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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY
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NAME
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ZIP TELEPHONE
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE CHECKEQ BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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PAY -
El RESIDENTIAL PLUMBING/MECH
'NEW
COMPLIANCE OR
ADDITION ��COMMEFICIAL CHANGE OF USE
El REMODEL
MULTIFAMILY 15�41GN
REPAIR
GRADING FENCE
CYDS 11 ( X FT,
DEMOLISH
TANK
11 OTHER
GARAGE
RETAININGWALL
FIRE SPRINKLER
0 ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE. BUSINESS OR ACTIVITY) PLAI
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLINGj
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AREAS
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: /7,4 1 VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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PERMIT EXPIRES
USE PERMIT
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N U M B E R
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ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
YESCIR Approved 0
RW Permit Required 11
Street uso Permit Roq'd 13
EXISTING - PROPOSED
Inspection Required Q
sidewalk Required 13
REQUIRED DEDICATION- FT
Underground
Wiring required [3
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 C3
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBH I INSPECTION BOND
REQ'D POSTED
AD j3_0,2_j-jq i4YES ONO S
SEPA REVIEW IGN AREA HEIGHT
COMPLETE EXEM &WSED , PROPOSED ALLOWED PROPOSED
EXP 17 7,,; �, - 0 ( I q / 1z, I L-1 "
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ-D I PROVIDED
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CHECKED BY TYP&-CT�COjWSTRUC N COQjE OCCUPANT
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED n N I LOAD
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REMARKS
I PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ1D 293:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION tA I I jjj
IT IS UNLAWFUL TO USE OR OCCUPY 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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 WOF1"UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE L A-C*E OF THE STATE OF WASHINGTON RELATING TO
waarunTq-rnmPENSA`&N INSUPhNCE AND RCW 18.27.
DATE
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FEE Description FEE
State Surcharge
City Surcharge /
Plan Chk. Deposit
ZVI
Receipt #
Total Amt. Due
Receipt ft
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APPLICATION APPROVAL
This application is not a permit until
signed by the
Building Official or his/her Deputy. and
nd
Fees are paid. and
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receipt is acknowledged in space provided
FF LS SIGNATURE
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DAT
BY
61
ORIGINAL -FILE YELLOW'- INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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MEMO TO:
FROM:
PROJECT
FINAL PROJECT APPROVAL FORM
TO:
DATE:, m2� &6
PERMIT COORDINATOR, BUILDING DIVISION
SITE ADDRESS
FIRE DEPARTMENT DATE
PLVISE SIGN
ENGINEERING DIVISION DATE
pLWE SIGN
DIVISION DATE ; Z- / "' 7 - C;! / -
PERMIT #
W)4 I ADB# INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
>�L_GRANT FINAL PRO3ECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
FA
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
3:
0
Underground .............
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Rough -In ...................
0
0
0
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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