20050616.pdfDATE RECEIVED
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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Siaewalk Required 0
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REQUIRED DEDICATION FT E3
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LOT RAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) X
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ADDITION CHANGE OF USE 3 &7. .-).S 15-1 S-4 M
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GRADING FENCE X M
REPAIR CYDS ( x FT.) REMARKS M Z
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41.2 ORKTO Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS
i,- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, Etc.) WILL REQUIRE Grading
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
IS Fire Review Plan Chk, Deposit,
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
HINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
2 EDMONDS,WAS
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANC� OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # aloil q1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECP AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT -OF This application is not a permit until signed by the
LATING CONSTRUC.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGU CALL Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowled I ged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 111:27. FI LS S11143URE DATE
SIGN RE (OWNER 0 N . DATE SIGNED (425)
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771-0220
EXT. 133
ENTION 3 Qb�
IT IS UNLAWFUL TO USE OR /OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- G At. FILE Y -LLOW INSPE :TOR
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91 IBC110 I IRC110- P 10 LOD �
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC10 OWNER ASSESSOR
10/04 PRESS HARD YOU ARE MAKING 4 COPIES
NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
FINAL PROJECT APPROVAL FORM
TO:
DATE:__
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM- FIRE DEPARTMEINTDATE
PLEASESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
PLEASE SIGN
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PROJECT
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PERMIT # 22 ADB# DATEINSPECTED 2 1-2 4. 1016'
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. 'Final appr*ova,l
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denotes that. there are no objections from the above signed Department to. the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0: Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1JC111p:,b1dg:fomis:ocaprv1 3/25/04