20020984.pdfDATE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPUCATION
)WNER NAME/NAME 00 BUSINESS
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AAILING ADDRESS
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.ITY
E01116 A/P-S
NAME
ADDRESS
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AC�DRESS
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109;2q- muK, TEO SP
ZIP TELEPHONE
CITY UKJ�
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STATE ENSE NUMBER
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ADDRESS
PLAT ;NAMElsuaDIVISION NO, LOT NO. LID 140
LID FEE S
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METER SIZE I LINE Bill NO. OF FIVURES PRV REQUIRED
YES 13 NO E3
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ALLOWS PROPOSED -Ag FRONT URSIDE HEAR
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IF
CHECKED BY _rPE O=
SPECIAL INSPECTION I —A
REQUIRED rl YES
" 61 9 VALLIAMON
aAs $
FEE
e..7jP,---_1_1EE Description
PlanCheck State Surcharge
HEAT SOURCE OLAaNG 'R
L T BID'S
B ilding Permit
City Surcharge
PLAN CHECK NO:
ESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZE ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
UcTIO ON EPODUC
PROPBS N THE
Grading
REDONE ON PRIVATE U.E
DOMAIN (CURM, SID ES, ETC,) WILL nE Re
3 as
Engr. ReVIDW
PERMIT APPLICATION: IN DAYS DAYS
PERUITUMM I YEAR -PROVIDED ORKESTA EOWITKIN 180
Engr. inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk.D Posit
*A 1UCANrr. ON H OF HIS 08 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
I INTEIIESTAA�G'�INE.El 1,0 INDEMNIFY, DEFEND AND HOL 0 HARMLESS THE CITY OF
Fire RevieW
Inspection
Receiptit
R A ANY AND
.B,W N ToN, ITSOFFICIAL EM OyEESANDAGENTSFO
UNS, A�JEING 011SECTLY OR INDIRECTLY
"COLAIMS NAPL
Fire
ALL FOR DAMAGES OFWHATEVESi
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION.'
NOR LIM WAY THE CTYS ABILITY TO ENFORCE
T IN ANY
Recording Fee
X
READ THIS,. APPLIcA1.101,; THAT THE INFORMATION
I'HER EBY ACKNOWLEDGE THA
AUTHORIZED AGENT Of
I "'I gnN by
�,AVE
H ,. OWNS IT TIE ULf
AN A!
"VEN is C Sor T 0 CONSTRUC_
CWH_ , AGREE To Co�p, WITH CITY AND STATE LAWS REGULATIN
CALL
Thn, �p --fl P—il
ly: IvKJ g
tt Offt I.,hi.1 I
THE N PERSON WILL BE EMPLOYED
TON, A". � DOING THE WORK AUTHORIZED THEREBY. 0 RELATING
CODE OF THE STATE OF WASHINCTON TO
FOR INSPECTION
1 11—kn. hl�-�F
IN VIOLATION OF THE LABOR
WOAKMENSJCOM�ENISATION INSURANCE AND RCW 18,27.
(425)
FF ATURE�
DATE
110
S= TOR JOWNER AGL�
DATE SIGNED
_4,
If -11 Z
771-0220
Re BED E
Exr 1333
WiTENTION
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION
OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
pINK.O.NED GOUD-ASSCSSOR
GREEN ACCOUNTING
CATE OF
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing,.... ..................
Wall .............
PlerlPorch .................
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Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground ...........
1711
C
-In ...................
MRough 0
0
Commercial Final
HEATING:
M
Gas Test
Gas Piping Ms
Lo —03
4
Equipment .............
0 -n
Commercial Final
n
MITI
EXTERIOR SHEATHING
NAILING .......................
0
09
FRAMING ........................
CA
M 0
FIRST FLOOR FRAMING...
z
-4
INSULATION ...................
;a
Floor Insulation
z
Wall Insulation
Ceiling Insulation ......
W
z
SHEETROCK NAILING
SPECIAL INSPECTION
R1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............... V�n