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Building Permit Sign-off Request


    Please use this form when requesting a final occupancy inspection for new construction, remodel, or tenant improvement * indicates required information

  2. (If there is no sewer connection, enter "n/a")

  3. (If there is no water connection, enter "n/a")


    A backflow test report must be submitted for devices listed below with backflow prevention assemblies. **Test reports must be emailed to before an inspection and sign-off will be completed.**

  5. Does the property have any of the following devices?

  6. Fire Sprinkler System*

  7. Irrigation/Sprinkler System*

  8. Boiler*

  9. Swimming Pool/Spa*


    IMPORTANT: Samammish Plateau Water will only complete building permit sign-offs for sites that comply with Governor Jay Inslee’s "Phase 2 Construction COVID-19 Job Site Requirements". Please answer the following:

  11. Is your site classified as "low risk" with the ability to maintain physical distancing of at least 6 feet of separation between all personnel?*

      1. Do you have a COVID-19 exposure control, mitigation and recovery plan?*

          1. Building permit sign-off inspections will take place the first business day after requested unless otherwise notified. To request a future date, please enter the date here.

          2. **Verifying Statement**

            By electronically signing and submitting this request, I verify the following: (1) that all building permit sign-off requirements have been met, (2) the site complies with Governor Jay Inslee’s "Phase 2 Construction COVID-19 Job Site Requirements", and (3) all backflow prevention devices have been tested and test results have been emailed to

          3. Electronic Signature Agreement*

            By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

          4. Leave This Blank:

          5. This field is not part of the form submission.