20050748.pdfDATE RECEIVED� e�JC�F,5—
I PERMIT
CITY OF EDIVIONDS INUMBER
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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E..INEERIKGII�VIE�E..Y DATE
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
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VESTED DATE
111`7
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES .141 THE WORK NOTED, THIS PERMIT COVERS WORK TO
Grading
8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUT c
n DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 11-00 005(A)(5)
Engr. Inspection
PERMIT L MIT.. SEE ECDC 19,00.005(A)(6)
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESSOR,
Fine Review
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Plan Chk. Deposit
�4 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS HE CITY OF
M EDMOND WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT RE,ARISINGO NDI.R.ECT.Ly
U =ILTY
Fire Inspection
Race t #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS SO.'A' 'L T E
CITY ORDINANCE
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFY, IVE OR REDUCE ANY REQUIREMENT OF ANY
WA
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVRSION.�
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Recording Fee
I Recent 4 1-47W
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFO MATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thb P11111- � b." A "b"', bbbI $19— by Ih,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
310b,ii OffIll 11 lb-1 D.,u" bd F ,, p,,d,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATI=CE AND RCW l8i2T.
1
DATE
ED
(425)
Y/h.,.
�DATE
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771-0220
AE1EASEDEY AT
ATTENTION
EXT. 1333
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IT IS UNL FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
AIN
— ,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
ORIGIf
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I III
PINK OWNER - COLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
�SETBACKS ......... .
FOUNDATION:
Footing ......................
wall..........................
Pier/Porch
Retaining Wall ...........
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Stab Insulation ..........
0
PLUMBING:
Underground .............
Rough -In ...................
3:
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Commercial Final
0
0
HEATING:
0
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Gas Test ....................
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Gas Piping
Equipment .................
3:
Commercial Final
0
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EXTERIOR SHEATHING
NAILING ..........................
MIT
FRAMING ........................
0
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FIRST FLOOR FRAMING
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0
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
3:
SHEETROCK NAILING
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SPECIAL INSPECTION
0
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
v/d
OCCUPANCY ...........
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