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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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HEIGHT
ALLOWED PROPOSED
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PLUMBING MECH
NEW PLUMBING / MECH
LOT COVERAGE
LOT COVERAGE
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ALLOWED PROPOSED
REOUIRED SETBACKS (FT1
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LA SIDE REAR
COMPLIANCE .
ADDITION o C MPUANCE OR
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REMARKS
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CHECKED By
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NUMBER I NUMBER F
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NUMBER
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PREMARKS
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC JOB(FINAL INSPECTION REOD
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VALUATION $
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VESTED DATE
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Plumbing
Mechanical
MIT C 0 A 0 "K
THIS PERMIT AUTHORIZES ONLYTHE OAK NOTED. THIS PERMIT COVERS WORK TO
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Be DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON -EP
Gracling
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I ILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) W I L a.
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SEPARATE PERMISSION.
Engr. Review
MPTAPPLICATHIN: INDAYS
I
80 DAYS
PERMIT "I EAR-PROVID WORK 13 STARTED WITHIN T.- -A
Engr. Inspection
SEE BACK Of PINK PERMIT FOR MORE INFORMATION
CE.-RS
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
'TY OF
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
IT
EDMONDS, WASHINGTON, 118 OFFICIALS, EMPLOY"', AND AGENTS FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Fire Inspection
a 0 rNA.
DEEMED TO MODIFY, VIA OR REDUCE ANY HE LIKE ENT OF ANY CITY ORDINANCE
IVE As I IW
NOR LIMIT IN ANY WAY THE DAYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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Land..awnsp-j
I HERESY ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I BEE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
TION; AND IN DOING TH WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEAur COMPENSATION INSURANCE AND RCW 18,27.
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(425)
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771-0220
WREVION
E)Cr 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10/01
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
Thl,lippl order, Is not. Pundit until signed by Uni
Building Officlid., liflinto., Deputy; end Fee, rod P.1d,.ed
toculptis-knovInnigod In sposint provided.
OFF L NATU DATE
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RE, DATE
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RECORD OF INSPECTIONS
INSPECTOA DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
OM
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Underground .............
00�
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Rough -In ...................
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Commercial Final
10-4
HEATING:
Gas Test .............
0 "In
Gas Piping ..............
In M
Equipment
Commercial Final
0
0
t�r
EXTERIOR SHEATHING
C
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NAILING .........................
Q 0
FRAMING ..................
FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
CA
Wall Insulation
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Ceiling Insulation
1711
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
LO
OCCUPANCY .............. ...