20040583 (2).pdfI
DATE RECEIVED
7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
NAME
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NAME
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PLAT NAME/SUBDIVISION NO.
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LOT NO.
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ZIP TELEPHONE EXISTING PROPOSED
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LID NO.
LID FEE $
I ESCP Approved
RW Permit Requited
Street Use Prinnit Req'd
Inspection Required
Sidewalk Required
Underground
wring required
PRV REQUIRED
YES 0 NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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installed on all hot water tiffits.
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PROPERTY TAX ACCOUNT PARCEL NO.
607-3 �e-100a
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EXPIRATION DATE
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RESIDENTIAL
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COMMERCIAL
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MULTIFAMILY
REPAIR
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DEMOLISH
TANK
GARAGE
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RETAININGWALL
ROCKERY
CARPORT
PLUMBING I MECH
COMPLIANCE OR
OF USE
CHANGE
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FIRE SPRINKLER
FIRE ALARM
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REMARKS
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NUMBER NUMBER OF
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SPECIAL INSPECTION OCCUPANT
LOAD
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK is STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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0APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND JjOI D HARMI ESS f HE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIAIS, EMPLOYEES, AND AGENTS FROM ANYAND
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ALL CLAIMS FOR DAMAGES OFWIIAFEVER NAIURF,ARISINGDIRECTIYORINDI EC _Y
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1111S PERMII SHALL Nor BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CHYS ABIt I1Y 10 ENFORCE ANY ORDINANCE PROVISION
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION. THAT 111E INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, Oil THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITII CITY AND STATE I.AilyS REGULAIING 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 COMPENSATION INSURANCE AND RCW I d 2 7
SIGNATURE
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DAL E SIGNED
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FEE Description
Sta4,9 Surcharge
City Surcharge I,
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
i tiisapritication is not a permit uniii signed by tile
Botiding official or hiSillef Deputy. and Fees are paid, and
receipt is acknowledged ill space provided
OFFICIAL S Si�;NAT UR�.: SAT E I
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RFI.FASFD try DATE'
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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
0903 PRESS HARD -YOU ARE MAKING 4 COPIES
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
O[IIGINAL - FILE YELLOVV - INSPECTOR
PINK OwNIER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION—,
Footing .......................
Wall. .............. ........
Pier/Porch .................
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
RoUgh-ln'-..� ................ ---------
Comm eibiaf 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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