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HEAT SOURCE LOT SLOPE%____7 VESTED DATE 5q — State Surcharge 14,50
Building Permit City Surcharge
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO 0
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPAR E PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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IL PERMIT LIMIT.- SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W U 'APPLICANT, ON BEHALF OF HIS OR HER SPOU SE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U.1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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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 Landscapelnsp. Total Amt, Due
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9 NOR*LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # )qa:
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Tnis application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisiher Deputy: and Foes are paid, and
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 receipt is acknowledged in space provided.
WORKMEWS/P"SATION INSURANCE AND RCW 18:27. �TM LS SI RE DATE
LF:I'G'NAT R WNER DATESIGNED (425)
A tj 1fV\ar& 4112N�S' 771-0220 'REAPASED 6ATE I
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINA ILE - YELLOW - INSPIECT011
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 if IRC1110. PINK -OWNER GOLD - ASSESSOR
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DATE
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FINAL PROACT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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DESCRIPTION Of WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with approved plans. Final approval
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RE-TNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcn1p:b1dg:forms:ocaprv1 3/25/04