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CONSTRUCTION PERMIT APPLICATION JAGGIE1 Fe
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PLAT NAMEISUUDIVISION No LOT 11, -IDN0---
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SERA REVIEW SIGN AFtEA HEIGHT
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LOT COVER REQUIRED SE BA�KS IFT� PROPOSED SETBACKS (M.
0 NEW C3 PLUMBINGIMECH ALLOW E G IFIO"POSED FRONT SIDE REAR FRONT UR SIDE REAR
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PLAN CHECK NO: IVIIIE'DATI
UTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tt BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CORDS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REG UIRE
SEPARATE PERMISSION
PER -IT APPLI CA`NO ; 160 DAYS
PERMIT LIMIT, I YEAR - PROVIDED W RK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
INDEMNIFY EFEND AND U.LG HARMLESS HE CITY OF
IN INTEREST, AGREES
S EMPLOYEES, AND AGENTS FROM ANY AND
WASHINGTON TS OprICJ�LD
Z EDMONDS,
ALLCLAIMS FOR DAMAGE�GF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APILICATION� THAT THE INFORMATION
OUSLI AUTHORIZED AGENT OF
GIVEN IS CORRECT. A D THAT , I AM THE OWNER6 BOTATT""'
L, WITH CITY AN E LAW REGULATING CONSTRUC
THEOWNER IAGRE ETOCOM'
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSATION INSURANCE AND RCW 8.27.
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DATE S11 NED
DATE 11
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VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADUIG?FiLl-
STATE SURCHARGE
END REVIEW FEES
ENG, INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
APPLICATION APPROVAL
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OFFICIA I T. D E
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771-0220
DATE
P.-E EDGY
ATTENTH Lx I JJJ
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX ki
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FINAL PROM CT APPROVAL FORM
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FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—a2- �O:?-
PLANNING DIVISION DATE
PROJECT
siTE ADDRESS
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DESCRIPTION OF WORK TO BE INSPECTED--A�s�����
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
EFRFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrM CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....... . ........... .
FOUNDATION:
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Ple,/Parch .................
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0
Retaining Wall
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Slab Insulation ..........
PLUMBING:
Underground .............
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Commercial Final
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Gas Piping .................
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FIRST FLOOR FRAMING
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Wall Insulation ...........
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 7,3
OCCUPANCY ..................
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