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AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in S Fire Review Plan Chk. Deposit
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSOR A Z_
Lu IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C' DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION., -') /I
x Recording Fee Receipt # U011�1 Q�-,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION LI ION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER 'A EE,�o COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or his/her Deputy: and Fees are paid. and
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TION: AND I� DOGINI WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLAT�N OF TA�ABOR DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
ION INSY
WORKMEN COMPE RANCE AND RCW 18:27. OFFICIALS SIGNATURE DATE
SIGNATUR OW G NT)y DATE SIGNED (425)
7 1`2 DATE
771-0220
EXT. 1333
ATTE ION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ;.IGINAL LE YELLOW -INSPECTOR
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FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110. PINK - 0 NER GOLD - ASSESSOR
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MEMO -TO: PERMIT COORDINATOR,: BUILDING DIVISION
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FAILEDIFINAL INSPECTION OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to- owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:f6rms:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall' ...........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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HEATING:
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Gas Test ....................
Gas Piping ...........
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EXTERIOR SHEATHING
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FRAMING........................
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INSULATION, ...................
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Wall Insulation ...........
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SHEETROCK NAILING ...
SPECIAL INSPECTION
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FINAL APPROVAL FOR
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