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�4 DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME Or BUSINESS
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CITY
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ADDRESS
LPERMIT EXPIRES
PERMIT ) 4 sl�.
NUMBER
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ADDRESS 2,z-
SUITE/APTft
PLAT NAMEISUBDIVISION NO,
LOT NO
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RVY Permit Requited
Street Use Permit Required
EXISTING PROPOSED
inspection Requited
Sidewalk Required
REQUIRED DEDICATION
FT
Underground
Witten required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESM NOE3
REMARKS
OWNERICONTRACTOR RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
ED
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ENGINEERING REVIEWED BY DATE.
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INSPECTION
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SEPA
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STATE LICENSE NUMBER EXPIRATION DATE
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WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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REMODEL El MULTIFAMILY El SIGN
GRADING FENCE
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LOT COVERAGE I REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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REMARKS
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DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
1:1 CARPORT El ROCKERY FIREALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE STRQCTION
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GROUP
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NUMBER
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NUMBER OF
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SPECIAL INSPFCTI N
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DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEATSOURCE
LOTSLOPE%
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
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC '19.00.005(A)j6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Fire Review
Plan Chk. Deposit
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_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 #
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscapeinsp.
Total Amt. Due
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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording ee
Receipt #
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APPLICATION APPROVAL
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
This application is not a permit until signed by the
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
CALL
Building Official or titsitier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
WORKMEN'S COMPENSATION URANCE AND RCW 18:27.
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jk000,_ 771-0220 EA Y DAT
ATTENTION 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- RIGINAL - LE ELLOW -INSPECTOR
OLD .
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - OWW GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION'
Fooling......................
Wall................ .........
Pier/Porch .................
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-Retainlng Wall .........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final
0
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HEATING:
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Gas ....................
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Gas Piping .................
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Equipment .................
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Commercial F! nal .......
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EXTERIOR SHEATHING
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NAILING ..........................
0 F_
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ............
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Ceiling Insulation .......
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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