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PERMIT
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NUMBER
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PLAT NAME)SUBDIVISION NO
PERMIT EXPIRES
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SUITE/APTP
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
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METER SIZE LINE SIZE NO OF FIXTURES
LID NO
LID FEE S
TESCP Approved
RvV Ppr"id Required
Street use Permit Required
inspection Required
S.ae6atk Required
underground
walrut required
PRV REQUIRED
YESO NOO
REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP TELEPHONE
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ENGINEERING REVIEWED BY DATE
-IRE REVIEWED BY DATE
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CITY
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERT� TAX ACCOUNT PARCEL NO.
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RESIDENTIAL
FJ—F�LUMBING
if MECH
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MMERCIAL
COMPLIANCE OR
El ADDITION
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MIXED USE
CHANGE OF USE
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MULTIFAMILY
SIGN
REPAIR
FENCE
x
GRADING
CYDS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
14
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NUMBER NUMBER OF
OF DWELLING
UNITS
STORIES
DESCRIBE RK TO BE DONE
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HEAT SOURCE
PLAN CHECK NO:
)N
LOTSLOPE%
VESTED DATE
VARIANCE OR CU
CAP I
WAIVER 13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ*D . PROVIDED
FT.) REMARKS
THIS PERM . IT 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
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING AD
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CITY
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NAME
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ADDRESS
NAME
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ADDRESS
TYPE
SPECIAL INSPECTIO]
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
CTION
SHORELINE. ORADB# INSPE SEPA
REO'D
COMPLETED EXEMPT
MYES 13N (0
ZONE SIGN AREA HEIGHT
TALLOWED , PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBA PROPOSED SETBACKS (FT.)
CKS (FT) LJR SIDE REAR
FRONT SIDE REAR FRONT
0
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LOT AREA PLANNING REVIEWED BY DATE
CONSUL
FEE
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Depositi
Receipt ft
Total Amt. Due
If zy
Receipt H . �j -/-
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 applical'oh 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 Fees are paid and
TION; AND IN DOING THE WORK AUTHORIZED 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 COMPENSATION INSURANCE AND RCW 1817. OFFiCIALS SIGNATURE DATE
DATE S GNED (425)
NT):
SIGNATURE I(OWNER OR AGE
/
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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771-0220 REL-
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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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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M 0
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0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .... I .................
z
Wall ..........................
0
_11
Pier/Porch ................. 0
M
Retaining Wall ...........
--i -n
Slab Insulation ..........
PLUMBING: M
M
Underground ............. 0
0
0 C
Rough -In ...................
M
M Z
Commercial Final ...... --I
C
HEATING: > z
Gas Test .......... .........
-3 0 -n
-n
Gas Piping .................
Equipment ................. M M
Commercial Final .......
0 M,
EXTERIOR SHEATHING C: Cn
NAILING .......................... M 0
Z
-1
FRAMING ........................
;U
FIRST FLOOR FRAMING ...
:E.
INSULATION ................... z
--I
Floor Insulation ......... :C
Wall Insulation ........... z
0
Ceiling Insulation ....... --I
0
SHEETROCK NAILING ... M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................