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PERMIT EXPIRES
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BUILDING
PLAN CHECK NO:
.... ED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COIERSWORK TO
SE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRAD;NGIFILL
E.MARN 'Q...�, SIDEWALKS, DRIVEWAYS' MARQUEES. ETC.) WILL REQUIRE
STATE SURCHARGE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEA "PROVIDED WORK 15 STARTED WITHIN 150 DAYS
R
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
M SSIONS AND SUCCESORS
;A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A
P E STAGAEESTO:ND NIFY, Y OF
NINT DEFEND AND HOLD HARMLESS THE CIT
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AULCLAIMS FOR DAMAGES HATEVER NATURE. ARISING DIRECT
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FROM THE ISSUANCE OF THIS PERMIT. ISSUAN E OF THIS PERMIT SHALL NOT
PLAN CHECK DEPOSIT
DEEMED To MODIFY,WAIVEOR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE -
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ORDINANCE PROVISION.
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY
OTAL AMOUNT DUE
I HE REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT TH E INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNEA.ORTHE DULY AUTHORIZED AGENT 01
STATE LAWS REGULATING CONSTRUC
CALL
THEOWNEPL I AGREE TO COMPLY WITH CITY AND
TION; AND IN 00 NG THE WORK AUTHORIZED THEREBY' No PERSON WILL BE EMPLOYED
I NG TO
FOR INSPECTII
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATI
WORKMENW CO.PEN.ATIO INSURANCE AND RCW 10.27,
E SIGNED
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(425)
1 71100
771-0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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SEE ATTACHMENT
HOWLAND HOME5 L.L.C.
ADDRE55: 1243 NE 152nd ST.
SHORELINE. WA 98155
PHONE: (20G) 3G7-7075
PLAN: CU5TOM HOMET ;u
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Project Review Checklist
Project Name: PlanCheck#: oo—(O<�K
Project Address: 2�2 Z- (0 QQ-7-J-- -2\ SU3 ReceiptDate:
Underground Wiring Required
Hydraulics Permit
Plat/Subdivision Requirements
Street Dedications
Easements - Public/Private
Engineering Storm Drain Review Feel
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
Driveway Slope & Vehicle Access
Sidewalk Required
Curb & Gutter Required
Curb Cut for Driveway Required
Street Paving Required
Right -of -Way Construction Permit Required
Bond Required for Public Improvements
FEMA Map Check[Water Table
Side Sewer Availability
Calculate Sewer Fee ifNo LID#
Water Meter Size
Water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Permit 4 Date Issued L�XZ.7 400 Receipt # i =21 9
SS Permit # 1�1 1 -73 Date Issued Receipt # LS:17Z--?
Meter Size Paid $ 7ZO — Date llh4�dd Rdceipt# ILM
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
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ENGINEERING DIVISION DATE...!��
—PLANNING DIVISION DATE
PROJECT —
SITE ADDRESS—
pERwT4 WD A #_______PATE INSPECT 1)
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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SETBACKS .....................
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Slab Insulation .......... ---
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WORKMEN� COMPENSATIOMINSURAN�CE AMORCW 18.27-
(425)
TAV
771 -0220
EXT 333
ATTENTION
ITJS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
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