Structural Observation Agreement - City Of Tukwila Building Division Page 11

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City of Tukwila
Building Division
Building Permit Number: __________________
Special Inspection and Daily Report
Project Name: ________________________________________________________________________
Project Address: ______________________________________________________________________
Inspection Type(s)/Coverage: ___________________________ [ ] Continuous [ ] Periodic
Time Beginning Inspection: _____________________ Time Ending Inspection: __________________
Describe Inspections Made, Including Locations: ____________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List Test Made: ______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List Items Requiring Correction, Corrections of Previously Listed Items and Previously Listed
Uncorrected Items: ____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List Changes to Approved Plan(s) Authorized by the Building Official and Architect or Engineer:
____________________________________________________________________________________
____________________________________________________________________________________
Comments: __________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
To the best of my knowledge, the work I inspected was in accordance with the Building Division
approved design drawings, specifications, and applicable workmanship provisions of the I.B.C. except
as noted above.
Signed: ___________________________________________
Date: _________________________
Print Full Name: ____________________________________
I.D. Number: __________________
(This report to remain at job-site with the contractor for review by the Building Division’s inspector
upon request.)
11

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