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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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Description
FEE
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Building Permit
City Surcharge 5
tTED DATE
PLAN CHECK tTED DATE
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TOV
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
OMAIN (CURBS. SIDEWALKS, DRIVEWAYS MARO EES, ETC.) WILL REQUIRE
3 0 SEPARATE PERM;SSIDN"
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OE 111TAPPLICATION: 180DAYS
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PERMITLIMpe IYEAR-PROVIDEDWO KIS STARTED WITHIN 180DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHAL OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Reviev,
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IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EOMONOS,WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
Fire nSpecti.n
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY Ct TY ORDINANCE
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Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISIONr.
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I HEREBY ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
is at. Farrah arall signed by Lee
1) EGULATING CONSTRUC-
THENOAW"N.El"N TEO,.C.OM" WITH CITY AN " LAWS R
PERSON WILL BE EMPLOYED
CALL
Re"Thisripplierewn
ding Olfidal of his/her Deputy: and Feet are paid, an,
.1AGRSE
T G I Dr. T. RK AUTHORIZED THEREBY. NO
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION 111apt is alk—ladged I—pacii purldred.
IN VIOLATION
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.2T
OFFICA DATE
Ow AGENM DATE SIGNED
(425),011
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7 Z-
771 -0220
�ED BY I 15ATE
TWENTION
EXT 1333
UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGNAL-RUC YELLON-4SPEC R
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OCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
PINK-O.NEq GOLD-ASSESSOA
CATE OF GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:-
DATE:-.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE -
FROM:
�kluz_)�ENGINIIERING DIVISION DATE,���
V
PLANNING DIVISION DATE-
PROJECT -
SITE ADDRES . . ..... .... .....
PERMIT #,Z����ADB#
____--DATE INSPECTED_ZV22 __3
ECTED
DESCRIPTION OF WORK TO BE INSP q4Z� rt-L4'L,
roval
A field inspection was conducted to determine final compliance with approved plans. Final app
denotes that there are no objections from the above signed Department to the release of,
P_ERFORAL4NCE BONDS and the granting of:
T FINAL PROJECT APPROVAL
p� ...-GRAN
APPROVAL WITII CONDITIONS NOTED
GRANT PROJECT
a Copy of CONDITIONS given to owner/contractorby inspector
TANDING ISSUES
FAILED FINAL INSPECTION - OUTS
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE
_INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Sign,
Date-
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
(c4-o�3
SETBACKS ...................
FOUNDATION:
1-0
Footing ......................
Wall........... ; ...............
-63
0
Pier/Porch . ................
Retaining Wall ...........
Slab Insulation
PLUMBING:
M
r_
M
Underground .............
It-
0
C
Rough -in ........... -
M
M Z,
Commercial Final
HEATING:
C —
Gas test ...............
_n
Gas Pi ping ..� ..............
4,1 3
X
Equipment ................
M IT
Commercial Final
0
EXTERIOR SHEATHING
yn Is
S— 8 - t.3
a or),
NAILING ......................
ID 0:
r
FRAMING
...............
FIRST FL06R FRAMING
INSULATION
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Floor Insulation
Wall Insulation ...........
Z,
Ceiling Insulation
M
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........