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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
ADDRESS
CITY
STATE LICENSE
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EXPIRATION DATE CHECKED BY
TAX ACCOUNT PARCEL NO.
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ADDITION
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REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
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RESIDENTIAL
D-COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
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CHANGE OF USE
PERMIT EXPIRES
PERMIT ? -y 0
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PLAT NAMEISUBDIVISION NO.
LOT NO
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Peml Required
Street use Permit Required
EXISTING —PROPOSED
inspeclion Req6ired
Sidewalk Required
REQUIRED DEDICATION FT
Underground
Wirinq required
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
YESE3 NO13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
13YES 13NO
CAII! ZONE SIGN AREA HEIGH
WAIVER 13 ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1
LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
SIGN REQ'D I PROVIDED
EFENCE
I ( X FT.) REMARKS
OTHER
FIRE SPRINKLER
FIREALARM
TYPE
OCCUPANT
GROUP
ILU NUMBER NWUMBEIR OF OCCUPAT
ELL NG
" OF D SPECIAL INSPECTION CONSULTANT
M UNITS LOAD
0 STORIES REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS LI)
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
VESTED DATE Plan Check State Surcharge
HEATS6URCE LOTSLOPE% Building Permit City Surcharge
ECK NO: 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 PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) Plan Chk. Deposit
(A 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
W
_j 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 #
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 REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
1..1111� Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPR6VAL
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 CONSTRUC- CALL Building Official or hisiher Deputy and Foes are paid. and
TION; AND IN DOING THE WORK ALI THORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S N INSURANCE AND RCW 18:27, OFFICIALS qIGNATURE DATE
DATE PIGNED (425)
S�IG�NT(1RE W6
GENT
771-0220 RELEASED BY DATE
EXT. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 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:
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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