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CITY OF EDMONDS zo
CONSTRUCTION PERMIT APPLICATION ic
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WNER NAME/N(ME OF BUSINESS
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STATE LICENSE NUMBER EXPIR TION ATE,
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW ESIDENTIAL YZ PLUMBING .4
COMPLIANCE OR
El ADDITION 1:1 COMMERCIAL CHANGE OF USE
REMODEL 13 MULTIFAMILY SIGN
GRADING FENCE
REPAIR 1:1 Cynq ( X FT) F
DEMOLISH 11 TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY FIRE ALARM
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUM13ER
NUMBER OF
CRITICAL
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STORIES
DWELLING
NITS
AREAS
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DESCRIBE WORK TO BE DONE
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HEAT SOURCE
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LOT SLOPE %
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PLANLdH1ECK NO:
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: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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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.
SIGN URE (OW E G
DATE SIGNED
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DATE RECEIVED
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PERMIT EXPIRES
PERMIT
NUMBER
B /'.I /
DRESS
LAT NAME/SUBDIVISION NO. LOT NO.
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
XISTING - PROPOSED
EOUIRED DEDICATION- Fr
AETER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Street Use Prima Roq'd
Inspection Required
Sidewalk Required
Underground
Winng required
PRV REQUIRED
YES 13 NO E3
EMARKS
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
JGINEERING REVIEWED BY DATE
RE REVIEWED BY DATE
VARIANCE OR CU SHORELINE ORAD1111 I INSPECTION BOND
REQ'O POSTED
OYES E3NO IS
SEPA REVIEW SIGN AREA HEIGHT
OMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
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LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
LLOWED PROPOSED I FRONT SIDE REAR I FRONT UR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
IEQ'D I PROVIDED I
EMARKS
HECKED BY ITYPE OF CONSTRUCTION OCCUPANT
MM,& GROUP
;PECIAL INSPECTION� JAREA�_ OCCUPANT
1EQUIRED C] YES I LOAD
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ROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
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i/ALUATION
Description
31an Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
P I ^
Plan Chk. Deposit
Receipt #
Total Amt. Due
FEE
Receipt # Z
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
, receipt Is acknowledged in space provided.
ALS_sigN$ruRE DATE
AITENTION Bff 1333
ITIS UNLAWFULTO USEOR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA 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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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
0
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Commercial Final ......
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HEATING:
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GasTest ...............
GasPiping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR,FRAMING ...
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INSULATION ....................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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