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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILINGADDRESS
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NAME
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PERMIT EXPIRES
PERMIT
NUMBER 0
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PLAT NAM E/SU BDIVI SION NO. LOT NO LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
Street use Permit Required 13
EXISTING PROPOSED_ Inspection Required Q
Shleiv4lk Required 13
REQUIRED DEDICATION FT Undp.rgfound 13
Wiling required E3
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
YES 13 NO13
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
[3YES 13NO I I
CA# ZONE SIGN AREA I HEIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13
PROPOSED SETBACKS (FT.)
NEW
ADDITION
'RESIDENTIAL
COMMERCIAL
MIXED USE
1:1
PLUMBING ir MECH
COMPLIANCE OR
CHANGE OF USE
LO I COVEIRAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS IF 1.)
FRONT SIDE REAR
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FRONT.
UR SIDE REAR.
DATE
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PARKING
LOTAREA
PLANNING REVIEWED BY
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REMODEL MULTIFAMILY Lj SIGN
GRADING m FENCE
REPAIR CYDS X FT.)
DEMOLISH TANK
GAR.AGE E3 RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
REQ'D
PROVIDED
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REMARKS
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(TYPE OF USE, Dual PE OF ONS N �UPANT
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NUMBER I
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NUMBER OF
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SPECIAL INSPECTION
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CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEATSOURCE
LOT SLOPE%
VESTED DATE
Building Permit
0
City Surcharge
PLAN CHECK 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
SEPARATE PERMISSION.
Grading
Engr. Review
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
Engr. Inspection
Ln . . S AND SUCCESSORS Fire Review Plan Chk. Deposit
Ln APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGN
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
rk 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
CC 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.-
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Recording Fee
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 ieceipt is acknowledged in space provided.
IN VIOLATION OF THE LAPOlt,,CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S CO��SfTIIAINS�IRANCIE AND RCW 18:27. OFFIPALS St NA UR TE
I !i�NE:RO A ENT . DATE SIGNED (425)
o.) 771-0220 RELEASED B) DA"W
EXT. I
TrTf.. 1333
I 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. UBC1091 IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .... .....................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
0
PLUMBING:
M
Underground, .......
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Rough -In ...................
Q.M
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Commercial Final ......
MID
0
0
HEATING:
C
M
Gas Test .....................
M
Gas Piping .................
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Equipment .................
Commercial Final .....
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EXTERIOR SHEATHING
NAILING .................. .......
M M
FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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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