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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDRESS
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FLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FRONT URSIDE REAR
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REMARKS
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,REQUIRED 13YES
REMARKS
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STRUCTURAL U_ESIGN
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DescHption
Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
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PLAN CHECK NO:
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERAIT 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
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Review
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'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 FROM ANY AND
ALL ULAIMb FOR DAMAGES OF 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
/NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Fire Inspection
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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
CALL
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
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION IN UR CE AND RCW 18:27.
(425)
SIGNATURE (OWNER OR GENT):
DATE SIGNED
d1d) A640
771-0220
EXT. 1333
CONSULTANT
OCCUPANT
GROUP
3
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due 6-9
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy, and Fees are paid. and
receipt is acknowledged in space provided
FICIALS SIGNATURE DATE
ATTENTION L-` i )e
IT 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. UBC109 / IBC110 / IRC110.
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ilGINAL - F&E YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FINA.- PROJECT APPROVAL FII,,_AM
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PI�HASE SIGN
ENGINEERING DIVISION DATE-
I-LVASI: SIGN
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DESCRIPTION OF woRKTO BE INSPECTED
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A field inspection was con I ducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from tile above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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KGRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITION S NOTED
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Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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