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Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
U qBS, SIDEWALKS. . DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
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SEP=TE ERMISSION. Recording Fee
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT'. SEE ECDC 19.00.005(A)(6) Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Receipt #
in 'APPLICANT, ON BEHALF No AND HOLD HARMLESS THE CITY OF Fire Review
W IN INTEREST, AGREES TO INDEMNIFY, DEFE
ED ONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Total Amt.. Due
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection A)
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
NY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY. WAIVE OR REDUCE A ION.* Landscapelnsp.. Receipt 4
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVIS
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
LITHORIZED AGENT OF CALL This application is not a permit until signed by the
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY A y and Fees ate paid. and
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- FOR INSPECTION Building Otticial at hiSther Dep
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is Ac 1 ledge in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO OFFI IA lu -
WORKMEN'S coty[PENSATI��ANCE AND RCW 18:27. (425)
SIGNA WNER OR AlijENTY j DAI t SIGNED 771-0220 RELEASED B
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
A FINA CY HAS BEEN GRANTED. UBC109 if IBC110 if IRC110. PINK -OWNER GOLD ASSESSOR
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