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I PERMIT EXP RES
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CONSTRUCTION PERMIT APPLICATION Joe suriEwr#
ADDRESS
OWNER NAUIENAME OF BUSI ESS
01 " PLAT NAMEISUBDIVISION NO. LOT NO, L NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP A,� U
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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THIS PERMIT AUTHORIMA ONLY THE WORK NOTED. THIS P�ERMIT COVERS WORK TO
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It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, MC.) WILL REQUIRE
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SEPARATE PERMISSION,
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PERMITAPPLICATION: INDAYS Engr,
PERMIT LIM r. I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
;APPLICANT
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
DMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
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ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SH
CRYALL NOT BE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY ORDINANCE
ORLIMFTINANYWAYTH DAYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAI THE INFORMATION
APPLICATION APPROVAL
GIVEN IS COB I AM THE OWNER, OR THE DUTY AUTHORIZED AGENT OF
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N, A UTHORIZED THEREBY, NO EASON WILL BE EMPLOYED
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IN 'LlITEHIA1.0 CODE OF T E TATE 01 WAS 11
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A C. N ATj
G I e._H DATE
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771-0220
RELEASED BY
ATTENTION Off 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 PINK-CsWER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS 2: .............
FOUNDATION:
Footing .............
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Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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HEATING:
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Gas Test ....................
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Gas Piping .................
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EXTERIOR SHEATHING
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NAILING .....................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Coiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................