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CITY OF EDMONDS, WASHINGTOL a
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate This Space Is For
the intention to fulfill all requirements of this code are attached hereto.
City inspector Only
Application is hereby made for permit to do the following work:
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Lot....................................................... Block ........................................................................
.... .....__. l_.......... _.......... _..__...... _ __.. ..
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1. Building dimensions ................... ..�.: x......... 7.... .
2. Lot dimensions .............••. .C'- c.._...x..........!.7 �..._.-.....-
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3. Building will be ....stories.
4. Basement .........................
S. Occupancy of building will be.....................:..............................._............_...........
6.......... et from the nearest adjoini);lg line. V
7. Owuer.... d . tct 1�� ;
T , ._..
. 8. Owners Address
9. Builder ...... , ......
-�� ............... `iS...� �, _/ .
10. Builders Address... _.....__.. `..`` ` " `_`•t:'r................
...................................... ........... .............
` Date .4.............19.
.2,1E `
X-KiSa�gent7 o .. (Owner or )i •
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications pettauiing hereto,
subject to compliance with the ordinances of the City of Edmonds.
............ .... I
,
Received/��
7 Zl.(��•.:c� p � r
(Isstrfng patter) / I14
Departmentvof Btl&d gs ,
City of Edmonds i
1. The building permit fee which applicant pays when permit is Issued shall be based on estimated cost of the proposed structure, at the rate of $2.00-for each
$l000.00 of cost. If the actual cost of tine structure, when finally determined, exceeds the estimated coat by more than 5%, applicant agrees to pay an additional fee `
of $2.00 for each $1000.00 of such excess cost.
2. Whenever a contract for construction is executed for any structure costing more than $1000.00 for which a licensed architect or engineer Is not required by f 1J
the Building Code of the City of Edmonds, the application for a building permit shall be accompanied by a copy of the contract and a copyof thedetailed
specifications.
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estimate of ,
the payroll and make monthly reports'of payrolls. Pull instructions should be obtained.from the nearest office of the Department of Labor and Industries.. Before .)
final payment, the owner should obtain a release from the general contractors who In turn should obtain release from all subcontractors. The releases should be
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Iasunnce Act.+J ,J
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