,+_,0- i i_6:3- . State: W_ A. . Zip: Ci g'ta CONTACT PERSON — person receiving all project communication Name: l'Jo9 lI •l,pal-%Z , Address: /6 ©�sf5, j 1S'T S �1v� City: .7-0 It_1 . , State: 141-A- .- Zip: col er Phone: Rei 4.— -3 g-0-y-/z_,Fax: Email: Fyv a1/4'•,•^1M t I Q 'a (? g 60.)n -e la • GENERAL CONTRACTOR INFORMATION Company Name: Address: Company Name: City: State: Zip: Phone: Fax: City: State: Contr Reg No.: Phone: Exp Date: Tukwila Business License No.: H:Wpplications\Forms-Applications On Line\2012 ApplicationsU'ermit Application Revised - 2-7-12.docx Revised: February 2012 bh King Co Assessor's Tax No.: Suite Number: Floor: New Tenant: ❑ Yes .. No ARCHITECT OF RECORD Name: Address: Company Name: Architect Name: Address: City: State: Zip: Phone: Fax: Email: ENGINEER OF RECORD Name: Address: Company Name: Engineer Name: Address: 1 City: State: Zip: Phone: Fax: Email: LENDER/BOND ISSUED (required for projects $5,000 or greater per RCW 19.27.095) Name: Address: City: State: Zip: Page 1 of 4 BUILDING PERMIT INFORMATION — 206-431-3670 N (741 Valuation of Project (contractor's bid price): $ 5 O 0 / ^ Existing Building Valuation: $ °L . $-0. vc' c . Describe the scope of work (please provide detailed information): N �� [-i2rv,c 7 FOA- wi N 7C -,W Will there be new rack storage? ❑ .... Yes LNo If yes, a separate permit and plan submittal will be required. Provide All 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) *For an Accessory dwelling, provide the following: Lot Area (sq ft): b Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? 0 Yes DNo If "yes", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 0 Sprinklers 0 Automatic Fire Alarm 0 None 0 Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes 0 No If `yes', attach list of materials and storage locations on a separate 8-1/2" x 11 " paper including quantities and Materia! Safety Data Sheets. SEPTIC SYSTEM 1Z14.- 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\Forms-Applications On Line \2012 Applications\Permit Application Revised - 2-7-12.docx Revised: February 2012 bh Page 2 of 4 Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC 1st Floor 1 3-a v 2nd Floor 3rd Floor Floors thru Basement / So O Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): b Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? 0 Yes DNo If "yes", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: 0 Sprinklers 0 Automatic Fire Alarm 0 None 0 Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes 0 No If `yes', attach list of materials and storage locations on a separate 8-1/2" x 11 " paper including quantities and Materia! Safety Data Sheets. SEPTIC SYSTEM 1Z14.- 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\Forms-Applications On Line \2012 Applications\Permit Application Revised - 2-7-12.docx Revised: February 2012 bh Page 2 of 4 PERMIT APPLICATION NOTES — Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR AUTHORIZED AGENT: /� Signature: " `fir1 Date: c•-. "] / g / / 12> - Print Name: cC( tiv\'w"v 1 . ®ouf - Day Telephone: 20c g(KO / 2— Mailing Address: /6 0 3 0 — 6--/.=5-T A (J .s . --r'' I Lie'' ikt A • f ge t • CityState Zip H:Wpplications\Forms-Applications On Line\2012 Applications\Permit Application Revised - 2-7-12.docx Revised: February 2012 bh Page 4 of 4 j PUBLIC WORKS PERMIT INFORMATION — 206-433-0179 •, r� Scope of Work (please provide detailed information): Call before you Dig: 811 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Water District ❑ .. Tukwila ❑ ...Water District #I25 ❑ .. Water Availability Provided Sewer District ❑ .. Tukwila ❑ .. Sewer Use Certificate ❑ ... Highline ❑ ...Valley View ❑... Renton ❑ ...Sewer Availability Provided 0... Renton ❑... Seattle 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. Submitted with Application (mark boxes which apply): ❑ .. Civil Plans (Maximum Paper Size — 22" x 34") ❑ .. Technical Information Report (Storm Drainage) D...Geotechnical Report ❑ .. Bond El...Insurance ❑... Easement(s) 0...Maintenance Agreement(s) Proposed Activities (mark boxes that applv): ❑ .. Right-of-way Use - Nonprofit for less than 72 hours ❑ .. Right-of-way Use - No Disturbance ❑ .. Construction/Excavation/Fill - Right-of-way 0 Non Right-of-way 0 ❑ .. Total Cut ❑ .. Total Fill cubic yards cubic yards ❑ .. Sanitary Side Sewer ❑ .. Cap or Remove Utilities ❑ .. Frontage Improvements ❑ .. Traffic Control ❑ .. Backflow Prevention - Fire Protection Irrigation ❑ .. Traffic Impact Analysis ❑ .. Hold Harmless — (SAO) ❑ .. Hold Harmless — (ROW) 0...Right-of-way Use - Profit for less than 72 hours ❑ ... Right-of-way Use — Potential Disturbance ❑... Work in Flood Zone ❑ ... Storm Drainage 0...Abandon Septic Tank ❑...Curb Cut El...Pavement Cut 12...Looped Fire Line Domestic Water ❑ .. Permanent Water Meter Size (1) " WO # 0 .. Temporary Water Meter Size (1) " WO # ❑ .. Water Only Meter Size " WO # 0 .. Sewer Main Extension Public ❑ Private 0 ❑ .. Water Main Extension Public ❑ Private ❑ 0... Grease Interceptor 0... Channelization ❑ ... Trench Excavation 0...Utility Undergrounding (2) " WO # (3) " WO # (2) " WO # (3) " WO # ❑ .. Deduct Water Meter Size f) FINANCE INFORMATION Fire Line Size at Property Line ❑ .. Water ❑ .. Sewer ❑ .. Sewage Treatment Monthly Service Billing to: Name: Number of Public Fire Hydrant(s) Day Telephone: Mailing Address: Water Meter Refund/Billing: Name: Mailing Address: City State Zip Day Telephone: City State Zip H:Wpplications\Forms-Applications On Line\2012 ApplicationsWermit Application Revised - 2-7-12.docx Revised: February 2012 bh Page 3 of 4 CO TUKWILA ETRAKIT 6200 SOUTHCENTER BLVD TUKWILA, WA 98188 206-433-1870 CITY OF TUKWILA 0017340000802374464500 Date: 09/24/2018 04:00:33 PM CREDIT CARD SALE VISA CARD NUMBER: **********5664 K TRAN AMOUNT: $144.87 APPROVAL CD: 05686D RECORD #: 000 CLERK ID: Rachelle X {CARDHOLDER'S SIGNATURE} I AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT (MERCHANT AGREEMENT IF CREDIT VOUCHER) Thank you! Merchant Copy Page 1 of 2 http s : //clas sic. convergepay .com/VirtualMerchant/transaction.do?dispatchMethod—printTra... 9/24/2018 CO TUKWILA ETRAKIT 6200 SOUTHCENTER BLVD TUKWILA, WA 98188 206-433-1870 CITY OF TUKWILA Date: 09/24/2018 04:00:33 PM CREDIT CARD SALE VISA CARD NUMBER: TRAN AMOUNT: APPROVAL CD: RECORD #: CLERK ID: **********5664 $144.87 05686D 000 Rachelle Thank you! Customer Copy K Page 2 of 2 https : //classic. convergepay. comJV irtualMerchant/transaction. do?di spatchMethod=printTra... 9/24/2018 Cash Register Receipt City of Tukwila DESCRIPTIONS PermitTRAK ACCOUNT QUANTITY PAID $144.87 D18-0237 Address: 4458 S 160TH ST Apn: 8108600441 $144.87 Credit Card Fee $4.22 Credit Card Fee R000.369.908.00.00 0.00 $4.22 DEVELOPMENT $134.26 PERMIT FEE R000.322.100.00.00 0.00 $127.76 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $6.50 TECHNOLOGY FEE $6.39 TECHNOLOGY FEE TOTAL FEES PAID BY RECEIPT: R15463 R000.322.900.04.00 0.00 $6.39 $144.87 Date Paid: Monday, September 24, 2018 Paid By: MAHAMMED I PATEL Pay Method: CREDIT CARD 05686D Printed: Monday, September 24, 2018 4:00 PM 1 of 1 CRWSYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS PermitTRAK ACCOUNT QUANTITY PAID $141.96 D18-0237 Address: 4458 S 160TH ST Apn: 8108600441 $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: R15068 R000.345.830.00.00 0.00 $137.83 $141.96 Date Paid: Wednesday, August 01, 2018 Paid By: MAHAMMED PATEL Pay Method: CREDIT CARD 26514D Printed: Wednesday, August 01, 2018 2:18 PM 1 of 1 SYSTEMS o c� CO TUKWILA ETRAKIT 6200 SOUTHCENTER BLVD TUKWILA, WA 98188 206-433-1870 CITY OF TUKWILA 0017340000802374464500 Date: 08/01/2018 02:17:49 PM CREDIT CARD SALE VISA CARD NUMBER: **********5664 K TRAN AMOUNT: $141.96 APPROVAL CD: 26514D RECORD #: 000 CLERK ID: Bill X {CARDHOLDER'S SIGNATURE} I AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT (MERCHANT AGREEMENT IF CREDIT VOUCHER) Thank you! Merchant Copy Page 1 of 2 https://classic.convergepay.com/V irtualMerchant/transaction.do?dispatchMethod=printTran... 8/1/2018 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION Dig -0237 6300 Southcenter Blvd., #100, Tukwila. WA 98188 Permit Inspection Request Line (206) 438-9350 (206) 431-3670 Pr ect:ed ]� % Type of Inspection: Address: ql/S- /i2 j'L Date Called: Special Instructions: 415D�-(iT4 /6© " G. Date Wanted /j a.m. -� �/�� p.m. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: pv,c,A4A 6- CL0-zr P!' 0 8 Inspector.° Date:9.2 / 2// REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. Z) 0 REVIEWED FOR CODE COMPLIANCE APPROVED SEP}1 9 2C 3 V Ci of Tukwila BUILDING DIVISION FILE COPY Permit No. l -is• oFQ-/7 ‘04-S CrIke 6 {,,sig9 C, s t o-) .� ' Jam f° z o"i n O Plan review approval is subject to errors and unicslons. Approval of construction documents docs the violation of any adopted colo or ordinanco. licccipt of approved Field Copy and conditions is aria, ic..r:cd ud: By: Date: .D7/ City of Tt.; ��a'iJ ;:. �l ,a 7 BUILDING DIVISION 0 L:4 0 s rl a /7'sOS0fi Ws -44419 444647-0 7 1 t/-14"9 0-1.3c O `It)N;_y No changes sh^" mnce to the scope of work withl: -, nor approval of Tukwila Bt.1;1'!ing Division NOTE: Reviso !; will i:;quire a new plan submittal and may inzlude add tionai plan review fees ! SA..1 Iii E C1: fl:chanical d Elect��cai [�F umbrng 0/Gas Piping City of Tu!<wila DNIFION �1a h0rG) -z rr- 0M o' 6,30/ ,9 l 3T -g" (c y S Ir 1 (65 600/ 1�C`A RECEIVED CITY OF TUKWILA SEP 0 it 2018 PERMIT CENTER .ORR,ECTION TR# bw- oz37 TO: FROM: DATE: SUBJECT: MEMORANDUM Richard Takechi Rachelle Ripley September 25, 2018 Patel Residence Permit Number D18-0237 Please credit $54.79 (fifty-four dollars and seventy-nine cents) for a credit card transaction made on August 1, 2018. The value of the scope of work was reduced. Please provide the refund as follows: Account 000.345.830.00.00: $ 54.79 Total: $ 54.79 Thank you! August 21, 2018 � D City of Tukwila Department of Community Development MAHAMMED PATEL 4458 S 160 ST TUKWILA, WA 98188 RE: Correction Letter # 1 DEVELOPMENT Permit Application Number D 18-0237 PATEL RESIDENCE - 4458 S 160 ST Dear MAHAMMED PATEL, 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 INFORMATION NOTE) PLAN SUBMITTALS: (Min. size 11x17 to a preferably maximum size of 24x36; all sheets shall be the same size; larger sizes may be negotiable. "New revised" plan sheets shall be the same size sheets as those previously submitted.) (BUILDING REVIEW NOTES) 1. The scope of work only specifies "Need work for Window". Specify more clearly in the scope of work all or which windows to be replaced. Include the U -Values of the windows. Show how the windows shall be flashed and sealed around the frames. 2. Clarify what the dimensions noted in (#. ##") next to window sizes represent. 3. Specify bedroom windows as egress and show sizes comply with egress windows. Note: Contingent on response to these corrections, further plan review may request for additional corrections. 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. Sincerely, Bill Rambo Permit Technician File No. D18-0237 6300 Southcenter Boulevard Suite #100 • Tukwila Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665 ERM T COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: D18-0237 PROJECT NAME: PATEL RESIDENCE SITE ADDRESS: 4458 S 16o ST Original Plan Submittal DATE: 09/05/18 Revision # before Permit Issued X Response to Correction Letter # 1 Revision # after Permit Issued DEPARTMENTS: 11\01;\(6 11YVv Building Division Public Works Fire Prevention Structural Planning Division n ❑ Permit Coordinator ❑ PRELIMINARY REVIEW: DATE: 09/06/18 Not Applicable n Structural Review Required (no approval/review required) REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved DUE DATE: 10/04/18 ❑ Approved with Conditions n Corrections Required ❑ Denied ❑ (corrections entered in Reviews) (ie: Zoning Issues) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg 0 Fire 0 Ping ❑ PW ❑ Staff Initials: 12/18/2013 5ERMIT COORD COPY PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: D18-0237 DATE: 08/01/18 PROJECT NAME: PATEL RESIDENCE SITE ADDRESS: 4458 S 160 ST X Original Plan Submittal Revision # before Permit Issued Response to Correction Letter # Revision # after Permit Issued DEPARTMENTS: C0 A g -fit Building Division III &s NA- it -to Public Wo s �M N// Fire Prevention Structural g-�-ts ►mss N/A- 8-n-rg Planning Division ip Permit Coordinator II DATE: 08/02/18 PRELIMINARY REVIEW: Not Applicable ❑ (no approval/review required) Structural Review Required REVIEWER'S INITIALS: DATE: n APPROVALS OR CORRECTIONS: Approved Corrections Required DUE DATE: 08/30/18 Approved with Conditions n Denied (corrections entered in Reviews)' (ie: Zoning Issues) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only �j CORRECTION LETTER MAILED: / Ij �C v Departments issued corrections: Bldg? Fire 0 Ping 0 PW 0 Staff Initials: 12/18/2013 REVISION SUBMITTAL City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Web site: http://www.TukwilaWA.gov Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: 07 /°'t l M. Plan Check/Permit Number: ❑ Response to Incomplete Letter # Response to Correction Letter # ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner ❑ Deferred Submittal # Project Name: Project Address: Contact Person: pp-re-e_�=�� t� U S5 / t o tr•� 111-09-avi M.L.-D Summary of Revision: (Jp 1g-62.37 RECEIVED CITY OF TUKWILA SEP 0 4 2018 PERMIT CENTER Phone Number: v[-, -- 38'0 —y 7.2-7. L.,) U a -s p z /Z/77-. ' —/-IC tJf'lwrrF V'f}t-VE j% -r-rt G- PQb z- -r is11 Sheet Number(s): "Cloud" or highlight all areas of revision includ, v-)/1/1 in dat ofrii ionReceived at the Ci of Tukwila Permit Center b h' Y ❑ Entered in TRAK1T on 1 W:\Permit Center \Templates \ Forms \Revision Submittal Formdoc Revised: August 2015 CITY OF TUKWILA Department of Community Development 6300 Southcenter Boulevard, Tukwila, WA 98188 Telephone: (206) 431-367o FAX (206) 431-3665 E-mail: tukplan@ci.tukwila.wa.us Permit Center/Building Division 206 431-3670 Public Works Department 206 433-0179 Planning Division 206 431-3670 AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION PERMIT NO: D1(6 /Oflj 1 STATE OF WASHINGTON) ) ss. COUNTY OF KING D9/4 -)T1 --re) sn Y 9 QI`1'TL L [please print name] , states as follows: 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 to), 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. Owner/Owner's Agent* Signed and sworn ,t�o"before me this IP+ day of "J1/• ,201 . NOTARY State of Washington P BLIC in a1d for e Residing at ... /�� ,c�nty Name as commissioned: My commission expires: 18.27.090 Exemptions. Thef `estration provisions of this chapter do not appy?