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CITY OF EDMONDS I
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NUMBER
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PLAT NAME, SUBDIVISION NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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NO OF FIXTURES
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REMARKS
OWNERrCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE SPRINKLER
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NUMBER NUMBER OF
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SPECIAL INSPECTION CONSULTANT OCCUPANT
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REMARKS
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VALUATION
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Description
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Plan Check
HEAT SOURCE
LOT SLOPE-.
VESTED DATE
Building Permit
PLAN CHECK NO:
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Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK N6TED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Mechanical
Grading
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. Review
Engr. Inspection
'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 FRONi ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY On 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.'
Fire Review
Fire Inspection
LandscapeInsp.
.nv A�Vklntlkll EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt Due
Receipt #
APPLICATION APPROVAL
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GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL This application is nota perinit until signea hy the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- BuilAing Official or his,her OLIPLITY ind FeesIrt' J)did ano
TION; AND IN DOING THE WORK AUTHqRIZ D THEREBY, NO PERSON WILL BIE EMPLOY]EDFOR INSPECTION rec(,irit is acknowledged in 5paCe provide.0
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IN VIOLATION OF THE LABOR CODK_QE,��[E STATE 2OF WASHINGTON RELATING TO
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(425) A
SIGNATUP45'(104NE R AGENT): DATE SIGNED
771-0220
EXT. 1333
ATTffiTION
IT IS 0KAWFUL TYSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FIOL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. USC109 / IBC110 / IRC110.-'
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation ..........
0
M
PLUMBING*
Underground .............
Rough -in ................... fn
C:
Commercial Final ...... M
0
0
0 C
HEATING:
-4
3: rn
Gas Test .................... M Z
Gas Piping ................. C
Equipment ................. 3:
Commercial Final ....... 0 -n
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EXTERIOR SHEATHING -1
3:9
NAILING .......................... rn rn
FRAMING ........................ 0 r-
0 rn
FIRST FLOOR FRAMING ... C C/)
C Cn
M 0
INSULATION ................... Z
Floor Insulation ......... ;U
Wall Insulation ...........
z
Ceiling Insulation ....... --I
3:
SHEETROCK NAILING ... Cn
z
SPECIAL INSPECTION ... 0
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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