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Home My WebLink AboutReport 01Denis Law· Mayor November 24, 2009 Deborah and Ken Root 18036 118 th Ave SE Renton, WA 980S8 Department of Community and Economic Development Alex Pietsch, Administrator Subject: Extension of Root Medical Hardship Temporary Use Permit 18036 118th Ave SE King County File #B01L0762, City File #LUA08-143 Dear Mr. and Mrs. Root: King County had previously granted you a temporary use permit for locating a manufactured home on a lot with one existing Single-family residence in a residential single-family zone due to medical hardship. The City of Renton will continue to honor the original permit issued by King County. This letter is to inform you that we have extended your Temporary Use Permit until November 28, 2010. The November 6, 2009 phychiatrist's letter submitted by Dane Wingerson demonstrates continued medical hardship. Please note that approval of the extension is subject to the original conditions of approval of the Temporary Use Permit. Please let us know in writing by late October of 2010 if you will be needing another permit extension, Please reference your City file number (LUA08-143) and attach an updated doctor's affidavit. Currently, there is no fee for medical permit extensions. If you have any questions regarding this letter, feel free to contact me at 425-430-7294. Sincerely, .. ~~fl~ Laureen Nicolay, Senior Planner Planning Division c: File LUA08-143 . . RentorlCit} Hall • 1055 South Grady Way • Renton, Washington 98057 • rentonwa.gov Nov. 2009 To: The City of Renton Laureen Nicolay From: Deborah Root 18036 118th Ave. S.E. Renton. Wa. 98058 Reference: City file #LUA08-143 TP Old King County #B01L0762 Enclosed is the letter you requested from the Veterans Administration medical staff in support of the continued use of the mobile home on our property for my disabled brother. Michael Corbett. Also. could you please clear something up for us? Your letter states that we are in a single family zone. However. according to the City of Renton Municipal code under the maximum housing density category. a R-4 zone is 4 dwelling units per 1 net acre. We have 2/3 of an acre. How should we interpret this information? Thank you very much for your assistance. Sincerely. Deborah Root American Lake Division Tacoma. WA 98493·5000 Seattle Division Seattle. WA 98108·1597 November 6, 2009 To The City of Renton RE: Michael Corbett SS# Ladies and Gentlemen: PARTMENT OF VETERANS AFFAI Puget Sound Healthcare System 1660 South Columbian Way Seattle, WA 98108·1597 In Reply Refer To: S-116-MHC Mr. Corbett has been treated for a severe and persistent psychotic disorder at the Seattle VA medical center since 1997. The treatment team here including Psychiatrists, psychologist, psychiatric nurses and MSW social workers believe it is absolutely necessary that Mr. Corbett lives very near his family. Mr. Corbett has a severe and persistent psychiatric condition that necessitates constant monitoring. Even at night Mr. Corbett has issues that need attention. At times he is incontinent of urine, he has dreams, walks in his sleep etc. Caring for Mr. Corbett is a 24 hour a day job. Mr. Corbet"s medications must be monitored. In other words the care giver sets the meds up and observes him taking each and every dose. He is not reliable to take his medications on his own and he has a history of non compliance with medications. When Mr. Corbett does not take his medications his psychiatric condition become unmanageable and this leads to commitments to psychiatric facilities. Mr. Corbett needs help and direction with his activities of daily living. His ADL's include eating, dressing, washing himself, keeping clothes clean, brushing his teeth etc. He requires assistance in getting to his outpatient appointments and community programs. It is ideal to have · . c family involved. So many of the Veteran's in Mike's situation have no support. Often the families are "burnt out" and have lost patience with the high intensity of care this population requires. Mr. Corbett's family is very committed to his care. We hope to support Mr. Corbett's highest level of independence which separate quarters will promote. At the same family provided daily care is a must. It is not often we have this kind of family involvement and support, We highly support the housing plan made possible by the City of Renton and the Root family. If you need more information, please call me at 764-2874. Sincerely, Dane Wingerson Psychiatrist Mary Lou McClure psychiatric RN Carol Guthrie psychiatric RN Ii, CITY OF RENTON DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT MEMORANDUM Date: April 17, 2009 To: City Clerk's Office From: Stacy Tucker Subject: Land Use File Closeout Please complete the following information to faCilitate project closeout and indexing by the City Clerk's Office Project Name: Root Medical Hardship LUA (file) Number: LUA-08-143, TP Cross-References: King County File #B01L0762 AKA's: Project Manager: Laureen Nicolay Acceptance Date: December 17, 2008 i Applicant: Deborah & Ken Root Owner: same as applicant Contact: same as applicant PID Number: 6197200383 ERC Decision Date: ERC Appeal Date: Administrative Approval: December 18, 2008 Appeal Period Ends: December 30, 2008 Public Hearing Date: Date Appealed to HEX: By Whom: HEX Decision: Date: Date Appealed to Council: By Whom: Council Decision: Date: Mylar Recording Number: " Project Description: Temporary siting of a manufactured home on a lot with one existing single- family residence in a residential single-family zone. Location: 18036 118'h Avenue SE Comments: CITY C RENTON December 17, 200S Deborah and Ken Root IS036 IISth Ave SE Renton, WA 9S05S Department of Community and Economic Development Alex Pietsch, Administrator Subject: Extension of Root Medical Hardship Temporary Use Permit IS036 IISth Ave SE King County File #801 L0762, City File #LUAOS-143 Dear Mr. and Mrs. Root: Your property was recently annexed into the City of Renton. King County Department of Development and Environmental Services forwarded the file history for Building Permit #80 I L0762. The County had previously granted you this temporary use permit for locating a manufactured home on a lot with one existing single-family residence in a residential single-family zone due to medical hardship. The City of Renton will honor the original permit issued by King County. This letter is to inform you that we have extended your Temporary Use Permit until November 28, 2009. The November 12, 200S physicians affidavit submitted by Dr. E. Alexandra Ashleigh demonstrates continued medical hardship. Please note that approval of the extension is subject to the original conditions of approval of the Temporary Use Permit. Please let us know in writing by late October of2009 if you will be needing another permit extension. Please reference your City file number (LUAOS-143) and attach an updated doctor's affidavit. Currently, there is no fee for medical permit extensions. If you have any questions regarding this letter, feel free to contact me at 425-430-7294. Sincerely, Laureen Nicolay, Senior Planner Development Planning Division lOSS South Grady Way -Renton, Washington 98057 @ ThiS p<lpm l.O<1'Cl,nS '.,,-".% n;.cvcled mat!o'rl<li 30'1" post consumor ;\Hf:\j) or I fir CLRVE City of Renton Department of Community and Economic Development Extension of Temporary Use Permit Project Name: Renton File Nnmber: Location: Project Description: Property Owner: Root Medical Hardship Temporary Use Permit LUA08-143, TP 18036 IISth Ave SE Temporary siting of a manufactured home on a lot with one existing single family residence in a residential single-family zone. Deborah and Ken Root 18036 I 18 th Ave SE Renton, W A 9S058 Date of Original Permit Issuance: November 28,2001 (King County) Last County Expiration Date: November 28, 200S City Extension Granted until: November 28, 2009 Date of Expiration: November 28, 2009 Period of Validity: One year Conditions of Approval: I. Pursuant to RMC 4-9-240L3 further extensions ofthe temporary use permit based on a medical hardship must be applied for prior to expiration of this extension and are subject to demonstration of continuing medical hardship. 2. This extension expires with cessation of the medical necessity underlying the temporary use. 3. The manufactured home shall be removed within ninety days of expiration of this extension. , Approved by Chip Vincent Planning Director , Date Appeals: Appeals of permit issuance must be filed in writing by 5:00 pm on December 30, 20l\9 together with the required $75.00 application fee to the City of Renton Hearing Examiner, City of Renton, 1055 South Grady Way, Renton, WA 98057. Appeals to the Examiner are governed by the City of Renton Municipal Code Section 4-8-110. Additional information regarding the appeal process may be obtained from the Renton City Clerk's Office, (425) 430-6510. William Scharer General Inspector III Building Inspection Section Building Services Division ~ King County Department of Development and Environmental Services OAK-DE-OIOO 900 Oakesdale Avenue Southwest Renton, WA 98057-5212 bill.scharer@kingcountY·9 0v www.kingcounty.gov 206-296-6775 Fax 206-296-7002 TIY 206-296-7217 .~-;;:-> xi· Wood. Bob·H From: Wood, Bob-H Sent: To: Monday, November 17, 2008 4:15 PM Scharer, Bill Cc: Rubalcaba, Vicki; Moore, Bernard Subject: B01 L0762: MHMH NOW WITHIN CITY OF RENTON Bill & Vicki: I did not post any fee on this -see explanation below that I've entered under the permit's comments (as a Notice). Could not figure how to even post it as a "manual" entry without assigning some sort of classification number to it, so that's why I went to Kim (since Mary is off on Mondays) to make sure to do it as per their wishes. Just make sure we let them know soon about what to do about the check they are holding. Following is my entry in the file: "11/17/08: Rcvd extn fee (copy of check fm/Finance) this date; found site annexed to City of Renton effective 3/1/2008; Checked with Kim Simpson as to how wanted the $236.00 posted; she prefers we do not post any fee at all, but will have Cashier hold actual check until we decide if any fee will be charged -or permit just sent to Renton. If no fee, then Finance will simply return their check to them; Permit to BSCH to process; Assigned SUSPEND status until transfer (or whatever) is completed. We are to let Kim know decision ASAP so we don't hold "live" check too long." Thank you ... BWoo Bob Wood Administrative Specialist II Building Inspections Section DOES/Building Services Division 206-296-7111 bob-h. wood@kingcounty.gov 1 Wood. Bob-H From: Wood, Bob-H Sent: To: Monday, November 17, 2008 4:15 PM Scharer, Bill Cc: Rubalcaba, Vicki; Moore, Bernard Subject: B01 L0762: MHMH NOW WITHIN CITY OF RENTON Bill & Vicki: I did not post any fee on this -see explanation below that I've entered under the permit's comments (as a Notice), Could not figure how to even post it as a "manual" entry without assigning some sort of classification number to it, so that's why I went to Kim (since Mary is off on Mondays) to make sure to do it as per their wishes, Just make sure we let them know soon about what to do about the check they are holding. Following is my entry in the file: "11/17/08: Rcvd extn fee (copy of check fm/Finance) this date; found site annexed to City of Renton effective 3/1/2008; Checked with Kim Simpson as to how wanted the $236.00 posted; she prefers we do not post any fee at all, but will have Cashier hold actual check until we decide if any fee will be charged -or permit just sent to Renton. If no fee, then Finance will simply return their check to them; Permit to BSCH to process; Assigned SUSPEND status until transfer (or whatever) is completed. We are to let Kim know decision ASAP so we don't hold "live" check too long." Thank you ... BWoo Bob Wood Administrative Specialist II Building Inspections Section DOES/Building Services Division 206-296-7111 bob-h. wood@kingcounty.gov 1 iii, Special Alerts For BOll1l762 Ei Monday, Nov 17, 2008 03:35 PM Bobby Printout , 801 L0162 Alerb Parcel Alerts I , , , , , , Alerts Inherited from the Parcel T ,p~, ."J P alcel No I Text ,,">, L J ~ Notice j 61 97?O',Q;383 J Annexed to the _g~ 01 Renton effective March 1. 2QQ8. cit,!! ordinance 5327. j !;ontinue 7i,ce i ;',Jf)f<ce' ;:'.nnc':,.f')": !A r:;:eni(',j', z>!i;;:d '.i<, H-:y( '·'ue. (Ii'.! :),di ~ .. t: .. W. ROOT DEBORAH,G. CORBEn·ROOT 1eQ36 llBrnAVE. S,E, 425-277-2J)68 " AENT()N;WA90058 ~";;l;k;ti';F<";'>;iit~'" , .. ', ~;~(h-p(Co ;l1a,605 ,~ Ii, ""',; , .' ,.' I f-./z. ::o:ot DATE 10-211250 ~~~#:17¢¢. 0 f:Qe\Je(l2f'~.ewf:+-~f'viVQt\III1M~ $ ~.oo ~i Jd:hy~dved 'itt 1\?:"N§r~ " ~ t;1oo _ POLlA", fD ilii"1,, sANK OF AIIERICA , PINE LAJ(E BAANCH 030801 J ::"~.ii~~D. S.E.. NO. 313 v~ur;Qt.:usTOMER SINCE 1990 ' =""'c...+.l,Ll.il· )LU,j~--bt..1.J!.L& Z-""'------_~,' •. _ •• _.,.~ .. I: -,,'. ,'\'I'1G COUNTY S " eTION ;c\IJILOING INSPE , /I/;~ -.?7¥/ JW-t-'16 t; y--s:i£ E JM;4.I-L ~. r ...... ~~ Xen & ve66ie 'Root 18036 118tfi .Ave. SF ]{ent"n. W.A9805 8 t ~tvtli ,.t,e-s;-/ .. ( ~ U£ . ~ao soc FS\~ ,I I_,=, I~ Department of Development and Environmental Services 900 Oakesdale Avenue SW Renton, WA 98057-5212 Subtype Date Issued Page 2 of2 Status ROOT DEBORAH & KEN@je==J~~i;;~~~~~~~~~~~~~~~~~~~1 180361l8TH AVE SE I FOR RENTON WA 98058 Date: 11 128/2008 xtension Fees: $236.00 This notice is intended to illfonn you that your Medical Hardship Pemllt has expired. If you do not extend your permit or w)tify us that you do not need this pennit within 10 days of the date ofthi5 letter, your permit \vi11 be referred to code enforcement. for your convenience we will issue your pennit extension by mail. To obtain your permit extension, please submit a check or money order made payable to the King County Office of Finance, along with your completed physicians affidavit. This affidavit lVlust be completed by your attending physician cach year that you request a medical hardship pennit extension. If you hdVC any questions about this extension, please contact Building Inspections at (206)296-6630. Medical Hardship Mobile Home Physician Affidavit To: Applicant's Physician: This form is required to be completed EACH YEAR ""'hen a permit extension is requested by the applicant. As the physician for 7'1\ .. (~._~ j"#'t..Cit.eJ2 at b etf ,I hereby verify that this person requires "daily care". PhysiCian (Srg;rature Reljuirep) Q'It (-Q (jp-/~ /1/\ i) Date __ J I I (-'~-f 0 f f Office Address~' ~'----l' L/c'-'/'2?t~. o"--'-'O'------=:;c::....:.. 10127;2008 soc I~t't Department of Development D and Environmental Services KingCoufity 900 Oakesdale Ave SW Renton, Washington 98057-5212 November 17, 2008 Summary of Charges and Payments ----~---------------------------------------r------~----~--~-- Applicant: ROOT, DEBORAH & KEN ! Activity Number: 18036 118TH AVE SE I Project Number: Page 1 of 1 BOIL0762 RENTON, WA 98058 ; Development Number: , Permit Type: MEDI-MII SUSPEND (425) 277-2868 Charges Description Bldg ExtensionlNo hourly Bldg FircFlow Review Bldg Insp Counter Fee Bldg Inspection Counter Service Fees Health-Septic Sys. Cerl. State Building Code SUB TOTAL CHARGES: Payments , Status: Amount $531.32 $165_00 $410.56 $275.00 $187.00 $210.00 $4.50 $1,783.38 Description Check # Checklogid Payee Date Entered Amount Check 3544 ROOT, DEBORAH & KEN 6/19/2001 ($562.00) Check 3780 ROOT, DEBORAH & KEN 11128/2001 ($279.50) Suspense Account 5410 76760 KENWROOT 11124/2004 ($235.47) Suspense Account 5994 89766 ROOT, KEN W. & CORBETT-ROOT, DEBORAH G. 12/13/2005 ($235.47) Suspense Account 6138 101145 ROOT, KEN W. & CORBETT-ROOT, DEBORAH G. 11122/2006 ($235.47) Suspense Account 6621 115937 ROOT, KEN W & CORBETT-ROOT, DEBORAH G 11130/2007 ($235.47) SUB TOTAL PAYMENTS: ($1,783.38) BALANCE: so.oo [The fees shown above represent current charges as of this date and are an estimate based on the information iprovided to DOES at the time of application. IFor services that are rendered on an hourly baSiS, the cost of those services will be based on the actual hours Iworked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with :any other outstanding fees. !Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be !billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. ______ ---1 soc DOES King County Department of Development and Environmental Services 9()O Oakesdale Ave SW Renton, Washmgton 98057-52 \2 November 17, 2008 Page 1 of 1 Summary of Related Activities/Projects/Dev. Applicant: ROOT, DEBORAH & KEN 18036118THAVESE RENTON, WA 98058 (425) 277-2868 Activity/Project # BJ11LQ762 B03X0115 B03X1230 TOTAL: Comp Type MEDI-MH EXTENSN EXTENSN Status SUSPEND EXT-CLSD EXT·CLSD ~.,-~~~~~--~,--I Activity Number: Project Number: De,,'elopment Number: 'O'''''' I MEDI-MH Status: Fee Charges Hours Charges $1,783.38 $0.00 $224.25 $0.00 $224.25 $0.00 $2,231.88 $0.00 .. ~ ... -~~.~ .... ~--..•. -.. -•.•.•..... SUSPEND Payments $1,783.38 $224.25 $224.25 $2,231.88 Balance Due $0.00 $0.00 $0.00 $0.00 ;The fees shown above represent current charges as of this date and are an estimate based on the information jprovided to DOES at the time of application. IFor services that are rendered on an hourly basis, the cost of those services will be based on the actual hours Iworked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. 0 __ ._." _ •• _._._"_"._"_"_"_"_"_" __ "."_. _________ ~~~ _______ ~_.~ _______ "______ • __ "_" ___ "_"_"_._. ___ ••••• _ Monday, Nov 17, 2008 03:41 PM Bobby Printout Site Address: jROOLKENW lROOT, DEBORAH!; KE,N , .... 8,."" II 001"'" It 11)1"" ...... " •• " ... " "" " ...... :!': ",,',!::"::~,",." Legal: INW 33-23-05 [iT Claos Code: 025 Inspecl"",,;,re,, IGREEN420 E niered 8)1: I PinTMPHA Issued by: 18wOO Applied: 106/1912001 Application Comple~~: L/_I_ VeslingDale: Ci:7._ Approved: 111127/2001 I .. ued: h 1/28/2001 I ............. ,.,.... .... . Dale Entered j!l6/1812001 Validaled bV: I I~I~I _._---------- FINAL AP' ~9VAL; It Number: Department of Development .' ate Issued: and Environmental Services Inspector: .. 4i'l-----::""-7"ft-.... -"'--J:j. King County B01L0762 11/28/2001 1112812008 900 Oakesdale Avenue Sout west Renton, Washington 98055-1)'late: ---"---"---- ;lff~ C /7MJ.5F&l-GD (Jtrj m:KGJ7lJiJ Permit Type, Subtype: MEDI-MH, MOBILE T";:~ ..: . :801L0762: 61li WlMH EXTN Description: MEDICAL HARDSHIP MOBILE HOME PERMIT FOR MICHAEL CORBETT Location: LOT 3 BLOCK 2 NORTHWESTERN GARDEN TRS DIV#2 List of Parcels: 619720-0383 Site Address: 18036 118TH AVE SE KC Valuation: $0.00 Applicant Name: ROOT, DEBORAH & KEN Comments and Conditions 1. Work Subject to Approved Plans and Conditions. Work authorized by this permit is subject to the approved plans and corrections shown thereon and the attached conditions of permit approval. Failure to comply with all conditions once construction is begun may necessitate an immediate work stoppage until such time as compliance with the stipulated conditions is attained. 2. Posting on the job site. This permit must be posted on the job site at all times in a visible and readily accessible location. 3. Scheduling Inspections. Inspection requests for residential, commercial/multifamily, and new construction fire permits may be scheduled by calling the DDES Voice Inspection Line at 1-888-546-7728. This request line is available 24 hours a day, 7 days a week for your convenience. Inspection requests must be called in prior to 3:00 pm, M-F to appear on the schedule for the following business day. Inspectors are available by phone M-F, 7:30 am to 8:30 am only at 206-296-6630. Scheduling and inspector availablility is subject to approved holidays. You may obtain inspection results by calling the DDES Voice Inspection Line, reviewing the inspection information left on site, or contacting the inspector of record. You may obtain general inspection information M-F, 7:30 am to 4:30 pm at 206-296-6630. 4. Expiration. Please note the expiration date on this pennit located in the upper right comer. A permit may he extended or renewed in accordance with the King County Code only if a request to do so is received at least 30 days prior to the expiration date. 5. Compliance with State and Federal laws and the Endangered Species Act. The applicant is responsible for making a diligent inquiry regarding the need for concurrent state or federal permits to engage in the work requested under this permit, and to ohtain the required pennits prior to issuance of this permit. It is understood that the granting of this penni( shall not be construed as satisfying the requirements of other applicable Federal, State or Local laws or regulations. In addition this permit does not authorize the violation of regulations. In addition, the granting of this permit does not authorize the violation of the Endangered Species Act as set forth at 16 U.S.c. § 1531-1543, including the prohibition on the "take" of threatened or endangered species. "Take" is defmed at 16 U.S.c. § 1532(19). It is the applicants sole responsibility to determine whether such "take I! restrictions would be violated by work done pursuant to this permit, and is precluded by Federal Law from undertaking work authorized by this permit if that work would violate the "take" restrictions set forth at 16 U.S.c. §1538. 50 C.F.R. § 17.21, 50 C.F.R. § 17.31, 50 C.F.R. §223 and 50 C.F.R. §224. 6. Fees due: Enforcement. The King County Code states that fees associated with the review and inspection of projects requiring permit applications are due at the time of application for service, or within fifteen days of receipt of an invoice from King County's Department of Development and Environmental Services (DDES) stating that currently hourly rates are due. DDES may require a deposit of between twenty to eighry percent of the total cost of the review and inspection of a permit application at the time of application. Failure to pay fees in a timely manner is a civil violation. It is King County's policy (0 take enforcement action including, but not limited to, the issuance of a Notice and Order andlor Stop Work Order, when an applicant has violated the King County Code by failing to pay fees when due. By accepting issuance of this permit, the applicant acknowledges that if he/she fails to pay fees when due, DDES may bring a code enforcement action to recover unpaid fees. 1012612004 OFFICE COPY ., ~ ;', ~' ,'. ~ • NC.·.·. IN soc ROOT, DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 Department of Development and Environmental Services 900 Oakesdale Avenue SW Renton, WA 96057-5212 Page 1 of2 KING COUNTY Status This notice is intended to remind you that this pennit will expire on the date referenced above. Permit extensions are issued for a one year period and must be accompanied with a Physicians Affidavit, provided below. This affidavit must be completed by the attending physician each year that a medical hardship condition exists. To obtain a permit extension by mail, please submit a check or money order in the amount indicated above; made payable to the KC Office of Finance. Please indicate, 'Building Inspections' and the permit number on your payment. By the expiration date, please mail the pennit extension fee and the original completed Physicians Affidavit to: KC DDES -Building Inspections 900 Oakesdale Avenue SW Renton,WA 98057-5212 ~rt?~-o? -.tLbv You may contact DDES, Building Inspections at 206-296-6630 for any questIOns regarding building pelmit ex",s~o/ procedures for this pennit. III z /! t77 MedicllLHardship Mobile Home J'hysicianAffidavit To Applicant's Physician: This fonn is required to be completed by the attending physician each year the medical hardship condition exists. As the Attending Physician for -1.t\--'.·~lc.ha=-"""e.t""L-'C ....... ::ov17"~JL ... etr~.1-___ ' I hereby verify that this person requires "daily care". Physician (Signature Required) __ ..,t:"""""cd2'-,O'...'----'L--",;,~~)FP?-==---==----~--'----=I.---~, ~~,~ Date _-,-1-'\-77ft~'t-='iHJ",----,Q~· _-="<'--Phone Number --1(L"'22:="""-t)~-I~Ao=-'-\~---'2--=--""-"'-'l---'-- Medical Facility Address Stamp: ~l ,,,,vJ, ~'<X1b '-'''' \l soc King County Department of Development and Environmental Services 900 Oakesdale Ave S W Renton, Washington 98057-5212 November 30, 2007 Page 1 of 1 Summary of Charges and Payments ,-~------------------------I Applicant: ROOT, DEBORAH & KEN Activity Number: 18036 118TH AVE SE Project Number: BOlL0762 RENTON, WA 98058 Development Number: (425) 277-2868 Char cs Description Bldg ExtensionINo hourly Bldg F ireFlow Review Bldg Insp Counter Fee Bldg Inspection Counter Service Fees Health-Septic Sys. Cerl. State Building Code SUB TOTAL CHARGES: Payments Permit Type: Status: Description Check # Checklogid Payee Check 3544 ROOT, DEBORAH & KEN Check 3780 ROOT, DEBORAH & KEN Suspense Account 5410 76760 KENWROOT Suspense Account 5994 89766 ROOT, KEN W. & CORBETT-ROOT, DEBORAH G. Suspense Account 6138 101145 ROOT, KEN W. & CORBETT-ROOT, DEBORAH G. SUB TOTAL PAYMENTS: BALANCE: MEDI-MH EXTENDED Date Entered 6/19/2001 11128/2001 11124/2004 1211312005 1112212006 Amount $531.32 $165.00 $410.56 $275.00 $187.00 $210.00 $4.50 $1,783.38 Amount ($562.00) ($279.50) ($235.47) ($235.47) ($235.47) ($1,547.91) $235.47 r~:v~~:~ ~~';,,;nE~b:tVt~~eC~:~~~~~;~~~t~~~.argeS-aSOfihiS date-aii'dare an estimate based ontiieinformatiO;:;~ For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. ® FINAL APPROVAL King County Permit Number: B01L0762 11/28/2001 Department of Development and Environmental Services Inspector: _________ -E!D=ate~lssued: "" ~.J.,.' • I ~, ~~ I" 900 Oakesdale Avenue Southwest Renton, Washington 98055-1219 0111\1:========-===,"-, __ =_ Construction Permit Permit Type, Subtype: MEDI-MH, MOBILE tJlllij! B01 L0762: 5TH - 1 YR MHMH EXl biiscrrplion:MEDtCAtHARDSHff>MeeltE~ME (DOUBLE-WIDE 1981 FUQUNPARKWAY, 2 BDRMS/1 BATH, 28X36; FOR MICHAEL CORBEn Applicant Name: NW 33-23-05: L3 Blk2 Northwestern Garden Tr 619720-0383 18036118TH AVE SE~ $0.00 :, ROOT, DEBORAH & KEN Comments and Conditions ~ -- 1. Work Subject to Approved Plans and Conditions. Work authorized by this permit is subject to the approved plans and corrections shown thereon and the attached conditions of permit approvaL Failure to comply with all conditions once construction is begun may necessitate an immediate work stoppage until such time as compliance with the stipulated conditions is attained. 2. Posting on the joh site. This permit must be posted on the job site at all times in a visible and readily accessible location, 3. Scheduling Inspections. Inspection requests for residential, commercial/multifamily, and new construction fire permits may be scheduled by calling the DDES Voice Inspection Line at 1-888-546-7728, This request line is available 24 hours a day, 7 days a week for your convenience. Inspection requests must be called in prior to 3:00 pm, M-F to appear on the schedule for the following business day, Inspectors are available by phone M-F, 7:30 am to 8:30 am only at 206-296-6630, Scheduling and inspector availablility is subject to approved holidays, You may obtain inspection results by calling the DOES Voice Inspection Line~ reviewing the inspection information left on site, or contacting the inspector of record. You may obtain general inspection information M-F, 7:30 am to 4:30 pm at206-296-6630. 4. Expiration. Please note the expiration date on this permit located in the upper right corner, A permit may be extended or renewed in accordance with the King County Code only if a request to do so is received at least 30 days prior to theexpiration date, 5. Compliance with State and Federal laws and the Endangered Species Act. The applicant is responsible for making a diligent inquiry regarding the need for concurrent state or federal permits to engage in the work requested under this permit, and to obtain the required permits prior to issuance of this permit. It is understood that the granting of this permit shall not be construed as satisfying the requirements of other applicable Federal, State or Local laws or regulations, In addition this permit does not authorize the violation of regulations. In addition, the granting of this permit does not authorize the violation of the Endangered Species Act as set forth at 16 u_s,c. § 1531-1543, including the prohibition on the "take" of threatened or endangered species, "Take" is defined at 16 U.S,c. § 1532(19), It is the applicants sole responsibility to determine whether such "take" restrictions would be violated by work done pursuant to this permit, and is precluded by Federal Law from undertaking work authorized by this permit ifthat work would violate the "take" restrictions set forth at 16 U.S,c. §1538, 50 C,F,R, §17,21,50C,F,R, §17,31,50C.F.R, §223 and 50 C.F,R. §224, 6. Fees due: Enforcement. The King County Code states that fees associated with the review and inspection of projects requiring permit applications are due at the time of application for service, or within fifteen days of receipt of an invoice from King County's Department of Development and Environmental Services (DOES) stating that currently hourly rates are due, DOES may require a deposit of between twenty to eighty percent of the total cost of the review and inspection of a permit application at the time of application. Failure to pay fees in a timely manner is a civil violation. It is King County's policy to take enforcement action including, but not limited to, the issuance of a Notice and Order and/or Stop Work Order, when an applicant has violated the King County Code by failing to pay fees when due, By accepting issuance of this permit, the applicant acknowledges that if he/she fails to pay fees when due, DOES may bring a code enforcement action to recover unpaid fees_ 1012612004 INSPECTORS COPY soc • King County Department of Development and Environmental Services 900 Oakesdale A't'c S W Renton, Washington 98055·1219 November 21, 2006 Summary of Charges and Payments Applicant: , "I Activity Num ber: I' Project Number: Page 1 of 1 BOIL0762 ROOT, DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 : Development Number: i Permit Type: MEDI-MH EXTENDED (425) 277-2868 Chan.!cs Description Bldg FireFlow Review Bldg Insp Counter Fee Bldg Inspection Bldg Inspection!No Hrly Counter Service Fees Health-Septic Sys. Cer(. State Building Code SUB TOTAL CHARGES: Pa) Il1cnts , Status: Description Check Check # Checklogid Payee 3544 ROOT, DEBORAH & KEN Check 3780 Suspense Account 5410 76760 Suspense Account 5994 89766 SUBTOTAL PAYMENTS: BALANCE: ROOT, DEBORAH & KEN KENWROOT ROOT, KEN W. & CORBETT-ROOT, DEBORAH G. PAID I tberl-A 6134 $,?'3I' '\ Amount $165,00 $205.28 $275.00 $265.66 $187.00 $210.00 $4.50 $1,312.44 Date Entered Amount 6/19/2001 ($562.00) 11/28/2001 ($279.50) 11/24/2004 ($235.47) 12113/2005 ($235.47) ($1,312.44) $0.00 'The fees shown above represent current charges as of this date and are an estimate based'o'n the information [provided to DOES at the time of application. iFor services that are rendered on an hourly basis, the cost of those services will be based on the actual hours !worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with lany other outstanding fees. [Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be 'billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. ROOT, DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 Oepartment of ll!MIelopment and Ernllroomontel Sor~i""", 9)0 Oake:sdaie Avenue SV·/ King CountV R~on. WA 96G'55~ t 21 S Page 1 of2 status This notice is intended to remind you that this penn it will expire on the date referenced above. Permit extensions are issued for a one year period and must be accompanied with a Physicians Affidavit, provided below. This aftidavit must be completed by the attending physician each year that a medical hardship condition exists. To obtain a permit extension by mail, please submit a check or money order in the amount indicated above; made payable to the KC Office of Finance. Please indicate, 'Building Inspections' and the penn it number on your payment. By the expiration date, please mail the pennit extension fee and the original completed Physicians Affidavit to: KC DOES -Building Inspections 900 Oakesdale Avenue SW Renton,WA 98055-1219 You may contact DOES, Building Inspections at 206-296-6630 for any questions regarding building permit extension procedures for this permit. Medical Hardship Mobile Home Physician Affidavit To Applicant's Physician: This form is required to be completed by the attending physician each year the medical hardship condition exists. As the Attcnding Physician for ---\.M-->-.. ich=~QLe~_~~l_~C.o~~v_12~e_±t:o\-'~ __ , I hcrcby verify that this person requires "daily care". Physician (Signature ReQUiredl __ +[J--,==-,_, __ ... ~_' _'--_«-'"'--__ (b---'~'---(fL flit }) (I ( f ( D (0 Phone Number d°Ce -7 G l( ~ d.S--:;--tj VA MEDICAL CENTER (116 MHC) 1560 _____ ~~~-~~~V~ffi~------- [Jate Medical Facility Address Stamp: 93138 '-""""",_ (®. King County FINAL APPROVAL Permit Number: Department of Development Inspector: ___________ "iD~a~t:5e_;;:lssued: and Environmental Services Expiration Date: 900 Oakesdale Avenue Southwest Permit Status: Renton, Washington 98055-1219 Date: _____________ _ Construction Permit Permit Type, Subtype: MEDI-MH, MOBILE Title: B01L0762: 4TH -1YR MHMH EXT Description: MEDICAL HARDSHIP MOBILE HOME (DOUBLE-WIDE 1981 FUQUNPARKWAY, 2 BDRMS/1 BATH, 28X36; FOR MICHAEL CORBETT Location: List of Parcels: Site Address: Valuation: Applicant Name: NW 33-23-05: L3 Blk2 Northwestern Garden Tr 619720-0383 18036 118TH AVE SE KC $0.00 ROOT, DEBORAH & KEN Comments and Conditions B01L0762 11/28/2001 11/28/2006 EXTENDED I. Work Subject to Approved Plans and Conditions. Work authorized by this permit is subject to the approved plans and corrections shown thereon and the attached conditions of permit approval. Failure to comply with all conditions once construction is begun may necessitate an immediate work stoppage until such time as compliance with the stipulated conditions is attained. 2. Posting on the job site. This permit must be posted on the job site at all times in a visible and readily accessible location. 3. Scheduling Inspections. Inspection requests for residential, commercial/multifamily, and new construction fire permits may be scheduled by calling the DOES Voice Inspection Line at \-888-546-7728. This request line is available 24 hours a day, 7 days a week for your convenience. Inspection requests must be called in prior to 3:00 pm, M-F to appear on the schedule for the following business day. Inspectors are available by phone M-F, 7:30 am to 8:30 am only at 206-296-6630. Scheduling and inspector availablility is subject to approved holidays. You may obtain inspection results by calling the DDES Voice Inspection Line, reviewing the inspection information left on site, or contacting the inspector of record. You may obtain general inspection information M-F, 7:30 am to 4:30 pm at206-296-6630. 4. Expiration. Please note the expiration date on this permit located in the upper right comer. A permit may be extended or renewed in accordance with the King County Code only if a request to do so is received at least 30 days prior to theexpiration date. 5. Compliance with State and Federal laws and the Endangered Species Act. The applicant is responsible for making a diligent inquiry regarding the need for concurrent state or federal permits to engage in the work requested under this permit, and to obtain the required permits prior to issuance of this permit. It is understood that the granting of this permit shall not be construed as satistying the requirements of other applicable Federal, State or Local laws or regulations. In addition this permit does not authorize the violation of regulations. In addition, the granting of this permit does not authorize the violation of the Endangered Species Act as set forth at 16 U.S.c. § 1531-1543, including the prohibition on the "take" of threatened or endangered species. "Take" is defined at 16 U.S.c. § 1532(19). It is the applicants sole responsibility to determine whether such "take" restrictions would be violated by work done pursuant to this permit, and is precluded by Federal Law from undertaking work authorized by this permit if that work would violate the "take" restrictions set forth at 16 U.S.C. § 1538, 50 C.F.R. §17.21, 50 C.F.R. §17.31, 50 C.F.R. §223 and 50 C.F.R. §224. 6. Fees due: Enforcement. The King County Code states that fees associated with the review and inspection of projects requiring permit applications are due at the time of application for service, or within fifteen days of receipt of an invoice from King County's Department of Development and Environmental Services (DOES) stating that currently hourly rates are due. DOES may require a deposit of between twenty to eighty percent of the total cost of the review and inspection of a permit application at the time of application. Failure to pay fees in a timely manner is a civil violation. It is King County's policy to take enforcement action including, but not limited to, the issuance of a Notice and Order and/or Stop Work Order, when an applicant has violated the King County Code by failing to pay fees when due. By accepting issuance of this permit, the applicant acknowledges that if he/she fails to pay fees when due, DOES may bring a code enforcement action to recover unpaid fees. 10/26/2004 INSPECTORS COpy s 18036 118TH AVE SE RENTON, W A 98058 Department or Deuelopment and Emrironmarn .. 1 Son.; ...... SOD Oak"sd!!lls .'I yerus S<N King CI;Iunty Rer«on. WI'. 96055-U19 Fees: $235.47 Page 1 of3 This notice is intended to remind you that this permit will expire on the date referenced above. Permit extensions are issued for a one year period and must be accompanied with a Physicians Aftldavit, provided below. This affidavit must be completed by the attending physician each year that a medical hardship condition exists. To obtain a permit extension by mail, please submit a check or money order in the emounl indicated above; made payable to the KC Office of Finance. Please indicate, 'Building Inspections' and the permit number on your payment. By the expiration date, please mail the permit extension fee and the originaj completed Physicians Affidavit to: KC DDES -Building Inspections 900 Oakesdale Avenue SW Renton,WA 98055-1219 You may contact DDES, Building Inspections at 206-296-6630 for any questions regarding building permit extension procedures for this permit. Medical Hardship Mobile Hom,,-PhysicianAfl1daYit To_Apph~<!lJ.tts ~hyslclan: This form is required to be completed by the attending physician each year ihe medical hanlship condition exists. As the Attending Physician for _ !0 '!ctv:Ao€.A CoVt?€--rt: , I hereby verify that this person requires "daily care". Physician (Signature ReqUired)~tr Date ---Let >0 ( 0:;'-- CC a· (rr/;Q-L 1(1"-~V\ ~ Medical Facility Address Stamp: Phone Number \JA I Gero C ./" Se Cz;r1-/ (' ;)z::--[y ,-7 (P 1-( -2(Y' 7 Lf ( 0 ( LA II'Y\. h i eli/I We, y wit 9S/oZ soc ® King County Department of Development and Environmental Services 900 Oakesdale Ave S IJ.,r Renton, Washington 98055-1219 December 13, 2005 Page 1 of 1 Summary of Charges and Payments Applicant: ROOT, DEBORAH & KEN 18036 II 8TH AVE SE RENTON, WA 98058 (425) 277-2868 Charges Description Bldg FireFlow Review Bldg Insp Counter Fee Bldg Inspection Bldg InspectionlNo Hrly Counter Service Fees Health-Septic Sys. Cer!. Stale Building Code SUB TOTAL CHARGES: PaYments , Description Check Check Suspense Account Check # CheckIogid 3544 3780 5410 76760 SUB TOTAL PAYMENTS: BALANCE: Activity Number: Project Number: BOIL0762 Development Number: Permit Type: Status: MEDl-MH EXTENDED Payee ROOT, DEBORAH & KEN ROOT, DEBORAH & KEN KENWROOT Date Entered 6119/2001 11/28/2001 11/24/2004 Amount $165.00 $205.28 $275.00 $265.66 $187.00 $210.00 $4.50 $1,312.44 Amount ($562.00) ($279.50) ($235.47) ($1,076.97) $235.47 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. For services that are rendered on an hourly basis. the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service. and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. ®. King County I [I 'p c C t II r: -r--lct-\T-'7"'T~/'fJL....:r'----Perm it Number: Department of Development Date Issued: and Environmental Services Expiration Date: 900 Oakesdale Avenue SouthJle\!\e: --+'""-->1-,,"------Permit Status: Renton, Washington 98055-1219 Construction Permit Permit Type, Subtype: MEDI-MH, MOBILE Title: B01L0762: 3RD 1YR MHMH EXTN Description: MEDICAL HARDSHIP MOBILE HOME (DOUBLE-WIDE 1 FUQUA/PARKWAY,2 BDRMS/1 BATH, 28X36; FOR MICHAEL CORBETT Location: NW 33-23-05: L3 Blk2 Northwestern List of Parcels: 619720-0383 Site Address: 18036 118TH AVE SE KC Valuation: $0.00 Applicant Name: ROOT, DEBORAH & KEN Comments and Conditions B01L0762 11/28/2001 11/28/2005 EXTENDED 1. Work Subject to Approved Plans and Conditions_ Work authorized by this pennit is subject to the approved plans and corrections shown thereon and the attached conditions of pennit approval. Failure to comply with all conditions once construction is begun may necessitate an immediate work stoppage until such time as compliance with the stipulated conditions is attained. 2. Posting on the job site_ This permit must be posted on the job site at all times in a visible and readily accessible location. 3. Scheduling Inspections. Inspection requests for residential, commercial/multifamily. and new construction fire permits may be scheduled by calling the DDES Voice Inspection Line at 1-888-546-7728. This request line is available 24 hours a day. 7 days a week for your convenience. Inspection requests must be called in prior to 3:00 pm, M-F to appear on the schedule for the following business day. Inspectors are available by phone M-F, 7:30 am to 8:30 am only at 206-296-6630. Scheduling and inspector availablility is subject to approved holidays. You may obtain inspection results by calling the DDES Voice Inspection Line, reviewing the inspection information left on site, or contacting the inspector of record. You may obtain general inspection information M-F, 7:30 am to 4:30 pm at 206-296-6630. 4. Expiration. Please note the expiration date on this permit located in the upper right corner. A permit may be extended or renewed in accordance with the King County Code only if a request to do so is received at least 30 days prior to the expiration date. 5. Compliance with State and Federal laws and the Endangered Species Act. The applicant is responsible for making a diligent inquiry regarding the need for concurrent state or federal permits to engage in the work requested under this permit, and to obtain the required pennits prior to issuance ofthis penni!. It is understood that the granting of this permit shall not be construed as satisfying the requirements of other applicable Federal, State or Local laws or regulations. In addition this permit does not authorize the violation of regulations. In addition, the granting of this permit does not authorize the violation of the Endangered Species Act as set forth at 16 U.S.c. § 1531-1543, including the prohibition on the "take" of threatened or endangered species. "Take" is defined at 16 U.S.c. § 1532(19). It is the applicants sale responsibility to determine whether such "take" restrictions would be violated by work done pursuant to this permit, and is precluded by Federal Law from undertaking work authorized by this permit if that work would violate the "take" restrictions set forth at 16 U.S.C. §1538. 50 C.F.R. § 17.21,50 C.F.R. § 17.31,50 C.F.R. /i223 and 50 C.F.R. §224. 6. Fees due: Enforcement. The King County Code states that fees associated with the review and inspection of projects requiring permit applications are due at the time of application for service, or within fifteen days of receipt of an invoice from King County's Department of Development and Environmental Services (DDES) stating that currently hourly rates are due. DDES may require a deposit of between twenty to eighty percent of the total cost of the review and inspection of a permit application at the time of application. Failure to pay fees in a timely manner is a civil violation. It is King County's policy to take enforcement action including, but not limited to, the issuance of a Notice and Order and/or Stop Work Order, when an applicant has violated the King County Code by failing to pay fees when due. By accepting issuance of this permit, the applicant acknowledges that if he/she fails to pay fees when due, DOES may bring a code enforcement action to recover unpaid fees. [012612004 OFFICE COPY RP]RMSOFT~ soc DOES King County Department of Development and Environmental Services 900 Oakesdale Ave SW Renton, Washington 98055-1219 November 22,2004 Summary of Charges and Payments Applicant: ROOT, DEBORAH & KEN 18036118THAVE SE RENTON, WA 98058 (425) 277-2868 Chargl:s Description Bldg FireFlow Review Bldg Insp Counter Fee Bldg Inspection Bldg Inspection/No Hrly Counter Service Fees Health-Septic Sys. Cert. State Building Code SUB TOTAL CHARGES: Payments Description Check Check Check# 3544 3780 SUB TOTAL PAYMENTS: BALANCE: Checklogid Activity Number: Project Number: Development Number: Permit Type: Status: Payee ROOT, DEBORAH & KEN ROOT, DEBORAH & KEN Date Entered 6119/200 I 111281200 I Page 1 of 1 BOIL0762 MEDl-MH EXTENDED Amount $165.00 $102.64 $275.00 $132.83 $187.00 $210.00 $4.50 $1,076.97 Amount ($562.00) ($279.50) ($841.50) $235.47 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. • :f1\1:\--~ ~~ :-.:; _ ~_ ®RTMENT OF VETERANS AFF ::; \\'~\~i \'i1 IT get Sound Healthca.re System ,--1660 South Columbian Way \~(j\~ i ') 2C~~ Seattle, WA 98108-1597 UN1'! K\NG ~~PEC1\ONS U\LD\NG \ American Lake DivisiJil N b 9 2004 Tacoma, WA 98493-5000 ovem er , In Reply Refer To: S-JJ6-MHC Seattle Division Seattle, WA 98108·1597 RE: Michael Corbett SS# 568-92-0215 Gentlemen: Mr. Corbett has been my patient since 1997. I believe it would be quite beneficial for Mr. Corbett to live very near his family, Mr. Corbett has a psychiatric condition that necessitates monitoring on a daily basis, and he requires daily care. Hc needs help and direction with his medications and activities of daily living, He requires assistance in getting to his outpatient appointments and community programs. It is ideal to have the family in his proximity to help with the above and yet not in the same physical space. We hope to support Mr. Corbett's highest level of independence which separate quarters will promote, at the same time have family provide needed daily care. It is not often we have this kind of family involvement and support, I highly recommend the housing plan proposed by the Root family. If you need more information, please call me at 764-2007. Sincerely, E. Alexandra Ashleigh, M.D. Staff Psychiatrist Seattle V. A. Medical Center and Clinical Associate Professor Department of Psychiatry and Behavioral Sciences • DEBORAH G & KEN W ROOT 18036 118TH AVE SE RENTON, WA 98058 OepMUnent or Development and Envinmmontel$4)ruoicD8 900 OakeWsle J\ '{eN..Ie SiN King Q;ounty Ret101>, VliA 96055-1219 Fees: This notice is intended to inform you that your Medical Hardship Permit will expire on the above referenced expiration date. For your convenience we will issue your permit extension by mail. To obtain your pennit extension, please submit a check or money order made payable to the King County Office of Finance, along with your completed physicians affidavit. This affidavit Must be completed by your attending physician each year that you request a medical hardship permit extension. If you have any questions about this extension, please contact Building Inspections at (206)296-6630. Medical Hardship Mo:,:eH:::-~-!1fiJ~r(;~:; '9 ~~ iol ---",,,, 1 5 LLJ 1\';';, :JJi Physician Affidavit K -. _ ING COUNTY To: App!!!,anJ'£J'hy~cian: This form is required to be completed EACH YEAR ~~~~Dd~~dllI.~f~1i1OAJS requested by tile appHcaul. As the physician for ________________ , I hereby verify that this person requires "daily care". Physician (Signature Required), _________________ _ Date _______________ ~ Phone: _______________ ~ Office Address ___________________________________ _ 11102/2004 Entered DateS:eI""'~In: Monday, Nov 22, 2004 03:43 PM Bobby's Business ReCOfd: 1 of 3 a.r,I':U<6,"-COIIn.\' Set r e'~AI~ilchrnents r P' ® King County Department ofDeveiopment and EnviroIlIIlental Services EXPIRED SINGLE FAMILY RESIDENTIAL PERMIT STATUS CHECK INSPECTION FORM 900 Oakesdale Avenue Southwcst Renton,WA9B055-1219 PERMIT # 80 /<--07 ~ Z .. "J;' 1'~ i»"O' >«~ ~~ ,,« ~«,.,- S _ DATE OF REFERRE~:_ /. 3D ' 03 ADDRESS: ~~ » CURRENT STATUS OF , II' h PROJECT: t-.' LJI/p! Irt_ ' D-t'~J~N fJ aLI e)-d,} L1;t., I C (,,-,1' _d,6-C1C , ANY OBSERVED LIFE-SAFETY HAZARDS?: __________ _ ANY OBSERVED SITE OR ENVIRONMENTAL HAZARD?: ______ _ ANY OTHER OBSERVED VIOLATIONS?: ___________ _ ANY ADDmONAL CONTACT INFORMATION?: -----------Person: Tele# _______________ _ Address: ____________________ _ COMMENTS: 7.?4 )..v jO-~~ 1w b. )/.;1.. 7Jl'.'-:;; INSPECTOR __ -----"L".L't!t='--'-i _' ___ DATE OF INSPECTION --f/-LI",.::J:c...:.c_! -=--C"c::.) __ Kingeounty Department of Development and Environmental Services 900 Oakesdale Avenue Southwest Renton, WA 98055-1219 EXPIRED SINGLE FAMILY RESIDENTIAL PERMIT CODE ENFORCEMENT REFERRAL FORM Permit # ______ Parcel# _____ _ ..... ~o = __ 7"" ""'~~~ ~'-"<' ,~ S Address: --~------------ Inspector ________ _ Date ___ _ VIOLATION: Expiration of Permit: Code Cites: K.C.C. 16.04.05013; 1997 UBC, Sec. 106.4.4.2 Description: Permit expired without completion of all required work. To Comply: Extend Permit # in conformance with the King County Code and any applicable inter- local agreement. VIOLATION: Required Approval: Code Cites: K.C.C. 16.04.011; 1997 UBC, Sec. 108.4 Description: Work done beyond the stage of inspection approval. To Comply: VIOLATION: Use and Occupancy: Code Cites: K.C.C. 16.04.05025; 1997 UBC, Sec. 109.01 Description: Structure used or occupied without occupancy and/or final inspection approval. To Comply: Complete all required work and obtain occupancy and/or final inspection approval, or ..... Other: Vacate the structure, secure from entry until permit approvals and/or Certificate of Occupancy has been obtained. VIOLATION: _______________ _ Code Cites: Description: To Comply: King County Department of Development and Environmental Services 900 Oakesdale A venue Southwest Renton, Washington 98055-1219 FINAL APPROVAL In'pcctm: ________ _ Datc: ___________ _ Permit Number:B03X1230 Date Issued:12/04/2003 Expiration Date: 11/28/2004 Permit Status:ISSUED Permit Extension Permit Type:EXTENSN , BUILDING Title:EXTN OF B03X0115 (B02L0763) Description:MEDICAL HARDSHIP MOBILE HOME PERMIT FOR MICHAEL T CORBETT Location:NW 33-23-05 List of Parcels:619720-0383 Site Address:18036 118TH AVE SE KC Valuation: $0,00 Applicant:ROOT, DEBORAH & KEN Contact the Inspections Section at 206-296-6635 to schedule the Inspection. 1. This extension does not replace the original permit --it does extend the life of the original permit to the new expiration date. This extension must be posted on the job site with the original permit in a visible and readily accessible location. 2. This permit is subject to all corrections indicated on the associated plans and conditions. 3. Work may proceed only at the direction of the field inspector. Please call the inspector at 206-296-6630 between 7:30 and 8:30 a.m. Monday through Friday, date printed 12-04-2003 I • ---.!....- Permit Project 1B03X01l5 BOIL0762 Department or Deueloprnent and f"uf,onmlln1al Se'''i., .... ® 9""JO Oake~Ut~ ,ilNCn....ae SVV King c.;.unt" R~or'. WA geO~5-1213 NOTICE OF PERMIT STATUS Permit Subtype Date Issued Type EXTENSN , BUILDING II 02/07/2003 APPLICANT INFORMATION I PERMIT INFORMATION DEBORAH G & KEN W ROOT TITLE: EXTN OF BOIL0762 I Status , ISSUED 18036118TH AVE SE DESCRIPTION: MEDICAL HARDSHIP MOBILE HOME FOR MICHAEL CORBETT RENTON, WA 98058 LOCATION: 18036 118TH AVE SE Parcel#: 6197200383 Jurisdiction: King County I 'Owner: DEBORAH G &. KEN W ROOT -"'~-~~~'~J Phone: (425) 277-2868 , Expiration Date: 11128/2003 ~xtension Fees: $224.25 This notice is intended to inform you that your Medical Hardship Pemlit will expire on the above referenced expiration date. For your convenience we will issue your permit extension by mail. To obtain your permit extension, please submit a check or money order made payable to the King County Office of Finance, along with your completed physicians affidavit, This affidavit Must be completed by your attending physician each year that you request a medical hardship permit extension. If you have any questions about this extension, please contact Building Inspections at (206)296-6630. --_._------------------------------- Medical Hardship Mobile Home Physician Affidavit To: Applicant's Physician: Tbis form is required to be completed EACH YEAR when a permit extension is requested by the applicant. As the physician tor __ ~_''l __ i ___ , (-,-"c_'---,--L~' ~(~_~~.,~. ,_. ~r-'t:'--·'-__"tt'_'__ __ , I hefeby verify lhat this person f(:quires "daily care!!. o. C{'{tf.J~ t~y:I-/;,~}) Date i ~ 11 / (~ :. Phone: c) 0 &;~ Ie L;' ;)~' -l/1 Physician (Signature Required) , I iff/ r f '-' Office Address, __ -,-i "hL.l",,-L.' ,,-=-u_~S"'/~--r-o---'cl-'Lt.=-¥'-"]A'-'-·"'-e\,'1 i--'-.L..! ""() ....... t""·, __ _'U"'" ~:-") ('.0~. -'~'-.. f--+(-'-~\'--~·-'-I-'( { .;n /f C) C / ~r c{.:z-,ff 'C" C.J..,.i ,t) '7' f Io[l 10/3012003 soc DOES King County Department of Development and Environmental Services 900 Oakesdale Ave SW Renton, Washington 98055U 19 Decem ber 4, 2003 Page.1 of 1 Summary of Charges and Payments r-~------------------------I Applicant: ROOT, DEBORAH & KEN 18036 II 8TH AVE SE RENTON, WA 98058 (425) 277-2868 Charges Description Bldg InspConDter Fee Bldg Inspection/No Hrly SUB TOTAL CHARGES: Payments Description Check # SUB TOTAL PAYMENTS: BALANCE: Checklogid Activity Num ber: Project Number: Development Num ber: Perm it Type: Status: Payee Date Entered B03XI230 BOIL0762 EXTENSN ISSUED Amount $97.75 $126.50 $224.25 Amount $0.00 $224.25 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. King County Department of Development and Environmental Services 900 Oakesdale A venue Southwest Renton, Washington 98055-1219 Permit Number:B03X0115 Date Issued:02/07/2003 Expiration Date: 11/28/2003 Permit Status:ISSUED I~crs;n~ ~O --Permit Extension Permit Type:EXTENSN , BUILDING Title:EXTN OF B01 L0762 Description:MEDICAL HARDSHIP MOBILE HOME FOR MICHAEL CORBETT Location:NW 33-23-05 List of Parcels:619720-0383 Site Address:18036 118TH AVE SE KC Valuation: $0.00 Applicant:ROOT, DEBORAH & KEN Contact the Inspections Section at 206-296-6635 to schedule the Inspection. 1. This extension does not replace the original permit --it does extend the life of the original permit to the new expiration date. This extension must be posted on the job site with the original permit in a visible and readily accessible location. 2. This permit is subject to all corrections indicated on the associated plans and conditions. 3. Work may proceed only at the direction of the field inspector. Please call the inspector at 206-296-6630 between 7:30 and 8:30 a.m. Monday through Friday. date printed 02-07-2003 'r *' soc DOES King County Department of Development and Environmental Services 900 Oakesdale Ave SW Renton, WashingLun 98055,1219 February 7, 2003 Summary of Charges and Payments Applicant: ROOT. DEBORAH & KEN 18036 I I 8TH AVE SE RENTON, WA 98058 (425) 277-2868 Charges Description Bldg Insp Counter Fee Bldg InspectionlNo Hrly SUB TOTAL CHARGES: Payments Description Check # SUB TOTAL PAYMENTS: BALANCE: Checklogid Activity Number: Project Number: Development Number: Permit Type: Status: Payee Date Entered Page 1 01' 1 BO.lXOl15 [lOIL0762 EXTENSN ISSUED Amount $97.75 $126.50 $224.25 Amount $0.00 $224.25 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. .' soc Pag~ 1 on King County D ep artJnent 0 f D"" elop ment and E mr iro run ental Services 900 Oakesdale Ave SW Renton, Washin~n 98055-1219 KING COUNTY BUILDING INSPECTIONS ROC'::', DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 11/28/2002 Fees: $224.25 This notice is intended to inform you that your Medical Hardship Permit has expired. If you do not extend yourpennit or notify us that you do not need this permit within 10 days of the date of this letter, your permit will be referred to code enforcement. For your convenience we will issue your permit extension by mail. To obtain your pennit extension, please submit a check or money order made payable to the King County Office of Finance, along with your completed physicians affidavit. This affidavit Must be completed by your attending physician each year that you request a medical hardship permit extension. If you have any questions about this extension, please contact Building Inspections at (206)296-6630. Medical Hardshill Mobile Home To: Applicant's Physician: This form is required to be completed EACH YEAR when a permit extension is requested by the applicant. As the physician for_l-'rn--'-'-'·"'C/.u""'''''/L--'c1>''''''Ro,.,;!Jp.£:II-''''-______ , I hereby verify that this person requires "daily care". Physician (Signature ReqUired)~~'"a"""'~ .... '"t-'"C$-.AP"""'-~~'-__j&:4~.,.,.~~...-"'-- Date '?-/3/0') __ Phone: __ dO&( Ito If-2461 Office Address, ________ . _________________________ _ VA MEDICAL CENTER (1l60TC) 1660 SOUTH COLUMBIAN WAY SUmlEr WASHINGTON 98108 01/3012003 ®DtES King County Department of Development and Environmental Services 900 Oakesdale i\ venne Southwest Renton, Washington 98055-1219 Permit Number: 801 L0762 Date Issued: 11/28/2001 Expiration Date: 11/28/2002 Permit Status: ISSUED r; () J' K f 1[:;- 7E{tf HH M HAI-O$H(;4 Construction Permit Permit Type: MEDI-MH , MOBILE Title: L3 Blk2 Northwestern Garden Tr Description: temporary Medical Hardship Mobile Home -double wide 1981 Fuqua/Parkway; 2 bdrms/1 bath; 28X36 Location: NW 33-23-05 List of Parcels: 619720-0383 Site Address: 18036 118TH AVE SE KC Valuation: $0.00 Applicant: ROOT, DEBORAH & KEN Comments and Conditions 1. This permit is subject to all corrections indication on the associated plans and attached conditions and must be posted on the job site at all times in a visible and readily accessible location. 2. This permit is subject to all corrections indicated on the associated plans and attached conditions. 3. Work may proceed only at the direction of the field inspector. To request an inspection of work completed, call 206-296-6635. 4. Please note the expiration date on this permit located in the upper right corner. A permit may be extended or renewed only if a request to do so is received at least 30 days prior to the expiration date. , , __ -~--------~roR;CO~~-- (I>Pt'iS uP Z/{g/03 BP RES3 ~ - ~ ... ~A n:GOru::E:S ~FO ~ Foundalioo(includtS Mobile Homes) R:::: DrlUDAg.u'EJOSWD Control . . =: rwnin~ . ~ Undci1Joor iuspcction ~ [I .~ 'uW for u.><. or occupancy INSPECTION LOG IT ~ 'lfCJOIac.c ME ~ Mcduuical (All T vpc:;) rv = fnvcsti ~"lc ES ~. Exterior Sheuing ruilwg WS = Woodrtovc SW ~ SlOp WoIl< Actions ACTION TAKEN CODES AP ~. Approved PA ~ Pctni31 Approval CN = Conceriou Notice NR ~ l'lot Rody oc = OtbcJlwlCommcotl SP = SlOp Work POSlcrl SL = Slop Work Ltfld I ~ ~ Other (D=nlx: lD mmtncntl) --rN7rECTOR ___ .~r DATE .' I~DR I HI' I ES I FIt ~ ME I HJ wsjrvlsw L 61 . COMMINTS._ :tI'?)ti' -_l_Ji/J q/ q[ ___ Jd-t_1 ",'lllif v' / r Ie", F --1-T _I_L __ ._, .---""-.----. ._------ ,£Ct __ ~ __ J_(j~/0LL----! _'_! ___ I_'_" 1'_ 1'_, __ ---1--L=1'-rLJ)~{ {e/h/f __ ~_' __ '_1 r +-t J-·--~t-·-·-·-----·-----·---·-·-· L __ J ___ . __ - ~ ___ --__ -____ -__ -1._-____ 1 ___ I ~--I--~-.-~_l_-t~l-.-~---t----L--.--.-----·-=----.------t \11 --. ,t----~t----l--I--l--r--T ~_. '--1. . 1 L --L _ .. __ LL __ I ++ J__ , __ L...----'.--'-.. ------. ~----_l--1-1! 1-}--f I-c-I-I-!~_L --1-. -.-1--~~---. .--' -=--.---~== __ J I I-X II J_-T-I .. J~_l I L_-.. ----.--- -----_._-. (£h ~-L J>' ru: . r t:d J---j O:'! I--~ C/) tr1 }-- L._. o '" (fl) AHB of HA~UfAc(Utl61Z-: ~u~u A -14vrfU6-~ V ~et r[) 'frCA~ OV ~Pff-JU"fAC,(ll\l& g t q«; { , , ( C{Uttf7l( t:}fli«' -7.lP f-~ ') 1)1)( O--itdt-J0( OW0; (,)-1 k7;(P):;;' {001 esb°.ff . I VtC(ul6t0 f1,~u-e , ctrO\J~ -? MH11~~t.tA: mz.f 01 Cez-(f)Z-® Ho-oc;:,L <i---L. a '1P~~ --:C:t7. * v (&'1 fi (r;"l"7; -"RX-E:1'( E:@;It'17 tf ::. /t{7j 00 to . L f CrE-Uqe f$. ~'1 fR~~-p'R 41" (C( tq~P -@ ~.o O~ ~ .. ()\J ~ g.Qv-1. 17ro-pev++ t-t\1... -4l ~q~ov -bQ..t1~o 06'\ c~~{:-( 1f -Zv,}7?qO /~ 1'~e.vt--t ilt-1-du€ /~/ ~<l ApVt'(~o. Wi~\~~ t::'-he;-r (P -/JllO. soc •• ES King County Department of Development and Environmental Services 900 Oakesdale Ave SW Renton, Washingtoll g8055~ 219 November 28, 2001 Summary of Charges and Payments Applicant: ROOT, DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 (425) 277-2868 Description Bldg FireFlow Review Bldg Inspection Counter Service Fees Health-Septic Sys. Cerl. State Building Code SUB TOTAL CHARGES: Description Check Check # 3544 SU B TOTAL PA YMENTS: BALANCE: Checklogid Activity Number: Project Number: Development Num ber: Perm it Type: Status: Payee ROOT, DEBORAH & KEN Date Entered 6119/200 I [)age 1 of 1 BOIL0762 MEDI-MH ISSUED Amount $165.00 $275.00 $187.00 $210.00 $4.50 S841.50 Amount ($562.00) ($562,00) S279,50 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C,O. or C.O. ( J L:··· ~) r> f.!'r -z-l , , ( Project/Activity Numb . Date: G (11(0{ Intake Technician: ~\ Ph 4) P arce I #_--I.C""-",.!,,.t q.J,.' ...L7.:::2::::o_~_D::..3:::2:..3=- Comments: Yi!l";." r"I~lc 1t7'Z1 rii 6)-1,L' ':I:dc );' ( __ -_~:.::.=.:....J '1:e .. .:.:i,i'.o:'r-.:li~-"--",-,-'I!::.tJ..,",-g' 1-"-,,1':: .':..... ________________ 7_, _.':_X_,:_3":..,--.!....:"-:..,p.::.:,.,,_'~.,:' , ,-' ',' j\C£..CI 1. ,'7r; 00,,(,''' -' , ~,J..' .' ",-'" \ .... .;;', ,/ , ( ,') .H." v-r'!"" 'J" ID' I (f.''7'Ii··, ,/'( I! r " '-'\ ' , ,'-. ' ~. I " "---,--' ....:' ,_. .::..'~ -C:-,/c-;-'--,;-:-;-' '. l \ '-/' / \ v' I .-/ Number 'o'f",ctJlr (,,(' '('S-treet(Nam~( (tb~1 (oJ) I L-I _vJ~1 L-I ~II iA/;')II~-3~-1 L-I _73--,' II 0 S Kroll EIW ,---__ '_Y.. ____ Y<_4 ___ S_e_c_t_io_n __ T_o __ w __ n----.shrci p_....:R.::..a=:n.:..:'g'-.:e=-----" ---, r 0\2-' Q Q 1 :JO{+(' ,k,;-'{ it '.~. <" ,/,;.j : ""5 IIL_L>_ij_~z..._' ~ Lot Block Plat Name Division ZONING: R 0 -So Setbacks: Street. __ _ Garage __ _ Interior __ _ Maximum Building Height;=: ==::...:M~ax Impervious Su;..:rf.=a-=-ce====:..:"A-=-o_=-==::;---- ~,.,---JI L---,I ~,---lll I J D )~ C (Q i. '----~-Z-,.,--&Lj-IJ'[)----"'---J(, ft I ) MPS School Fire Dis!. Comm, Plan Lot Size o Sewer (or) 0 SeptiC 0 Well (or) 0 Public Water L-I _I L-I --,I L-I _II I ,----I _1'--1 ---'11 L-_ 2nd Other TOTAL Garage Porches Decks REVIEWS Ji Addressing __________ _ ;n Health, ___________ _ ~ Fire Flow ___________ _ o Drainage, ____ c-;-_c-;-____ _ o RSCR 0 PLTR Submittal Requirements Checklist o Certification (and Transfer) of Applicant Status o Affidavit for Application o Property Tax Account # (parcel) o Legal DeSCription o GEO, _____________ _ o Wetlands, ___________ _ o Site Plan (to scale on legal or letter) <"'1 J i/o o Working Drawings '1.,) '''' Ii o Water Availability Letter %,7t!, I ~,~ o Shorelines, __________ _ o Streams ___________ _ o GRADing, ___________ _ o SEPA ___________ __ o Farmland Preservation SENSITIVE AREAS o Erosion 0 Landslide o Flood Plain 0 Seismic o Wetlands 0 Coal Mine o Streams 0 Shorelines o Sewer Availability Letter -(}'J1,f) o Proof of Legal Lot (NEW RES) o Septic Design Approval (NEW RES) o Fire District Receipt (NEW RES) o Contractors license (by issuance) Are Taxes Current? 0 yes 0 no Issue Permit by Mail? 0 yes 0 no NO\-27-01 TUE 03: 10 PM EASTGATE ENVIRON, HEALTH FAX NO, 60946 • 11B)UbliC Health FAX Sc.ltlc 80: King tounly ---'""--_.,.'----------- IIEAlllIY PEOPlL I4£MTHY COMMUNIfIH, AJmu/J L P(qygh, PiI.D .. MrH. DirocIQ( 'filc/ol/owinK faCJimil~ ",eHagc is CONFfDENI1AI, atul is inlend<"d ollly for 'h" use oJlhe {,('rsoll 10 whom iI':' addressed. Ally di.lln'baliall, copyillg or olher use by at,yone i.I :rlde/iy pro/Jib/In!. I/you IIl1Ve rece/vcd rIds J<u ill en·or. {,ir'l.,e tclephofle tile sender imtfIPdiately (md ticstroy rid, fax. -~-----,-'--_ ... _-,---.,---, ..... _- DATE: ___ ."-~~l __ .. , __ _ ---... ---.--~-----._-- FAX#:, ______ .. __ TEL#: TEL#: Number of pages including this cover:_? ____ ... MESSAGE: Urgent [l [nvifonmcul311 ic.tlllh 5e! ... iC(;'~ E3stgatc Public 11~all11 Cerlter Roview~. 1~3~ SE Ea$19~lc Woy -Belkwlle, WA 9U007 Tel: tlOG) 29GA932 lax. (200) ?ga 4919 Comment [,.J )l, 01 NOV~27-01 TUE03:l'OPMEASTGATE ENVIRON, HEALTH FAX NO, 60946 ~, 02 ' : Se:tt!lc-Kill!,: County J)c (ment "r Puhlic 1.lcallh ~\J' . ----.-. -":J' " 'Applirit!illll for Ih'alth U<'parllllcnt ApprIWal of Building \'(.nllillll~,tt ?~~rap,~I!.oc . ('or hOlls,'s or ,,[.uelurl'S SCI VL"\ by 1m on-sn~ scwag_ (scP[',) sysh'm .~.--. ---------- ... ~ '1 1>:"'II'"IIIi< 1I(',"lIh ('cllicr 14.150 St,; F.:lslg"ll' Way _n,,· • -~..!..:..-----.'-=- . "" I 1'0, DnES nse OnlY C (20(,) 296-4<).12 Al'l'licMioll Ffc; $210.0U n;l!e Recei",,,1 .. ' ~.I~:O ,_ t.l-,,-~<c_~I.l."mi! al'pJicatioll"LI!lnll-,~lIl'l~'fllmcnt~ i!Lll!Q)j-",l~ T.-"ckin[: No ~I?c!.IL12J(;'~ '1'11\: ulinillllllll ~'ll)P1jrL do!" UIlll:nl s illClmh.:: l'crmit l'c('h ~t1]: L delailed rou!e 111:'1' "n" din't\jolls 10 prorclty liD Fee COll"CI~(T(j:;;--No 2. ,,1011'1:1" ",:1IC11 al I "~20' or I "-"30' II , 17 max, sile, to i'~~L~d.l'; • hou';c footprint :md nny propo~c'l ~hangcs to tll;l\ 11.-,otprinl • loc:lli"11 ofs"plic lonk and pump l;1uk, dlilinfielcl ant! allli¥,hl 'eWer lincs • tornliOH of rc<;crvl! tlrainlkld HL~:l (repair Mel) • nil Willer lilies ""<\ well ,i1e<. show lOOn radiol orOl1nd 011 well siles • local ion of all oul b<lildlll~' • II)c:ltion ()r all tlrivcways and p;Hkin)~ :11 cas. • all pn,'1pcriy bOIll1(larli:!' and eaSl'Jw.:uts • ;111 stfl',iUH,,) :md bOllil.::\ ofw;)\cr }. Floor plans "fwhill i, cilallging inlhc building 11 x J7 mill. SilC. Ylu,~ ~~lAStl '*' ~l~ l~y(1-,kp r---.----~--.---.... ---~ .. ----~--.--~.---------.. --.- J'nllls.rh: Inf51f.!lWli!!!,\ 1'-('Mllt\ '.t10'i1; . ._ - Addres> () f I'10perly J1;O?tlLJ [ji -t 1\ j~J"t:..:z: t~ .. l'ilIcd No !r2I (~?:loJQI1;>Jil~] Al'l'lic""ts Namc~il!. .. -t:I(-€.",.jloo .. L-_ .'_ .. _._ Pay 1'hono {c,lL~'l-'-7--'lll1 ____ _ Applicant< M.1i1il1~ AddJOSS (w..!J<.t.j.I1!h{!\!:t~~1lft\.t.~f\ .. illa: __ .q f~.1 .. ___ '.~_" U""cr< Nom~1Zt-t>;'rl\h..t J::ek...k<>-r. ____ . __ . ___ .... D"y Phone Lq!-C;}"t-"'tl,'t.~!L1_. ___ " __ Age of I Ioosc_~!L'lf/l.~'!l n"\"",,, \0 l\core,\ public-,,,wc·'. -ml1'. ,,\<I\()""_ I I , Fxisting S'l'larc fOOl:lee of hQIJ:,L', t(lJ:tO< __ ... _,_ Number \,.1f existing Ur • .'df00I1lS _. '-.:::t . ~ . _ , __ . _. __ .. ' S'l"a.·c 1,,,":I!:c to be "ddc'" ... __ ~:!.\ A ___ 1/._._ .. NUIllI)~r ofbcJrnol11$ hcing odrled. __ ~_ f.Jl~. __ .' ______ . I Ik'"r<l'llon ofp'''I'''SC.! ckl"EC.' ... h12't21!--tp ___ b(01Jll.LJ1:p~(L1t~t'Jl'QJ!:a v.-t_r-j"emC,8L-HflrrP'7H 1" ... ----~1>':'." ?;CI'.. -----" -----. ------.------... --" .-----.. -.--... " --.. .. . _--_ .. _-_._-----;-----_. ._-----.. --_. ---" .-----_._---- Iks~rib!.: or atl,lch :U1Y (hainfit:ld ca~enwllt<:; or COVCil:lJIts wbil:h m.,y imp.let liw properly r----"'~.----."...,..,....~;--~.........".... ... ~.~,.--~<.¥.:i~~.~~--~----,.----=---,"' ... --~-W ,!! l'.r. S.I! 1!!l!YJ 1)[0 r 111 al i 0 1\ __ 5. . I'uvlic WilitT ,ystel11 (WOk, supply wilh 2 of rnore wlIElcction:;) ;.J --,---------------- " , , EO 'd ~ Or:: .., .. C!E No> ~ ~ -i ':;i _r:t' Nil! . ~ ~U 0;.;: :.: ·u II! " Do -", ... 11: .. ~ '" N j I • 164.7!;' 9t609 'ON X~j Hll~3H 'NOHIAN3 31~~lS~3 Wd 11:£0 3nl 10-LZ-AON King County Department of Development and Environmental Services 900 Oakesdale Avenue Southwest Renton, Washington 98055-1219 Application Acknowledgement An application has been received for the following work: Application Number:B01 L0762 Application Date: 06/19/2001 Applicant:ROOT, DEBORAH & KEN Permit Type:MEDI-MH , MOBILE Title:L.3 B.2 NORTHWESTERN GARDEN #2 Description:temporary Medical Hardship Mobile Home -double wide 1981 Fuqua/Parkway; 2 bdrms/1 bath; 28X36 Valuation:$O.OO Questions about this application and it's status should be directed to the permit service center at: 206-296-6600. Date Printed:06-29-2001 bp_appl 8-20-99 , ' .' " , ' c;,aJ.. [r '}oa[ . ®'C U ' '~~,,')~I,:If): Ii ~ I ,j ~ Jl 0 3 10Dl L " W'tCL-L _ KC.O.o.I::.5 . ~J.~.f~~ ~Vt)~ II '1k NrJ.-~~ rt-«Vv ' .. CD {)(ZkO fip ~ ( o (7?rCo1&~r King County DepartInent of Developm.ent and Enviromnental Services 900 Oakesdale AVI:lluc Southwest Renton, VW\ 90055-1219 IT5)~: I I llll JUl 0 2 Z001 • DATE:'1f.J 4 1 { r i-oO( TQTlIEAlTENTlONOF: Vho .. Llb~ K.C. D.D.E:.S. (BSD STAFF/SECTION) , . Return this form and related submittal items to the King County Building Services Division Permit Center. If you have any questions, please call 206-296-6600. This slip MUST accompany all submittals of additional information to King County Building Services Division. SUBMffiALS WILL NOT BE ACCEPTED WITHOUT TI-IIS COMPLETED FORM. KING COUNTY TRACKING NUMBER:_--I,~,Ll-O~IL--'b'::::!;O.L.-J....w.(,/E.?="";==--___________ _ PROJECT NAME: ~li(\'k: +-t:~~ \ZooT HUjc a l ±kax40h'f l1ov\le ADDRESS OF PROJECT: (f()}7(p ((19-aUf· Cj~f. tet'\~l()..N\· tLoc?c;f ANY QUESTIONS ABOUT nus ADDmONAL INFORMATION SHOULD BE DIRECTED TO: NAME:1)tf1t7(~ ot !cetf) llQot til ARM NAME: ,...,(A. PHONE NUMBER: _________ _ MAIUNG ADDRESS: ($017tt r {"6U Cl Uf' 0. f( • CITY, ST & ZIP: :{Letl4.Ml ! uJCJ -0 for; { STATE THE SCOPE OF ANY CHANGES OR DEANE THE ADDmONAL INFORMATION PROVIDED WITH THIS DOCUMENT. I DOCUMENTS SUMIlTED (UST ALL DOCUMENTS AND THEIR QUANTITIES): ITEM QTY DESCRIPTION 1 ( ~Vt7 *?! ..h, I" W\of7, (-€. l-\--r){Nl e· 2 3 4 5 6 King County Department of Development and Environmental Services 900 Oaksuale Ave SW Renton, Washington 98055-1219 Tuesday, June 19,2001 Activity Number: [JOIL0762 Project Number: BOIL0762 CHARGES Applicant: FEE RECEIPT ROOT, DEBORAH & KEN 18036 118TH AVE SE RENTON, WA 98058 (425) 277-2868 Description Chccklog Check # Payee Date Entered Amount ~'-=2~~~ ______________ <>-_________________________ --=== Counter Service Fees $187.00 DEF-Bldg FireFlow Rev $165_00 DEF-Bldg Inspection $275_00 ~Hc:e";al--ith=--"'S-"ep-'t"-ic"'S"'y-=-s=-. C~ert-:-.------------------------------------------$·21 0.00 State Building Codc $4.50 SUB TOTAL: $841.50 PAYMENTS Description Checklog Check # Payee Date Entered Amount Check 3544 ROOT, DEBORAH & KEN 06/19/2001 ($562.00) SUBTOTAL: ($562.00) CHANGE GIVEN: $0.00 BALANCE DUE: $279.50 The fees shown above represent current charges as of this date and are an estimate based on the information provided to DOES at the time of application. DOES permit fees were restructured effective March 1st, 1999. Many fees previously assessed a flat fee, now are assessed as hourly charges. Because of this change, and to ensure that our customers secure permits as quickly as possible, permits may be issued prior to all hourly charges being recorded into our billing system. For services that are rendered on an hourly basis, the cost of those services will be based on the actual hours worked. Hourly fees are charged at the rate in effect at the time of service, and will be billed monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. All fees must be paid in full before DOES issues Final Approval, T.C.O. or C.O. Page 1 of 1 nnE! King County Department of Development and Environmental Services 900 Oakesdale Ave SW Renton, Washington 98055-1219 Tuesday, June 19, 2001 ----------- Activity: BO 1 L0762 Project: BOl L0762 Type: MEDI-MH . jApPlicant: I Address: I PERMIT FEES ROOT, DEBORAH & KEN 18036118TH AVE SE RENTON. WA 98058 --------------~------ Description: Phone: (425) 277-2868 Due at Application: Due at Settlement: Counter Service Fees DEF'Brdg FireFiow Rev ------$187.00-------------- DEFBrdg Inspecflon HeaTlll'Seplic Sys. Ceil. Sta[eBi..Jilamgco~-------------"--------- --- Totals by Category: TOTAL FEES: $16500-- ----~""" ~210.00 $562.00 The fees shown above represent an estimate based on the information provided to us at time of application. $275:00 $279.50 $841.50 For services that are rendered on an hourly basis, the cost of the services will be based on actual hours worked. Hourly fees are charged at the rate in effect at time of service, and are billed approximately monthly, along with any other outstanding fees. Fees that have been posted prior to permit issuance will be collected at that time. Fees subsequently posted will be billed to the applicant. I, I ~ ~ • AW\-bv00 e 12oen'C{C-- (,Jvl'c, '* LG c;~ [7)"'6 ~t -to 0--t to. DEPARTMENT OF VETERANS AFF~ ... S Puget Sound Healthcare System 1660 South Columbian Way Seattle. WA 98108-1597 In Reply Refer To: S-116-MHC American Lake Division Tacoma, WA 98493-5000 June 20, 200 I Seattle Division Seattle, WA 98108-1597 RE: Michael Corbett SS# 568-92-0215 Gentlemen: Mr. Corbett has been my patient since 1997. I believe it would be quite beneficial for Mr. Corbett to live very near his family. Mr. Corbett has a psychiatric condition that necessitates monitoring on a daily basis, and he requires daily care. He needs help and direction with his medications and activities of daily living. He requires assistance in getting to his outpatient appointments and community programs. It is ideal to have the family in his proximity to help with the above and yet not in the same physical space. We hope to support Mr. Corbett's highest level of independence which separate quarters will promote, at the same time have family provide needed daily care. It is not often we have this kind of family involvement and support, I highly recommend the housing plan proposed by the Root family. If you need more information, please call me at 764-2007. Sincerely, <e. {jfjz~Ad ~ E. Alexandra Ashleigh, M.D. Staff Psychiatrist Seattle V. A. Medical Center and Clinical Associate Professor Department of Psychiatry King County Department of Development and Environmental Services 900 O<JkL'Sdalc Avt:nuc Southwest Renton, WA ~ltlO55-U1~ AFFIDAVIT REGARDING MEDICAL HARDSHIP Mobile Home Permit I, ,.. () am the applicant for a medical hardship mobile home permit number.J;d.LloJ.....l.<'-!.\!~:.. and I hereby certify that: 1. The temporary dwelling is necessary to provide daily care defined in Chapter 21A.06.262 of the King County Code as: medical procedures, monitoring and attention that are necessarily provided at the residence of the patient by the primary provider of daily care on a 24-hour basis. 2. The primary provider of such daily care will reside on-site. I acknowledge that I understand that the mobile home is temporary in nature and must be removed within 90 days of the permit expiring or when daily care is no longer required. I understand that the permit must be extended on an annual basis and that an updated physician's letter must be submitted each time the permit is extended. Additionally, I have attached a statement from the physician certifying that a resident of the property requires daily care as defined in Chapter 21A.06.262 of the King County Code and the statement contains an original signature and is dated within the last 90 days. Signed:11~17AtPt ~1<J2,. ~ate: ~ ;;.01 ~( Subscribed ar:ld.~;Wprn to, before me the "d-..O day of ~ ~O \ _ ,,~-.' .... LEc:; "0,,, ( . v .... 6. °61 " , "v:-·~ EXPI.q,i".. '-:. , "4 _,0 .1 .so. A,#' . "-:'" ~ ..... ~ . ~.0 • ~ ,q;:~ ~, c,;:~~, "tI:." ~o ,'fo ~:§) 0: (!j~; ~a::o ,~<IJ.:;;:;; :,0-.0 <?,'V <::l':'~:': ':>. ~~~..., -:'" .... ~f..~?'f';.~'1~ .... '·,oS'-"J1TE o~ "J I" .., , \;,.~ ""tI.UIO \\. S te of Washington (1) OT2.f:()1G~? (i) ~~/;ttq A --_ 7... "1 I _~ ___ _ .,~. . .' ----- +-"3' \0"-'> -~' IO'~ ?, .'~ .", r . ·,t '" --0 - F- 1 + ~~ LJ ,..., Y-o P 0* " 8:: -~ 7::. 10 0 . -t 0 10 Q,Z <> ~ J '®m King County Department of Development and EnviromnentaJ Services 900 Oakesdale AVcrlUC SoUthWl~st Renton, W\ 9B055-1219 TO THE ATTENTION OF: __ ----:=-=:"-l¥'~:_::i :=',-r""h:'-A=l'Y\-,----,,:--__ _ (BSD STAFF/SECTION) Return this form and related submittal items to the King County Building Services Division Permit Center. If you have any questions, please call 206-296-6600. This slip MUST accompany all submittals of additional information to King County Building Services Division. SUBMmALS WILL NOT BE ACCEPTED WITHOUT THIS COMPLETED FORM. KING COUNTY TRACKING NUMBER: ____ ~e,_O...:..I_L_=O...!..7!::6L~=___ ___________ _ PROJECT NAME: ~II f-12*rCi h J!oOT -I-1f12[CfH-Ha r-12~+f i p /hOB'L& /tc)jI.1G ADDRESS OF PROJECT: [1pZlCc [l'$Uo.u-e-<S.t. ]2en+ot" \ we--. . ANY QUESTIONS ABOUT THIS ADDmONAL INFORMATION SHOULD BE DIRECTED TO: NAME: 1)ep;J1;if; Oy (?en ]2.v0T FIRM NAME:_~~'------_-----LrJ_?1-'4:::..L.:-'-----_____ PHONE NUMBER: C·{-zb)'Z-"l1-21,,-( MAILING ADDRESS: rr;o~ ((rt~ avo.('. ti ~. CITY, ST & ZIP: 7?'el1.fofl, we..-'1]'09 f.k I STATE THE SCOPE OF ANY CHANGES OR DEFINE THE ADDmONAL INFORMATION PROVIDED WITH THIS DOCUMENT. 1Hfti0 1712Cv Mfi.!r0 fmf;-~ '10 Qoe.x/ vuf:, ftP'eu (Atl' 0 vJ 1h>Cf>h? o'f-Iher7l C4L-ti-ATk1?1ttfl?' (}1O'6i LE-t!o M.e-. DOCUMENTS SUMITTED (UST ALL DOCUMENTS AND THEIR QUANTITIES): ITEM QTY DESCRIPTION 1 2 3 4 F (YlOl?t' 5 6 o JUN 27 ZOOl K.C. D.D.E.S. certificate provides maltio'n necessary to development Certificate: 3493 SOOS CREEK WATER AND SEWER DISTRICT CERTIFICATE OF WATER AVAILABILITY Type: Building Permit: plicarlt's Name: Kenneth & Deborah Root Proposed Use: Accessory Dwelling Location: Lot: 3 Block: 2 Development: NORTHWESTERN GARDEN TRA Parcel: 6197200383 Address: 18036 118TH AVE SE, RENTON Information: WATER PURVEYOR INFORMATION Must apply for an Extended Service Agreement. 1. a ii!'I Water will be provided by service connection only to an existing 6" inch water main, 12 feet from the site. And I Other b 0 Water service will require an improvemnt to the water system of: 2. a ~ The water system is in conformance with a County approved water comprehensive plan. b 0 The water system improvement will require a water comprehensive plan amendment. 3. a l>1l The proposed project is within the corporate limits of the district, or has been granted Boundary Review Board approval for extension of service outside the district or city, or is within the County approved service area of a private water purveyor. b D Annexation Or Boundary Review Board approval will be necessary to provide service. 4. a l>1l Water is/or will be available at the rate of flow and duration indicated below at no less than 20 psi measured at the nearest fire hydrant 200 feet from the building/property (or as marked on the attached map): Rate of Flow: 1,000 gpm Duration: 2 hours or More b 0 Water systems is not capable of providing fire flow. Cross Connection Control devices must be in conformance with state laws. Service is subject to the applicants agreement to comply and perform to make such installation and/or connections to the standards, regulations, requirements and conditions of this District and such other agency or agencies having jurisdiction. This District is not representing that it's facilities will be extended or otherwise modified to make such service availabie to the applicant. It is the responsibility of the applicant to make any required extension of facilities to serve their property. I hereby certify that the ahove water purveyor information is true. This certification shan be valid for one year from date of signature. SOOS CREEK W A TER & SEWER DISTRICT Agency Name Development Coordinator Title 5(}", CreekWater & Sewn D,slnct "rptAvailSiJlgleParcelAddWakr" 216196 Lori Westendorf Signatory Name " 6127101 Development .. nental Services AvcrlUl' Southwt'St .J8055-1219 DATE:~0~(?:'--'-'-~t-=-( 0 -I--{ __ I L TO THE ATTENTION OF:--LIJ--""u..~i=1b±,:::,:a:?:.Wt~=== __ _ (BSD STAFF/SECTION) Return this form and related submittal items to the King County Building Services Division p. ermit Center. If~OU have any questions, please call 206-296-6600. This slip MUST accompany all submittals of ad ni:ir«O!rilatiBnM g~nty Building Services Division. SUBMmALS WILL NOT BE ACCEPTED WITHOUT THIS C LB-EB' ffiRrl1. .. . lW KING COUNTY TRACKING NUMBER: aO f L 01 rt 2: JUN 28 2001 PROJECT NAME: ~+-Wbbie &oor Heoiud HO" ..... d<?bLp HcMl·/{J·D.E.S. ADDRESS OF PROJECT: t60?;~ Il$U aue. 0·t 1ZeO±Oh I 4,)Ct '1.. roS-1' ANY QUESTIONS ABOUT THIS ADDmONAL INFORMATION SHOULD BE DIRECTED TO: NAME: =oe.f?f7J e 0 V ~el'l troo-r FIRM NAME: 6J(A MAILING ADDRESS: f$01k ( ,ill C1. Vf . 0. ~ PHONE NUMBER: [<JZ5)41'1-)1ta! cm, ST & ZIP: 1Ze f1 b '" (j)C1' V11oC:;l STATE THE SCOPE OF ANY CHANGES OR DEFINE THE ADDmONAL INFORMATION PROVIDED WITH THIS DOCUMENT. AW[~.f-io&\ . . DOCUMENTS SUMITTED (LIST ALL DOCUMENTS AND THEIR QUANTITIES): ITEM QTY DESCRIPTION 1 ( .::SOO?) ( ~ Ie L\ ) A-tt--':IT At lA-I! lrt7Wt-..f [tev+i'"H Cti.. t-e 2 3 4 5 6 Medical Hardship permit application for mobile horne: Parcel # 61972Oc0383 Zoning R&-50 approved for mobile home Root Residence: 18036 118th Ave. S.E. Renton,W.A.98058 We certify that the following information is accurate and true: • The primary provider(s) will be Debbie and Ken Root and will reside on site. • We understand that the mobile horne is temporary in nature and must be removed within 90 days of permit expiring or when daily care is no longer required. • We understand that the permit must be extended on an annual basis and that an updated affadavit must be submitted. ,,- Signed this rf.'J day of r~\L\Cb 2001 Debbie Rootl1~ ~ Ken Root ~ gcti-{ ~ULU{U C ~-Jly-:' Notary Public in and for the Sclte of Washington residing at Ro ~ 1\ ) 1 JJA My appointment eXPires~~h (h ?:>DjJ{X'",-- DR:sr "Vellbutrin SR@ (b . Hel) "W'"''",''''' uproplon TlB'_ml~O"",Ii'n~ '. /' ~ " . 1..Jl..-U ''v~ l C ---- 6~1!-CJC~--'-"VI.~-----"q,,+-(A/LiP 0 J""J --- ~/"\0Z.\('J ~~(OfJ~C:-- .-fu C OJ 0' CL (!y.? "j fA I k .P VETERANS AFI S Healthcare System Columbian Way 98108-1597 In Reply Refer To: S-116-MHC 1997. I believe it would be quite beneficial for Mr. has a psychiatric condition that necessitates direction with his medications and activities of to his outpatient appointments and community proximity to help with the above and yet not in the . Corbett's highest level of independence which separate quarters will promote. It is not often we have this kind of family involvement and support, I highly recommend the housing plan proposed by the Root family. L.'(./ C. LLt_~./'"cv<'C::'~---'-/.':c~' '7 __ LCC'::.~--,-+_-",-=lGV-'-· i I ___ ----'-I -,-11 L __ _ If you need more information, please call me at 764-2007. Sincerely, E. Alexandra Ashleigh, M.D. Staff Psychiatrist Seattle V. A. Medical Center and Clinical Associate Professor Department of Psychiatry and Behavioral Sciences , King County Department of Development and Envirorunental Services 900 Oakesdale Avt'nill: Southwest Renton, W\ ~&l55-1219 , " DATE: F ?i ,')a2( TO THE ATTENTION OF:_-"-y---=-::fJ..:-::t":::-:::fJ=:Yt-={J./J/Jt../=-====::--__ (BSD STAFF/SECTION) Return this form and related submittal items to the King County Building Services Division Permit Center. If you have any questions, please call 206-296-6600. This slip MUST accompany all submittals of additional information to King County Building Services Division. SUBMITTALS WILL NOT BE ACCEPTED WITHOUT THIS COMPLETED FORM. KING COUNTY TRACKING NUMBER: 60 t kO"1 &?-0". "Pa. ,,"eel =ij:. c;'CGj'1:?O -<::)~~~ PROJECT NAME: ~"t:12e.f2t?f e. 1Z.00T" He:t;l(c.A-k AAv=d"l/A iF HoPilf. H-oWl..e.... ADDRESS OF PROJECT: f10nt, U1-u,.. o.U{· 6. q. Ee\l\±oV\ \ l,Vet· 0"Qo5"1 ANY QUESTIONS ABOUT THIS ADDmONAL INFORMATION SHOULD BE DIRECTED TO: NAME: :QPhble Of ~eV\ ~o-r FIRM NAME: V(A. MAILING ADDRESS: (!O?k (( $1"~ q V£' t;. tt: . PHONE NUMBER: Ctfzb)?r1'l -2-,[<0,,( CITY, ST & ZIP:lZefHoo, IAJA' vt'1 u c;i' STATE THE SCOPE OF ANY CHANGES OR DEFINE THE ADDmONAL INFORMATION PROVIDED WITH THIS DOCUMENT. DOCUMENTS SUMITTED (LIST ALL DOCUMENTS AND THEIR QUANTITIES): ITEM QTY DESCRIPTION 1 1.. ~ ""~rJl-e_~ o-f ~r'+-€ -I7!t:l1/\ of. l1"o1tf Il'!"''' &tU-e·.:j. t. 2 \ • 3 4 5 D ~ (!U IS n ~{! f? _ 6 II . ''2,~ L 'J Lc " ~ lJUI~ t:. fJ 2001 ~ K.C. D.D.E.S. King County Department of Development and Environmental Services 900 Oakesdale A venue Southwest Renton, Washington 98055-1219 An application has been received for the following work: Application Number:B01 L0762 Application Date: 06/19/2001 Applicant:ROOT, DEBORAH & KEN Location:NW 33-23-05 Site Address: Parcel: 619720-0383 Permit Type:MEDI-MH , MOBILE Title:L3 B.2 NORTHWESTE ARDEN #2 Description:tempora Fuqua/Parkway; arm edical Hardship Mobile Home -double wide 1981// bath; 28X36 --:-:::-/ -----~----------Valuation:$O.OO Questions about this application and it's status should be directed to the permit service center at: 206-296-6600. Date Printed:06-29-2001 bp_appI8-20·99 " i'T'; ~I , <01 '" '" ; • ,~ .~ -(~- Q l " , " w , o ti' I " ,., " , • , " . <. , " , , ~ .;. , ~ ~ .. .. " ~ , " ~ " , , , ; ,. \' ': n. i-_w uN ",0> Ul ~ 'Y"C~I/ 0°· ~ 9 ,., , ,~ I" • "'I .. " , '" . N "'HI C .. -.. -1.-,. • 1<) I \ I ~19 'gfjZ , l '66Z ~'I ~I I r ,so Kina: County Dept. of DcvelopmePl .nd Environmental Service8 IIuiIdiDI Soniceo Di..- 900 Oakesdale Ave Southwest Renton I W.lhingtoo 98055~1219 '. Date: ~, t~-0 I DDES Pre-Application File Number: _______ _ Proposal: 1"'e-vn.rov,ar'! Mfld.t~1 iia..rda..biV Mobile.. HoVII£_ Tax Lot(s): (PC 6,7?-0 -0'5 Z~ Applicant: 1282t7t e t ~eV\ 12001: The applicant has discussed the above referenced proposal with a representative from the Building Services Division. Based on this discussion, I agree to waive the following submittal requirements as determined to be unnecessary for review of this application: )( 1c-9/or Sewer Availability Certificate(s) '-==~------------------------------ o 2. Septic System Design Approved by Health o 3. Certificate(s) of Future Connection o 4. Environmental Checklist (due to EIS/prior determination) 0 5. Fire District Receipt 0 6. Proof of Separate Lot 0 7. Certificate of Transportation Concurrency 0 8. Certificate of Applicant or Applicant Transfer Form 0 9. Site Plans Containing all Required Information 0 10. Architectural/Structural/Mechanical Plans 0 11. Documents & Plans Per Surface Water Design Manual 0 12. Variance(s) Required/obtained Under 21A 0 13. Other o 14. Comments The director or his designee may require the submittal of additional information including, but not limited to the submittal requirements waived above, if it is determined the information is necessary for the review 0 application. <. uilding Services Division Manager or Director's Designee White copy -Pennit File Pink Copy -Managers File . .. , ®LPS King County Department of DeveloplIlent and Enviromnental Services 900 Oakt:sdalc Avenuc SouthW'l'St Renton, WA 913055-1219 I \ ~ .. Application number assigned: _______ _ Parcel Number: {flq,1'UJ-o~1" Legal Description: .... L""efT"'-'---'o-3.-L---'Io.8a l"'o .... c t:.~,..~-----lH----"'vv:'-":fn'-'-'-"'W-!f?1:~> '-"ru(--'-v¥-'------'c2al.<!A.L~~d-'"'-eVltl' _=t---I-LV'-'<lIl~C.=r.L:5::L-]?..I::...L·I..:..-V-=---• ..;;ld-C-_ Address of proposed work: --=-[--'1=O:......?£eL::L.._t"-'('-<KJoL.t-_h--'av~-"'e"-. q--'<-...... f~.-"-. ___ _ D address not assigned yet (if not yet assigned, check box at right) Related Permits or PreApp number: ___________ _ .. Descriptive summary of proposed work: :::from.lla:Hot'\ of /tentP· ACC€000H 1jWE'(((~( Hot/Ie tt oll1e) Valuation of project: ___________ _ Contractor's License #: _______ _ Expiration Date: Check aI/applicable items This is: This is: D New Construction D Sign D Remodel/Addition D Tenant Improvement D Single Family D Duplex or Multi-Family D Retail/Office D Agricultural '&Accessory Structure D Other D Commercial/Industrial D Other \Cen ~1' Property Owner: 12e,t.OY'4. h J?OO1' Telephone Number: thS ~ Z"11-'7.."&1'11 City: J2en+Olll state:U. Zip: 41oq1 Telephone Number; Ltt-s -7:11 >c"lc,,"b Mailing Address: ~ [(1+10\ ave . .". f. . Applicant Name: tEn oV'-Pf;b21f"-h "Jroo+- Mailing Address: I$o?XR (/$ fl.. CivP, C;. ~ • City: ""Ve'l+ClVl State: (}...Q Zip: fuos ~ Contact/ Agent Name: _____________ Telephone Number: _______ _ Mailing Address: ___________ City: ______ State: __ Zip: Sensitive Area Compliance: The undersigned applicant declares: L That the applicant is competent to be a witness herein; 2. That the-applicant is the applicant for the above project; 3. That to the best of the applicant's knowledge, the sensitive areas on the development proposal site have not been illegally altered; and 4, That the applicant has not previously been found in violation of sensitive areas regulations for any property in King County, or alternatively, that if there have been any violations, such violations have been cured to the satisfaction of King County. I am submitting for a permit authorized by the uniform building, fire or mechanical codes and in anticipation of having it approved or approved with conditions I have read the following statement and understand that failure to comply with all conditions once construction is begun may necessitate an immediate work stoppage until such time as compliance with the stipulated conditions is attained, I certify that I have made a diligent inquiry regarding the need for concurrent state or federal permits to engage in the work requested under this building permit, and no such permits are required or I will have obtained the required permits prior to issuance of this permit I understand that the granting of this permit shall not be construed as satisfying the requirements of other applicable Federal, State or Local laws or regulations, In addition I understand and agree that this permit does not authorize the violation of regulations, In addition, I understand and agree that this building permit does not authorize the violation of the Endangered Species Act as set forth at 16 U.S.C. § 1531-1543, including the prohibition on the "take" of threatened or endangered species, "Take" is defined at 16 U.SL § 1532(19), I fully understand that it is my sole responsibility to determine whether such "take" restrictions would be violated by work done pursuant to this permit, and I understand that I am precluded by Federal Law from undertaking work authorized by this permit if that work would violate the "take" restrictions set forth at 16 U5.C §1538, 50 CF.R, §17,21, 50 CF,R, §1731, 50 C.F,R, §223 and 50 CF.R, §224. I certify under penalty of perjury and under the laws of the State of Washington the foregoing is true and correct. I further certify that all easements, deed restrictions, or other encumbrances restricting the use of the property are shown on the site plans submitted with this application. I accept financial responsibility for all fees associated with this permit or approval and will receive any refunds, Please mail any refunds to the address above. Applicant Signatur~ 11 ~ Date--,C'l'-elf-/.LC1~{",O-,-I ___ _ t(~W. ~ 6(17{O/ .... '" .t:. -.J IJ> t ~ " rf.. 'I. -() -1¢'-nP;lIE· ~·r. ifl 60' \,,,' ; \'-:-,,[ ~14T\'Nf"r :;'~1"E:: 'WAT' 1 , Ie' Ij 1'1, --- \ i ,-L,,---.i I E't;..,.n IVGo MIlo;N 6)' 51TE PI ",N S CA'~ I;. ~ 1.".: 4(5" !;; StPf'l! , tRA,N 52' h,", 52' c,"~ / " 0'(',\', 7 .. -,o,-fi2-/----'TTl I ~ , , " ' GAR,"IGt:: \ .i , I \ 21 '-----.1 T L " 38' ,<1.,,-,",," i ;]' 1~25'~['11 j/,!/;;r C"': i- " ", , I '/ p~~~ot~4; 3' • t' ,.: / t-;:\obj'"e,:' / :1' .... Z Z. '--." : / At,* "~/'/:,'1 I"~ 1'-';' ( ///5/ 1 T~-;:b_1 14' I' P/,.r:':_EL--¢ S !:~7Z,J 0363 ~ '" J:: " v, ATT£NTION t.tINIMUM ~ SETBACt;S STREET 10' '" 1NT6AICJA ___ J __ _ MEl&JAEMEHT ALONG CENTER LINE OF DRIvewAY TO FAt,'E OF ('~, CAAf'ORf, OR On-lffi FENCED PARKING AREA ~ REFeR 10 ItC.C. nTLE 21A.12.170 FOR AllOWA8I..E Pf«lJHTION INTO THE RB:lUIREo S£Te~(',S ATTENTION Maximum Impervious Surface Allowed 15JjJ'o sq ft Maximum Bldg Height Allowed 3) , Ref: K,C.C.21A,12.030 for specific requirements '. ~ o -r-o --.J " tV ; '" ."... -