20020378.pdfRECEIVED
EXPIRES
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CONSTRUCTION PERMIT APPLICATION
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THISPERMITAU7 ORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONTHC PUBLIC
Grading
Recording Fee
LKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
3. DOMMN (CUfIW'SlDEWASEPARATEPEFIMISSION-
-
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Engr, Review
City Surcharge
PIERMITAPPLICATION: VIDDAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Butcher a
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-
Plan Chk Deposit
NT HIS OR 11. SPOUSE. lips. ASSIGNS ABU SUCCES.11
'APPLICA ON BEHALF OF
T"din' ""gation
IN INTEREST, AGRE58 TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt#
ED..N.S. WASHINGTON, Be OFFICIALS. EMPLOYEES, AND A.-TS PRO. ANY AN.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. A.11IM6 ISECITY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Fife Review
Fire Inspection
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WAIVE OR REDUCE ANY REOWNEIVINTOPANICITY
Moral,
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ol T IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIONI�'
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I HEREBY ACKNOWLEDGE THAT I RAW READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPF
GWEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING CONSTRUC.
CALL
11 net A Par-[' vital t
TION; AND IN E WO K AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE "LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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WORKMEN'S CFWtVSATION INSURA CE AND RCW IB.27.
0 bIALS SIGNATURE DATE
SIGNATU DATE;IG 0
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771-0220
j#�TION
EXT 1333
-fl-IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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771-022
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGZALL-iji.EJ YELLOW,lNdPECTO H
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE a , 0'�
PLANNING DIVISION DATE—,
PROJECT—_Z_e�L4
SITE ADDRES
PERMIT ADB# -I() 'o3
-------PATE INSPECTED—IL-1— —'—J
DESCRIPTION OF WORK TO BE INSPECTED—Ea-L2��...
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
_pERFORMANCE BONDS and the granting of:
L----�GT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy ofCONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign
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RECORD OF INSPECTIONS
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DATE APPROVED
SETBACKS .....................
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Slab Insulation ..........
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HEATING:
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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