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USE PERMIT
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CONSTRUCTION PERMIT APPLICATION AOG R E S s SUITE/APTN
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SEPARATE PERMISSION.
STATE SURCHARGE
P.�. T APPLICATION I.- DAYS
I PERMITUMIT.1 YEAR, PIRIOVIDED WORK IS STARTED WITHIN IBODAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCES.RS
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AGREE' TO DE.NlC1Y SS THE CITY OF
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RECEIPT
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NOR LIMIT IN ANY WAYTHE CITY SABILITY TOENFORCE ANYORDINANCE PROVISION
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ACKNOWLEDGE THAT I HAVE READ THIS AT,�CEAGNY., THAT THE I N
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN$ COMPENSATION INSURANCE ANDRCW 18.21.
o CIALS SIGNATURE DATE
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ER GEN DATF/�EG
(425)
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sIG&RE IOWI
771 -0220
RELEASED BY
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
YELLOW -INSPECTOR
FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
ORIGINAL FILE
GOLD ASSESSOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SE07ION 109
FAX
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SETBACKS .....................
FOUNDATION:
Footing ......................
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Pier/Porch .................
Retaining wall ...........
Slab Insulation ...........
f PLUMBING:
Underground .............
RoUgh-In ............
commercial Final
HEATING4
Gas Test ....................
Gas Piping .................
Equipment .................
commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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FINAL APPROVAL FOR
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THIS PERMIT AUTHORIZES ONLY THE WORK N D, THIS PERMIT COVERS WORK
BE O.E . PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
IRE
ETC.� WILL REQUIRE
GRADINGIFILL
DOMAIN 'CURSE. SIDEWALKS, DRIVEWAYS. MAROUEES,
SEPARATE PERMISSION.
STATE SURCHARGE
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PERMIT APPLICATION 1.0 DAYS
PERMIT LIMIT. I YE I WORK S STA IT.E.D W 0 DAYS
ENG. REVIEW
. R; MIT FORMORE' IN RM='
SEE BACkAO
OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
,w ;APPLiCANTONBEHAL
DEFEND AND HOLD HARMLESS -THE CITY OF
N INTIREST.=TS.TO No E." N�o FROM ANY AND
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..N.B.. N. IF 1y4LS, EMPLOYEES. AND AGENTS
ED CTLY 09 INDIRECTLY
DIRE
INSPECTION E
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING
OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK EPOSIT
RECEIPT
Gb
FROM THE ISSUANCE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITYORDINANCE
ENFORCE ANY ORDINANCE PROVISION.
RECEIPT
5
0 NOR LIMIT IN ANYWAY THE CITY'SABILITYTO
TOTAL AMOUNT DUE
7
CA H
I HEREBY ACKNOWLEDGE THAT I HAVE R D THIS AppTHETIULN AT THE INIF AMATION
APPLICATION APPROVAL
.�A
.,W E OR AUTHORIZE AGENTOF
GIVEN IS CORRECT. AMD THAT I AM T CONSTRUC.
THE OWNEl, AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING
CALL
This ppfic.lion I, aM . P-11 bi,el ,g,,d by he
B.1hii .1 e.
K.ffbi
I
Loy
TION: AND IN DOING THE WORK AUTHOFFZTED THERE Y.N PERSON WILL BIEEII E
SHINGTON R LATING TO
m,,,pla,, ,knowlodg,d,n pa,, p—ebe.
FOR INSPECTION
N OLATION OF THE LABOR CODE 0 HE STATB OFO
I VI 3
E8.27. WA
OAT
on RCW 1
W KMEN'S COMPENSATION INSURANCE AND
OOCIALS SIGNATW19._)
W.;7 , �N,�
DATE - SIGNED
(425)
771-0220
A41
DATE
RELEASED
EXT 333
bi,)
ATTENT16N
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-
- GOLD - ASSESSOR
ORIGINAL -FILE - YELLOW - INSPECTOPj�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER Jul