Structural Observation Agreement - City Of Tukwila Building Division Page 13

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City of Tukwila
Building Division
Building Permit Number: __________________
Discrepancy Notice
Project Name: ________________________________________________________________________
Project Address: ______________________________________________________________________
Area Inspected: ______________________________ Type of Inspection: ________________________
Special Inspector: ____________________________ Laboratory: ______________________________
Notice Delivered to:
[ ] Contractor
Date/Time: _______________________
[ ] Engineer/Architect
Date/Time: _______________________
[ ] Building Division
Date/Time: _______________________
Make the following corrections and secure inspection approval prior to proceeding with this phase of the
work: ______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Contractor’s Response: ________________________________________________________________
____________________________________________________________________________________
[ ] Repair or Replace in Accordance with Approved (stamped) Plan(s) and Specifications
_____________
____________________________________________________________________________________
____________________________________________________________________________________
[ ] Modification Evaluation _____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Signed: _______________________________________
Date: _______________________________
COMPLETED AND APPROVED
CONTRACTOR: _______________________________
DATE: _____________________________
INSPECTOR: __________________________________ DATE: _____________________________
DO NOT REMOVE THIS NOTICE
Contact the City of Tukwila Building Division inspector upon issuance/posting at 206-431-3670
Post Adjacent to Building Permit Inspection Record Card
FINAL SPECIAL INSPECTION REPORT
13

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