20040646.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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PERMIT EXPIRES Z/ 3/
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PERMIT
NUMBER
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
TESCP Approved [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required 0
Street Use Permit flert'd E3
EXISTING - PROPOSED
Inspection Required Q
Sidewalk Required 13
REQUIRED DEDICATION- FT
Underground
Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES IJ No LJ
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
ADDRESS
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INSPECTION
13OND
STATE LICENSE 14UMBER EXPIRATION DATE
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEM13T
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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EXP ,
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E] NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr)
FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REMODEL El MULTIFAMILY SIGN
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GRADING FENCE
REPAIR CYDS ( X FT)
REMARKS
DEMOLISH TANK Ei OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
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NUMBER
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NUMBER OF
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REMARKS
PROGRESS INSPECTIONS
PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REQ'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
city Surcharge
PLANCHECKNO- VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
UJI PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
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Cal 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
�j 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
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
X:l NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official at his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICellIGN DATE
SIGNATURE DATE SIGNED
AGENT)?
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(425)
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000
771-0220
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RELEASEDPY ATE
ATTILNITION EXT 1333
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ITISUNLAWFULTOU E (OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
�KG YELLOW IdSPECTOR
PANCY HAS BEEN GRANTED. UBC109/18CI10/IRC110.
PIN GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
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
OCCUPANCY .................. �4
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