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NAMEISUDDIVISION NO. I LOT NO, L16 N13
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CHANGE OF USE DATE
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City Surcharge
PERNITTAPPLICATION: IN DAYS
PERMIT LIMIT I YEAR. PRDWU` D WORK IS STARTED WITHIN INDAYS
Engc Inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICA ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
EST. AGREES TO IND MNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
1E.DM-ONDF, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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Receipt #
I ALL CLAIMS FOR DAMA ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANC OF THIS PERMIT. ISSUANCE OF THIS P T SHALL NOT HE
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Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
THE OWNER. IAG"' TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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applica"", Is nal a permit Until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
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RECORD OF, INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..................
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Pier/Porch ..............
Retaining Wall ...........
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Slab Insulation ..........
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EXTERIOR SHEATHING
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FRAMING ........................
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FIRST FLOOR FRAMING
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............