21327 95TH PL W (3).pdfIle 1.`1
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CITY OF EDMONDS, WASHINGTON
BUILDING PERMIT
�,'Applicaint hereby certifies that a sufficient details to indicate
plot, plan, drawings, and This Space Is For
int)enti6n.to fulfal aU requirements is cb e ttaCh to -
of th d are a ed here
City Inspector On
M,�43,,, cati
pp on
A is hereby made for permit to do the following work:
................. . ......... ..... . .........
IN id 11'ry i,
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.... . .... . .......... . .....................
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................
. .. . . . . . .. . . .
mensions .. ..............
1. Building di #14r 44-
.......... X....
.... X.4
2. Lot dimensions t% ..... X ..... ..................
3. Building wi 11 be ............. Z ....... stories.
4. Basement ......... t:'1-1z1 ......
5. Occupanc u
y of b ilding will be ........
feet from t . he nearest adjoining line.
6 . ........... ............... '.'i -�
....... ... ........ ......... .....
7. Owner ........ 2,:...
1.1en-e-
8. Owner's Address .... J-4 . . ...
9. Builder ............................................... ............ ..... .................. ........... ...... ...............
10. Builder's Addres& ......................... ........................ . ...................
Date............. ..................... 19S!...
....................
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications pertaining hereto,
subject to compliance with the ordinances of the City of Edmonds.
PERMIT NOO 760 -
Estimated cost
Life of permit-e2..,l
I date
Plans filed: Yes No 0
v�' .1101, . .................
Received by
lite Ti4Zf.;4Z;F
�;r . .......... . .........
Department of Buildings
City of Edmonds
1. The building permit fee which npplicant pays when permit is Issued shall be based On estimated cost of the proposed structure, at the rite of $2.00 for each
$1000.00 of cost. if the aitual cost of the structure, when finally determined, exceeds the estimated cost 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
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
the payroll and make monthly reports 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 release from all sub -contractors. The releases should be
Ruested by the Department of Labor and Industries. The above prQcedures are requirements of the State Industrial Insurance Act.
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& F""LOING PERMIT Appl. No._...-..
APPLICATION
CITY OF EDMONDS Building Department zt- Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom,
roval
panying plans and specifications. Two sets are submitted herewith for app
Off -St.
alter
.. .................................................... Parking ......................
repair ........... .. .......
Wo
............ Fire zone ...........................
_Ctonst e
Occupanc . ............ gr ons e ............................... t Use zone..
YaQ 7
d
..... ...... Lot ...... ......... Blk ........................ Ad -------- ..
Address ... . ... .. .. . ....... ......... ..
Septic tank ..........................................................
..............................
Lot frontage ........................................ Area ..... ......
. ............. rear ................................
Bldg. setbacks — front ........................... r. side .............................. I side
......... ..
el.
............... .
Owner..eo� ......................... Addres&.../-//
Builder.............. ...................... Address .................................................... Tel. No .............................
................. Address .................................................... Tel. No .............................
Plans by ................................................
Remarks............................................................................................................................................................................. . .
This permit covers work -to be 'don6
............... 6ii ... vfi:Vb:t6 ..' Prop art7 ..CrITLY ......................... ................
i�ny construction on thn public domain
.......................... — .................. * ...... --------
cgripis$ o
The aboveAPa WiLAta�Q9TRan Vgreeieo mply wift'A I applicable Codes and State laws regulating this
work.
I -so 1_e�,.� ...... bate -A.
... 44
ner/Agent ........ .. . ... Address ......................................
Signed Ow -Z)K�z .... .... .
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap-
proved plans and specifications, and Building Department notations thereon.
-Z' .... .. ...... .....
Valuation .................. ........................ Permit fee .......... ........... Recd.
Building Department, By..... ........... .............. Date ..... .. ....................... .. . ......................
........................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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