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DATE RECEIVED
142 J4 PERMIT EXPIRES
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CITY OF EDIVION6S�� Z"Es PE."mm.ER,�� —
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
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NAME ETER SIZE I LINE SIZE 1 110. 01 FIXTURES PRV REQUIRED
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REMARKS
PROGRESS INSPECTIONS PER USC, 1081FINAL INSPECTION REO'D
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VALUATION $
Building
PLAN CHECK NO:
VESTED DATE
Plumbing
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2
THIS PERMIT AUTHORIZIES ONLY THE ORKNOT90. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
To W. LL . U
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
PTAPPLICATION: INDAYS
mechanical
LGrading
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Engr. Review
PERMITUNIMIZ -PROVI ED WORK IS STARTED WITHIN '80DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection
-APPLICWr ON BEHALF OF HIS OR HER SPOUSE, HERS. ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EOMONDS' SHINGTON, ITS 1111,101AU1, EMP'OYEFS, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIR MEW OF ANY CITY ORDINANCE
Fire Inspection
NOR LIMIT IN ANY WAY THE CITYS ABILITY To ENFORCE ANY ORDINANCE PROVISION -
Landscapoinsp.
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE is CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
NWNER.
THE I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERE N WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
WORKMEN'S 9OMPENS2!IIANC' HCW 18,21,
;I
(425)
=WNER,
771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due 1715
Receipt # I / V1114
APPLICATION AP
�ls arepilsue,a Is not a permit until signed by 9m
g Olklal or his/her Deputy: and Face am paid, and
,.c,lpl Is ackamledged In ermes ruoldui.
V§, S!GNiTVRE DATE
RELEASED BY DATr/
ORIGINAL - FILE YEt,[OVV, INSPECT IT
P.K. OWNER : GOD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing*
Wall... .......................
PiedPorch .................
Retaining Wall . .........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In .................
Commercial Final
HEATING:
Gas Test'..�
Gas Piping
Equipment
Commercial final
EXTERIOR SHEATHING
NAILING .........................
FRAMING ........................
FI FIST F LOOR FFIAMING
INSULATION ...................
Insulation
Wail Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................
. ............ ..
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