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CONSTRUCTION PERMIT APPLICATION J(
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PROPERTY TAX ACCOUNT PARCEL NO. U
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NEW RESIDENTIAL PLUMBING / MECH it
ADDITION COMMERCIAL COMPLIANCE OR
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DEMOLISH TANK OTHER
ElGARAGE RETAINING WALL FIRE SPRINKLER
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GLAZING %
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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: 1180DAYS
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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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'APPLICANT, ON BEHALF OF kits OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT * AND TIIAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION A14D IN DOING THE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V�61_ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW I B 27.
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NLATUE,JOWNER OR AG])
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES,
PERMIT la�
NUMBER
LOT NO,
)UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'XISTING — PROPOSED
I SUITE!APT#
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LID NO.
LID FEE $
I ESCP Approved
RW Permit Required
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
Under round
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3EQUIRED DEDICATION— FT ming 9 required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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)WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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NGINEERING REVIEWED BY DATE
IRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINEORADBI I INSPECTION BOND
REO'D POSTED
OYES ONO I S
SEPA REVIEW SIGN AREA HEIGHT
,OMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
,LLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREATLANNING REVIEWED BY DATE
4EO'D I PROVIDED i
1EMARKS
;HECKED 13Y ITYPE OF ��JSnIJATJOJ_ 5Q��E
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OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED E] YES I LOAD
iEMARKS
)ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
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
ATfENTION EXT 1333
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
FEE I Description I FEE
State Surcharge
City Surcharge
. 3 �-' . -
Plan Chk. Deposit
Receipt # it
TotalAmt.Due (&_15D
Receipt N
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APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building 011icial or his/tier Deputy: and Fees are paid. and
receipt is ackfi.owledged in space provided.
FFIVI'AtS SIGNAT41f PATEI
LEASED BY
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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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:
GasTest ....................
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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The illitials MT are Milton
Thollipsoil, a temporary co"It"',Ict
illspector for tile City.
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