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THIS PERMIT AUTH0131ZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONST MOTION ON THE PUBLIC Grading
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DOMMN (CURBS. SIDEWALKS, DRAIMAYS. MAR UEES, ETCJ WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
INDAYS
PE MITAPPUCATION:
PERMIT LIMIM I YEAR - PROVID WORK IS STARTED WITHIN 180DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHAL 0 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review PlanChk.Deposft
IN INTEREST. AGREES TO NDEMNIFY, DEFEND AND HOLD HAR LESS THE CITY OF
A' IN " TS OFFICIALS, EMPLOYEES. AND AGENTS F OM ANY AND Fire Insvection Receipt #
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ALI CLAIM DIRECTLY OR R.I.E.TlY
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FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapoinsp. Total Amt. Due AN�
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NOR LIMIT IN ANY WAY THE CIW8 ABILITY TO ENFORCE ANY ORDINANCE PROVISIOM'
Recording Fee Receipt #
HEREBY ACKNOWLEDGE T I HAVE READ THIS APPLICATION; THAT THE INFORMATION I
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GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE To MPLY WITH CITY AND STATE LAW REGULATING CONSTRUC-
CALL
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ou' i�' `B`I hi' WV
LABO OF c I- d
IN VIOLATION OF THE THE ITAT SHINGTON RELATING TO FOR INSPECTION �� PP.X�P
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W1111ME111 COMPENSATIO M CE AND RCW 18 27,
OF A G U
L�URE (OWNER OR Z -11 SIGNED (425)
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ATTENTION Off 1333
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IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORtGINAL-FILE YELLOW -INSPECTOR
CATE
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD*ASSESSOR
04J02
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
FINAL PROJECT APPROVAL FORM
TO -.-
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM*
FIRE DEPARTMENT DATE--9-- 6 --()
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
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PROJECT—,,
SITE ADDRBSS- :2 30 e±lm c-�
PERMIT # -),Q 0 —()- ADB#_____--PATE INSPEC
PATEINSPEC
INSPECT
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DESCRIPTION OF WORK TO BE IN SPECTED S
A field inspection was condacted 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: C, 0
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--�--GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy ofCONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sigq__�,
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