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DATE RECEIJEJ
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
NAME
ZIP TELEPHONE
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CITY
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TELEPHONE
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STATE LICENSV NUMBER
EXP!P&JION
DATE
CHWKEIZ BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( x FT)
DEMOLISH
TANK
OTHER
GARAGE
r.APPnRT
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RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
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(TYPE OF USE, BUS�4§SS OR ACTIVITY) EXPLAIN
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NUMBER
NU MBE OF
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DWELLING
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STOF16PYOZ
UNITS
ESCR E WQg
TO BE DONE
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CRITICAL
AREAS
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HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED DATE
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PERMIT EXPIRES _L�j . t
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USE PERMIT C
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NUMBER
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J SZTE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
7ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Pnritill Required C3
Street use Permit Roq'd 13
EXISTING - PROPOSED
inspection Required 13
Sidewalk Required 0
REQUIRED DEDICATION- FT
unde!groijnd
Waing iorperod 13
METER SIZE
LINE SIZE
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NO, OF FIXTURES
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PRV REQUIRED
YES 0 NO 11
REMARI
OWNER,
ENGINEI
1�&,PONSIBI.4FOR EROSIOjq COUlROL/DRAINAC
I LU L11r, A Uquil ell
an aper-ax,ckel
pressuFe/r-elief valve,
eyliansion tank shall
ringtalledo on all hot water tanksil
DATE
UP
0
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FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVER AGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPEC-nON REO'D - -
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
.j SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
Ul
a. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
U)
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt it
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
Receii t
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT TH E INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
[his application is not a perinit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Litt Official or his/her Deputy: and Fees are paid, and
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
FOR INSPECTION
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receipt is acknowledged in spaFo
irovided
,SATION INSURANCE AND RCW 18.27.
WORK ME N;,q-00)_;jTEN
SIGNATUPE
TE 'IGNED
'NAT E (OWNE Rr�GENT) DA (425)
"j, /A, 771-0220 __FVt EASED BY DATE
7_9
A17ENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
Slab Insulation .......... M
PLUMBING: =n-
Underground .............
0 rTj
Rough -In ................... M 0
0
Commercial Final ...... 0 0
C:
HEATING: X M
M Z
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Gas Test .................... -7 - 64 0
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Gas Piping .................
Equipment .................
0 -n
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Commercial Final ....... --I
M M
EXTERIOR SHEATHING 0 —
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NAILING ..........................
0 r-
0 M
FRAMING ........................ C C/)
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FIRST FLOOR FRAMING ... M 0
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INSULATION ...................
Floor Insulation ......... x
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Wall Insulation ........... z
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Ceiling Insulation .......
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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Tile Initials Ware Milton
Thompson, a temporary Contract
inspector foi- tile City.
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