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NAPPLICAT�'!& BUILDING PERMIT Appl.o ..%.��-
CITY OF EDMONDS Building Department Permit limit,` one; year
17
APPLICATION "is hereby made for a, permit to construct the following work, in.aceordance with the accom•
ex r+ ire i s 1 s• „ a �.
panymg plans' and�'specifica�ioi�i . T,wo sets`'•are submitted herewith for approval'
new ✓ alter Of lun
} Work addn repair ......................���: ......�............. ....... ..... Par g ......
Const. e........ ...... ........ Use Zone..;r.L.. Fire Zone
.....
Occupancy ................. ....typ
r J V ' J
Address ..../P.1.:- /....... �'?`""' Lot � . 1.. %l0 ! —A dn.�: I
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Lot frontage ....: ............................... Area ..../.a�..... ?e..../..... Septic tank :.,' . ..... ...
Bldg. _set•backs —front ..........................r. side......../.� ........... ! side ........ 7./ .... rear.,......�.
ev
Owner... ........ Address..je
Builder........... .................. Address.................................................... TeL No ;
Plans b ......... Address ..................................................... Tel. No .......
y..............` t
Remarks...
.. .. .......... ..... ....... '
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...................................................... ......... ...... . .. ..... ...
......................
The'above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this1.
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CITY OF EDMOI.aoS. WASHINGTON — DEPARTME�— OF BUILDINGS
BUILDING PERMIT
ieant hereby certifies
that a plot, plan,
drawings,
and sufficient details to indicate
iteration to fulfill all
requirements of
this code are attached hereto.
ication is hereby made for permit to do the following work:
Q_ _..............................................................................................................
.................................
...........................
*fit �n�u Jrr�
n�kl .....................
'{ 1 (Street a r or lot and block numbers)
`
„ Building dimensions 4...................X..�to 1...........................
Lot. dimension are......RQ...................x........... ......................
NI.
3. Building will be ....�.. stories in height.
4. Number of basements �.•»
i. Occupancy of buildin&will be .... ...¢�'srar r�rr , .. � ...................
s
6. Building be... 1 ..... t frrlm)cy adjoining of line.
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7. Owner.
S: Owners Add , .....................................
aI..c%a .......
9. Builder.......... i �. Y..L......................................
10. Builders Address ._..�'R�i4....................................I
it. A •tect or engineer ................................................
Date V-1.....................19 �
Applicant's Signature. .....o ..... 4...- ub r •••L
(Owns or his ager
Permission is hereby granted to do the work descnbed hereon, according to the approved plan and specifications pertaining hereto,
subject to compliance with the ordinances of the City of Edmonds. This copy is your receipt for the following fees:
0
1. Building permit fee ..................................» �r
$. .....»..................
2. Sewer permit fee ................................... ................. »..... $ ......................................
3. Inspection and supervision fee.......................................•$....................... ».... ........
4. Total..........................................................................................................»....»....».....
PERMIT N4 424
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 $1.00'for each !
i
$1000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 5%. applicant agrees to pay an additional fee
of .f2.00 for each $1000.00 of such excess that. In such event no use permit shall be issued until such "discrepancy fee" Is paid.
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
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 copy of the detailed
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 1 .
the payroll and make monthly report, of payrolls. Full 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 releaie from all subcontractors. The releases sbould. be •'
granted by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act:'
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