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CONSTRUCTION PERMIT APPLICATION
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FLAT NAMEISUODPASION NO.
LID NO.
MAILING ADDRESS -
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED ETRACKS IFT.)
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0 ADDITION COMMERCIAL o COMPLIANCE OR
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REPAIR GRADING F NCE
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ARPORT ROOKERY RENEWAL
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NUMBER "UMBER OF
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STORIES NITS NUMBER _A REQUI E] YES LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REOD
LU $
FEE
Description
FEE
Description
[VALUATION
Plan
HEAT SOURCE GLAZING as LOT SLOPE %,
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Building
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PLAN CHE?,��: ED DATE
Plumbing
Mechanical
..MIT COVERS WORKTO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
DOMAIN (CURBS. SIDEWALKS,01IRVEWAY8,111MAGUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PeRMITAPPLICATI W. NXIDAYS
PERUITUMM. I YEAR - PRO"A' 0 WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
1�;fiiEREST, AGREES INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EOMIIIIDI, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS Flo" ANY AND
Fire Review
Receipt #
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE . ARIS NG DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO 2DIFY, WAIVE 08 REDUCE ANY _ UIREMENT OF ANY CITY ORDINANCE
RCO
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscape Insp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; T THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
CALL
This appic.11- Is A., . pft naffil.19a.d by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
111d�%th"101 or Weiner Deputy: and Fees are paid, and
C.1p, I—k—Indg.d! In speed pr.1d.d.
WORKMENS COMPENSATIO��URANCE AND ROW 111.27.
0 — F1 SIONATU E DATE
SIG A AIR SIGNED
(425)
MA/10,
IL
771-0220
,
SED BY 15ATIt
ATTENTION
EXT 1333
UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0221
)LLO)e9/
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YE W - 14SPE40R
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK -OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE:_Z&�/ �,�
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPAR11vMNT DAT`E_
A ENGINEERwrDlvisioNDATE�__
MAVA PLANNING DIVISION DATE /0—/'
PROJECT
SITEADDRESS
PERMIT -04 2Y4�_1ADB# j)ATEINSPECTFD
DESCRIPTION OF WORK TO BE INSPECTED
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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:
X-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
Footing ......................
Wall ............... ..........
Pier/Porch ... ..............
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Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground ......... . ..
M
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Rough -In
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Commercial Final
M
HEATING:
Gas Test ............
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Gas Piping .................
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Equipment ...........
Commercial Final
In M
EXTERIOR SHEATHING
C3
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NAILING .........................
0
FRAMING ... .....................
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FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
0
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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