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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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❑ NEW RESIDENTIAL ❑ PLUMBING / MECH
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR
CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR ❑ GRADING ❑ FENCE X FT)CYDS
❑ DEMOLISH ❑ TANK OTHER 6 �G GARAGE RETAr
FIRE
z ❑ CARPORT ❑ R CKIERY NING WALL El FIRE ALARM SPRINKLER
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ii (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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oNUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
M STORIES UNITS TNUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PERMIT EXPIRES
USE tT
?7 PERMIT _
J L NUMBER 'y��i! SU E/APT#
IC `�%`-)(+�� I rME/SUBDIVISION NO. ,� OT 0. LID NO.
LID FEE $RIGHT OF WAY PER OFFICIAL- STREET MAP 1escP AnProvod ❑RW PormnRoquuod❑Street Use Permit Roq'd PROPOSED—• — Inspection RequiredSidewalk RequiredD DEDICATION FT Undmpround
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SIZE LINE SIZE NO )F FIXTURES PRV REQUIRED l7YES ❑ NO 13 z
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ONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE . EXEMPT
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
DATE
DATE W
LL
SHORELINE OR ADBN INSPECTION BOND
RE 'D POSTED
s ❑YES NO S
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR t7
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LOT AREA PLANNING REVIEWED BY hATE g
CHECKED BY TYPE OF CqNSTIJIUCTION CODE OCCUPANT.
GROUP
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED ❑ YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
VALUATION
Description
Plan Check r
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
.::7�•) State Surcharge
City Surcharge ✓
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due �l5
Receipt H 2
APPLICATION APPROVAL
T his application is not a permit until signed by the
Building Official or hisiher Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
FI EASED BY PATE
ATTENTION EXT 1333 1 L�'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INS CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
PLAN CHECK NO: ��,Gc�4 VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
F BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
-r SEPARATE PERMISSION.
F
¢ PERMIT APPLICATION: 180 DAYS
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a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
rn
W 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
¢ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
o DEEMED 'TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
O NOR LIMIT IN ANY WAY THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION 4
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. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE Eh1PLOYED
IN VIOLATION OF T i& LABOR CODE 9F THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM NS 114?N.l RAy E AND RCW 18.27
SIGNATURE (OW R O DATE SIGNED
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Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
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FOUNDATION:
Footing
Wall...°...................... �'`
Pier/Porch
Retaining Wall .:.........
Slab Insulation
PLUMBING:
Underground
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 MS
OCCUPANCY V
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