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PERMIT EXPIRES
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
8 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION OWNITLE PLI 5
GRADINGIFILL
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SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NEE LF F HIS OR HER SPOUSE, EIRS. ASSIGNS AND SUCCESORS
END INSPECTION FEE
;APPLICAN
NiNTERES A REES DEPEND AND HOLD HARMLESS THE CITY UI-
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�NDEMNIPY.
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA CEPROVISION,'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICXTION� THAT THE INFORMATION
A APLICATION A�PROVAL
GIVEN IS CORECTANDCTHOATPLYM THE OWNER. OR THE Ul-1 AUTHOR, ED AGENT OF
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TION. AND IN DOING THE WORK AUCT)HORIZED THEREBY. LEMPLOYED
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FOR INSPECTION T-p---wI.dg.,I
IN VIOLATION OF THE LABOR CO
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WORKMEN S COMPENSATION INSURANCE
ATE S IGNED
(425)
SIGNATURE (OWNER
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771-0220
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EXT 1333
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ITISUNLAWFULTOUSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
APPROVAL OR A CERTIFI-
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ORIGINAL FILE - YELLOW - INSPECTOR
A FINAL IN S ECTION HAS BEEN MADE AND
P
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUN61 ATION:
Footing ......................
wall ...........
Pier/porch .............
RetaInIng Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ..............
Gas Piping .... ............
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING .......................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ................
Floor Insulation
Will Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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LPERMITEXPIRE
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'NAME
CITY ZIP
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RE UIREDDEDICATION FT
METER SIZE NO: OF FIXTURES
REQUIRED
YEPRV
_SE3 No 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTRPLIORAtNAGE
ZIP
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LOT COVERAGE
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ALLOWED PROPOSED
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PLAN CHECK NO: STEoibATE
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PLUMBING
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MECHANICAL
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THIS PERMIT AUTHORIZES ;NLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
C
8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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GRADINGIFILL
G I L
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SEPARATE PERMISSION.
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PE!U IT APPUCXHOh A'
PRO11DEOW RK b , ---
PERMIT LIMIT. I YEAR I�tlll E�1111.1.
R I I
ENI REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HCA SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
THE CITY OF
IN NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE C TY OF
I
LANDSCAPING
N SC
Y
M EDMONDS. WASHINGTON. ITSOFFIC:ALS. EMPLOYEES. AND AGENTS FROM ANYAND
ECTL,
A L CLAIMS FOR DAMAGESOFWIHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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INSPECTION FEE
R
F T .
ROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
LA
0 EMED TO MODIFY. WAIVE 08 REDUCE ANY REQUIREMENTOFANY CITY ORDINANCE
SON .
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.*
R
TO.L AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
�
THEOWNER IAGREETO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION. AND IN 00 NO THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELArING To
FOR INSPECTION
WORKMEN S COMPENSATION INSURANCE A NO RCW 18.27,
SIGNATURE (OWNER ORATRTJ 0 TE SIGNED
'425
Z24'
1 -o
771
EXT 1333
A17ENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CrRTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION __FIE
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