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STATE SURCHARGE
PERMIT APPLICATIO : 180DAYS
ITHIN 180 DAYS
PERMIT LIMIT. T AR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
E G. REVIEW FEE
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P LICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
A P
ENG. INSPECTION FEE
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TOTAL AMOUNT DUE
RECEIP 7A
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLI ATION A 0 AL
GIVEN I RRECT. AND THAT I AM THE OWNER. ON THE DULY AUTHORIZED AGENT OF
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Th., PPI-C-1-0h hI
NiR t AGREE To COMPLY WITH Cl TY AND STATE LAWS REGUILATIN 6 CONSIRUC
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IN VIOLATION OF THE LABOR CODE 01 THE STATE
WORKMEN S I;OMPENSATION INSURANCE AND RCW 19 21
0 C LS SIGNATU DATE
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__SI_GNATU OW R OR DATE SIGNED
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(425)
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771-0220
ASED By
EXT 1333
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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DLpaTtinenj of Iabor & industries
Specialty Complian�. sc�i� FINAL ACCEPTANCE
Savalorsocrio.
PO Box 444SO
0j)jnpiaWA 985D4-448D co-cyAnct(O A
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(360) 902-6130 Location (car 00
conveyance Location
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sts perfurnled with no apparent deficiencies.
This convcyance(s) has been inspected and all acceptance te
Building Owner or Manager Pn %je Reqidence Owner
issued. Priva
A jemp..ry 30 cUY pe�mjt has boe if you wo: Id like 2A annual safety Inspection, You
Owner must Purchase and posi an annual operating may purchase an Annual operating Permit &
p,.it before the 30 day temporary Permit expires. receive an Inspection.
t, d tobecomplctodwd you are DOE required to purchase an annual
�Operating permit must be posted wb �'c pers'on.4
using the conveyance can see it.
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(RCW70.87.09()).
none Nuiniiir
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DEVELOPMENT SERVICES CM
CITY OF EDUMS
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Plot/Porch .................
Retaining Wall 4 ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
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HEATING:
GasTest ....................
Gas Piping � ................
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING..........................
FRAMING .....................
FIRST FLOOR FRAMING
INSULATION ...................
Floor insulation
Wall Insulation
Calling Insulation
C,
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
C� — 0
OCCUPANCY ..................
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NUMBER NUMBER F ClIT CAL /4
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RE.0 P E] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG"
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LUATION
FEE
PLANCHECKFEE
HEAT SO LOT
BUILDING
ILI
PLAN CHEC�� --D DATE
PLUMBING
MECHANICAL
THIS PERMIT AMORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINI
OMAIN (CURES, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
M
I: SEPARATE PERMISSION.
PE MIT APPUCATION: 180 PAYS
I I
PERMITLIMI ly ROVIDED WORK IS STARTED WITHIN 180 DAYS
t-. EARR P
REVIEW FEES
No REVIEW FEES
SING
SEE BAD K OF PINK PERMIT FORMORE INFORMATION
r
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS.ASSIGNS AND SUCCESORS
No 0
ENO. INSPECTION FEE
IN INTEREST. AGREES TO �ND'MNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
LA
EDMOND WASHINGTON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
S
ALLCLAIMS FOR DAMAGESOF WHATEVER,NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
PIECE —_
.1 FROM THE ISSUANCE OF THI SPER.IT. SSUANCE OF THIS PERM T SHALL NOT BE
PLAN CHECK DEPOSIT
N97Y /71—
DEEMED To MODIFY, WOUVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
0
TOTAL AMOLLNT.DUE
IR CE17 g'17!� 1 �2 7&1�;d
I HEREBY ACKNOWLEDGE THAT f HAVE REA. THIS APPLICATION: THAT THE INFORMATION
"APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNEP. qRjHE DULY AUTHORIZED AGENT OF
Th,, ppl,,,tl,, 1, ,t a pe,mit 11111 liped by 11,9
THEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONST RUC-
CALL
FFOR
Budd�,,9,Offl6-:...htl/h., D.pul y: F 11, PlId.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
:,d
p
0 INSPECTION /\ Ipt k,mIzdIP ImpIllid1d.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN*:XMPENSATION INSURANCE AND FCW 18.27,
'
0 19 LSSIGNATU DATE
`NATU'
SI DATE SIGNED
(425
(4
11 -
1 Akio AlfflA%,71,�,A9
771-02�20
SED
EXT 1333
ATTENTION
440-L
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
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