HomeMy WebLinkAboutPermit PL18-0062 - HALL TREE - TREE PERMITHALL TREE
0042000415
PARENT FILE
PL18-0062
THIS FILE
L18-0072
TREE PERMIT/NON-SHORELINE
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CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-3670
TREE PERMIT
A. Tree Removal >8"/Hazardous
Trees on Vacant Lot
B. Work in Critical Root Zone
C. Heritage Tree Removal
D. Emergency Tree Removal/
Utility Work
Sensitive Area Tree Removal
E.
APPLICATION
FOR STAFF USE ONL Y
Planner:
File Number: (_j
_ col
Application Complete Date:
Project File Number:
lc_ 010vl-
Application Incomplete Date:
Other File Numbers:
. " 21a0
NAME OF PROJECT/DEVELOPMENT: +k\\
TYPE OF TREE PERMIT (CHECK APPROPRIATE BOX):
A.
Tree Removal for trees larger than 8-inches in diameter and on sites zoned single family and developed
with a single-family dwelling;
B.
Work in the Critical Root Zone;
C.
Heritage Tree Removal or pruning of Heritage Tree over 20% of existing crown
D.
Emergency Tree Removal/Utility Work
E.
Tree Removal in sensitive area outside of the shoreline jurisdiction.
BRIEF DESCRIPTION OF PROJECT: i))0&2,( iIfr, , eT --7Lres-S
LOCATION OF PROJECT/DEVELOPMENT: Give street address or, if vacant, indicate lot(s), block and
subdivision, access street, and nearest intersecti .
LIST ALL TAX LOT NUMBERS (this information may be found on your tax statement).
�- 2.Ltei
DEVELOPMENT COORDINATOR : The individual who:
• has decision making authority on behalf of the owner/applicant in meetings with City staff,
• has full responsibility for identifying and satisfying all relevant and sometimes overlapping development standards,
and
• is the primary contact with the City to whom all notices and reports will be sent.
Name: 2v55 ,L/i1-,
Address: /, /.(95'
Phone: 1 D(o `'5'4/ 4/6'O/
Signature:
E-mail:
Date:
RECEIVED
AUG 20 2018
Community
.-0evelopment
C:\Users\DCD-Admin\Documents\Forms\Permits\Tree Permit docx
Page 3 of 7
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-3670
AFFIDAVIT OF OWNERSHIP AND HOLD HARMLESS
PERMISSION TO ENTER PROPERTY
STATE OF WASHINGTON
COUNTY OF KING •
The undersigned being duly sworn and upon oath states as follows:
1. 1 am the current owner of the property which is the subject of this application.
2. All statements contained in the applications have been prepared by me or my agents and are true and correct to the best of my
knowledge.
3. The application is being submitted with my knowledge and consent.
4. Owner grants the City, its employees, agents, engineers, contractors or other representatives the right to enter upon Owner's real
property, located at l ,. D S! 57.�c1 c�S for the purpose of application review,
for the limited time necessary to complete that purpose.
5. Owner agrees to hold the City harmless for any loss or damage to persons or property occurring on the private property during the
City's entry upon the property, unless the loss or damage is the result of the sole negligence of the City.
6. Non -responsiveness to a City information request for ninety (90) or more days, shall be cause to cancel the application(s) without
refund of fees.
EXECUTED at
(city), (state), on , 20
(Print Name)
(Address)
(Phone Number)
(Signature)
On this day personally appeared before me to me known to be the individual who
executed the foregoing instrument and acknowledged that he/she signed the same as his/her voluntary act and deed for the uses and
purposes mentioned therein.
SUBSCRIBED AND SWORN TO BEFORE ME ON THIS
+4
DAY OF , 20
NOTARY PUBLIC in and for the State of Washington
residing at
My Commission expires on
C:\Uscrs\DCD-Admin\Documents\Forms\Pcrmits\Tree Permitdocx Pagc 4 of 7
Cash Register Receipt
City of Tukwila
DESCRIPTIONS
ProjectTRAK
ACCOUNT
QUANTITY
PAID
$120.05
L18-0072 Address: 15103 515T AVE 5 BLDG 1
Apn: 0042000415
$120.05
Credit Card Fee
$3.50
Credit Card Fee
R000.369.908.00.00
0.00
$3.50
TECHNOLOGY FEE
$5.55
TECHNOLOGY FEE
R000.322.900.04.00
0.00
$5.55
TREE AND LANDSCAPE MOD
$111.00
NON -SHORELINE
TOTAL FEES PAID BY RECEIPT: R15187
R000.322.100.00.00
0.00
_
$111.00
$120.05
RECEIVED
AU6 20 2018
Date Paid: Monday, August 20, 2018 e�e Am nt
Paid By: HALL RUSS
Pay Method: CREDIT CARD 200818A42-05971976-D
Printed: Monday, August 20, 2018 11:24 AM 1 of 1
CSYSTEMS