20050098.pdfDATE RE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
00116
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PLUMBING MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MIXED USE
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MULTIFAMILY
SIGN
REPAIR
FENCE
CYDS X
7-
DEMOLISH
TANK OTHER
GARAGE
RETAINING WALL FIRE SPRINKLER
CARPORT
ROCKERY FIREALARM
(TYPEOFUS BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITEtAPT#
ADDRESS I
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Permit Required
Stieet use Permit Requited 13
EX�STING PROPOSED
inspection Requited [3
Sidewalk Required 0
REQUIRED DEDICATION FT
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METER SIZE
LINE S�4
NO. OF FIXTURES
PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE
Description
FEE
Plan Check
state Surcharge
HEATSOURCE
LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CO NSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICAilON: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
W
PERMIT LIMIT. SEE ECDC i9.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
En
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PPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
'A S
Fire Review
Plan Chk. Deposit
W
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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 #
x
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT LY
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL'
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 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
FORINSPECT 10 receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OF I SIGNAT E ATE
SIGNATU to OR *E DATE SIGNED
(425)
W )hib,
771-0220
RE E D E
ATTE14TION V
EXT. 1333
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 - IV4ECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
COPIES
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FINAL PROJECT APPROVAL FORM
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 -
Underground .............
Rough -In ...............
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Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ....................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
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FINAL APPROVAL FOR
OCCUPANCY
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