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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY
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NAME
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PERMIT EXPIRES
PERMIT ;0
NUMBER
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ADDRESS
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PLAT NAM E/SUB DIVISION NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
13
RW Permit R "od
EXISTING PROPOSED
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StreeltisePe it R quiled
inspection Required El
Sidewalk Required 13
REQUIRED DEDICATION
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Wiring required [3
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV RE QUIRED
YES 13 NOO
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REMARKS
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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SHORELINE OR ADBN
INSPECTION
REQ'D
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COMPLETED I EXEMPT
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SIGN AR EA
ALLOWED , PROPOSED
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ALLOWED PROPOSED
PROPERTY TAX AP�:OUNT PARCEL NO.
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NEW
ADDITION
REMODEL
RESIDENTIAL
COMMERCIAL
MIXED USE
MULTIFAMILY
PLUMBING; MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
PARKING
REQ*D PROVIDED
LOTAREA I
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PLANNING REVIEWED 13Y DATE
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GRADING CYDS FENCE . I
REPAIR M ( x FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
CODE
OCCUPANT
�AM
STORIES REQUIRED DYES
DESCRIBE WORK TO BE DONE
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REMARKS
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Warum Q14;MJCTURAL DESIGN
BY:
VALUATION
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Description FEE Description FEE
6� A_A_ Plan Check State Surcharge
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iAT R �CE LOT SLOPE% VESTED DATE Building Permit City Surcharge )k5, 0
PLAN CHECK NO: Plumbing Ro 0 Base Fee 30.00
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical C;?o 00
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT- SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Depositi
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGESOF 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 LandscapeInsp. Total Amt. Due
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 APPLICATIOW THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DUN 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 tits/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION k rec.ei-,;� �rknnwleclqecl in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 10:27.
DATE SIGNED
S71fr OWNE RA ENT): (425)
771-0220
ATTENTION XT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
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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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......................
Wall ..........................
Pier/Porch .................
Retaining Wall .......
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Slab Insulation ..........
0
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PLUMBING,
Underground .............
Rough -In ...................
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Commercial Final ......
M
0
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'HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING
NAILING ............. ...........
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FRAMING ....................... .
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FIRST FLOOR FRAMING...
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INSULATION ...................
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floor Insulation .........
Wall Insulation ...........
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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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