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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
PERMIT EXPIRES OFtli,
PERMIT
NUMBER
JOB SUITE/APTN
ADDRESS 7
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
I LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
RW Permit Req ired C3
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STATE LICENSE NUMBER EXPIRATION DATf I CW5 f- Kfi-' D B ]Y
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PROPERTY TA"(�COTVARCEL
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MULTIFAMILY
SIGN
REPAIR
GRADING
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DEMOLISH
TANK
E3 OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
1:1
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINF4S QaACINTY) EXPLAIN
REMARKS
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OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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on
ENGINE5[MaL1?MMfV9UBWRWr,5 V4&71_-5 "1131
4 , listed aypansioa. tank shall be
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VARIANCE OR CU SHORELINE RADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
113 YES 13 NO I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED I ALLOWED , PROPOSED
STUDY E3 I
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE RE FRONT L/RSIDE REAR 10
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LANNING REVIEWED BY DATE
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PARKING LOTAREA
REO'D . PROVIDED
REMARKS
OCCUPANT
GROUP
NUMBER NUMBER OF &I y 4.� 1
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS ... L REQUIRED 13YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURPE LOTSLOPE% VESTED DATE Building Permit City Surcharge
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PLAN CHECK NO: Plumbing Base Fee
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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
x PERMIT APPLICATIONt SEE ECDC 19.00.005(A)(5)
W
116 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lid
_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 #
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< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE -
-at DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt, Due /145; CIO
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
9 Re cording Fee Receipt # lr�—J�z_5LJ I
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 receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSA��IONSURANCE AND RCW 18:27. CIA SIGN RE DATE1
DATE S71G 7_ —"7
771-0220 RE E Y DATF -pr
SIGNATUI�o;MWNEPROY4NT/ (425)
ATTENTION A L I JJJ
IT IS UNLAWFUL TO USE OR OCCUP)(A_�U WING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 i IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............
Wall..........................
Pier/Porch .................
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Retaining Wall ............
Slab Insulation ..........
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PLUMBING:
Underground ... .........
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Rough -In ....................
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Co mimerclal Final, ......
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HEATING:
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Gas Test ....................
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Gas. Piping ............
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ...........................
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FRAMING .............. i .........
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation ........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
36
OCCUPANCY ..................