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DATE RECEIVED /._ e5
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWqER NAME/NAME OF USINESS
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CITY ZIP TELEPHONE
NAME
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
El NEW
O(RESIDENTIAL
F� ADDITION
M COMMERCIAL
El REMODEL
E3 MULTIFAMILY
El REPAIR
[] GRADING CYDS
E] DEMOLISH
E] TANK
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CARPORT
ROCKERY
r(rYPE OF USE, BUSINESS OR ACTIVITY) EXPLAA
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NUMBER OF
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DESCRIBE WORK TO BE DONE
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USE PERMIT
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JOB UITE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO
LID FEE $
TFSCP Aptaravad
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw permit Required
Street use permit Huq,d
EXISTING — PROPOSED
Inspvc.lionRequeed
Sidewalk Required
REQUIRE[) DEDICATION— FT
underground
Witingiroquirod
METER SIZE
I LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
REMARKS
YES 0 NO 11
AGE
gardless of whe
open or closeds
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FIRE REVIEWED BY DATE
VARIANCE OR CU SHORE4L��-f`1?1*�I N BOND
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LUMBING / MECH SIDE REAR FRONT L/R SIDE REAR 0
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OMPLIANCE OR 2
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PA KING, �&AREA PLANNING REVIEWED BY DATE
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El OTHER AFFIDAV1TS SHALL NO I
EFIRE SPRINKLER
] FIRE ALARM I .01f ACIC*EPTED
CHECKED BY I TYPE F MRUIJClON COC!E OCCUPANT
I GROUP
CRITICAL I
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRED [] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'D 3
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GLAZING % I LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M SEPARATE PERMISSION.
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Lul PERMIT APPLICATION: IBODAYS
CIL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
En
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr, ISSUANCE OF 1 HIS PERMIT SHALL NOT BE
C31 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY 1HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION� AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS��t"ANCE AND RCW 18.27.
SIGNAMRE (O� 4601A AGJaD5:�' DATE SIGNED
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
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Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # -7 -72
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in Space provided.
FFICIALS SIGNATURE DAIE
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ATTENTION z -7 �C) EXT 1333 IIJ
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IT IS UNLAWFUL TO USE OR OCCUf'Y A BUILDING OR STRUCTURE UNTIL
A FINAL. INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER COLD -,�SSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing.,—, ..................
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'Pi6 OPorch
Retaining Wall ...........
Slab Insulation ..........
PLPMBING:
6�de r O'd
groun .............
Rough -In ......
Commercial Final ......
HEATING:
Gas Test ........ ...........
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING..
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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