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DATE RECEIVED PERMIT EXPIRES
PERMIT
USE
CITY OF EDMONDS ZONE NUMBER C)q,
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDHESS -Z_Z C")2
OWNER NAME/NAME OF BUSIVESS
PLAT NAME/SUBDIVISION NO. LOT N6. LID NO.
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MAILING ADDRESS LID FEE $
TESCP Approved
-7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit noq'd
Inspection Required
CITY LEPHONE EXISTING - PROPOSED Sidewalk Required
Underground
REQUIRED DEDICATION- FT - Wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES13 NO 13
ADDRESS
CITY ZIP [TELEPHONE
NAME CBL
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ADDRESS
CITY ZIP ELEPHO
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STATE LICENSE NUMBER 2�0i"EXPIRAIION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING i MECH
ADDITION
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COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
SIGN
F1 REPAIR
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GRADING FENCE
CYDS ( x FT)
DEMOLISH
TANK
F� OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY 11 FIRE ALARM
UYPE OF U4F, BUS)NESS OR ACT[Vn)() EXPLAI�:,
NUMBER
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NUMBER OF CRITICAL
DWELLING AREAS
NUMBER
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GLAZING % I LOT SLOPE %
I VESTED DATE
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE OR ADBN I INSPECTION BOND
REQD. POSTED
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COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I 1;K1
LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
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REMARKS
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PROGRESS INSPECTIONS PER UBC 10811SC109/IRC109 FINALINSPECTION REQ'D
-
VALUATION
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Description
FEE
Plan Check
Building Permit
Plumbing
Mechanical
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Grading
Engr. Review
Engr. Inspection
Description FEE
State Surcharge
City Surcharge
Base Fee t aO
Fire Review Plan Chk. Deposit
Fire Inspection Receipt
Landscapelnsp. Total Amt. Due
Recording Fee Receipt
APPLICATION APPROVAL
This application is not a pennif until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION— tecLipt is acknowledged in space provided.
OFFICIALS SIGNATURE TE
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771-0220 RELEASED By
Biff 1333
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YABUILDING OR STRUCTURE UNTILAFINAL
IT IS UNLAWFULTO USE OR OCCUP
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGIN<FI�LE) YFLLOW-INSPFCTOR
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PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK -OWN- GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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: 160 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, 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 NOI BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAI [ON
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 COMPENSATIONtp��RANCE AND RCW 18.27.
SIGNATURE NER, ATE SIGNED
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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 ....................
f1A
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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