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PROGRESS INSPECTIONS PER UBC 1o8jIBC109/IRC109 FINALINSPECTION REn,n
VALUATION
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STRUCTION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
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City Surcharge
plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. lnspecfionT
Fire Review Plan Chk. Deposit
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LandscapeInsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a peunit until signed by the
CALL Building official or his/tier ooputy: and Fees are paid. and
FOR INSPECTION receipt isacknowledged in space provided.
OFFIC NA DATE
(425)
771-0220 REI SED BY bATE
ATTENTION
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 'z
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLCAN - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF 13USINESS
MAILING ADDHESS
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CITY
NAME
ADDRESS
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CITY
NAME
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AdDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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GARAGE
RETAINING WALL
FIRE SPFdNKLER
CARPORT
ROCKERY
FIREOLARM
(TYPE OF USE, BujVESS OR ACTIVTTY) EXPLAIN:
NUMBER OF CRITICAL
NUMBER
OF
M DWELLING r7 AREAS
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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(00 shald—r-&— or pe6i
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK IND: , , I VESTED DATE
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PERMIT EXPIRES
USE PERMIT
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JOB SUITEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO,
LID FEE $
IFSCPApproved C3
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP
HW Permit Required
El
street Use Permit Aoq'd
13
EXISTING - PROPOSED
inspection Required
[3
Sidewalk Required
[3
REQUIRED DEDICATION- FT
Underground
Wiring required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
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OWNEF XONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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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: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, 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 BE
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.*
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 COMPENSATION INSURANCE AND RCW 18.27.
SIG)"TI)RE (PVVNER OR ENT)'�� DATE SIG I �ED I
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
0
Retaining Wall ...........
—4
?5
M
Slab Insulation ..........
PLUMBING:
Underground .............
0 M
C
M 0
Rough -In ...................
0
0
0
Commercial Final ......
C
M
HEATING:
M Z
Gas Test ....................
C
>
Gas Piping .................
Equipment .................
0 -n
-n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING..........................
0 IT!
C 0)
FRAMING ........................
9 Cl)
M C)
FIRST FLOOR FRAMING...
Z
--I
INSULATION ...................
Floor Insulation .........
>
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Wall Insulation ...........
--I
Ceiling Insulation .......
C/)
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................