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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E ONE 0. PRIVATE PROPERTY ONLY. ANY CONSTRUCTI ON ON THE PIT EILI C
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMAT ON
APPLICATION APPROVAL
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GIVEN IS CORRE 1. AND THAT I AM THE OWNER'OR
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OFF, AILS SIGNATURE-� DATE
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771-0220
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TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
17FIS UNLAWFUL
MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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FLUE, CHIMNEY AND EQUIPMENT INSPECTION CHECKLIST
Each year before a stove or fireplace is put into service the cbimney flue should be thoroughly cleaned
of soot and other residues. Prior to installation of a solid fuel burning appliance in an existing masonry
chimney, the following items must be inspected by the owner. This form must be completed and
submitted to the Building Division with the permit application.
1. CHD4NEY LINING:
Is the chirriney lined with fireclay flue tile, firebrick or other approved lining?
Yes_-��_No
Is the lining in good condition? No voids, cracks or deterioration?
Yes— -K —No
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2. CLEARANCE TO CONIBUSTIBLES:
Are all combustible materials, i.e., wood framing members, a minimum of 1" away from the
chimney walls? Yes 'Y
_ —No
3. GENERAL CONDITIONS:
Is the exterior masonry in good condition, free of cracked or broken liners, rotten mortar joints
or structural defects?
Yes X —No-
4. EQUIPTNIENT:
Have you read the manufacturers instructions for the equipment installation and is the existing
chimney compatible for installation?
Yes
No_
I hereby acknowledge that I have read these inspection requirements; have personally inspected the
chimney; that the information given is true and accurate; that I am the owner or the duly authorized
agent of the owner.
Signa e DATE
CHM-TEY �AFETY:
Please observe the following warnings in order to install and use solid fuel burning equipment.
1. Use all appliances in the precise marmer described and tested by the manufacturer.
2. Follow listing instructions for clearances to combustibles.
3. Inspect chimney flues and appliances yearly for needed repairs.
4. If creosote accumulates in the flue and starts to bum call 911 immediately.
5. Keep an extinguisher on hand and make sure all your smoke detectors work.
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DATE APPROVED
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Slab Insulation ..........
PLUMBING:
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Gas Piping .................
Equipment
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EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ............
Floor insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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FINAL APPROVAL FOR
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GRESS INSPECTIONS PER UBC 1081FINAL INSIPEL; I lu- H--
LOT SLOPE I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I, E DANE (1.1 N P.R.IVAT E P ROPERTY . XLl. AN Y CONSTRUCTION ON THE PUBLIC
'0. N U. SIDEWALKS, DRIVEWAYS ARQUEES. ETC.) WILL REOUIRE
SEPARATE PER�IBSION.
PE MIT APPLICATION: 180-AYS
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PERMIT LIMIM 1 YEAR PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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VALUATION FEE
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ENG. REVIEW FEES
ENG. INSPECTION FEE
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TOTAL AMOUN DOE
REC P
t HEREBY ACKNOWLEDGE THATI HAVE READTHIS APPLICATION: THAT THE INIORM-1— L
GIVEN I S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLIC ION APPRO
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Thl, IPPI'lat - p_,t,,pj S,gn.d by thO
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ION; AND IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE E DYED Blid.19 01111 1 pl,lidld.
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ,.,.pt is —nowWdpd il 10
WORKMEN'S C2��PNSATION INSURANCE AND ROW 18.27 OFF IALSSIONATURE DATE
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IYIS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR[GINAL FILE YELLOW'INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 139 FAX PINK -OWNER GOLD.ASSESS011
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