21408 92ND AVE W (3).pdfI
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APPLICATION BUILDING PERMIT Apil. No . ......................... I .. . ....
CITY OF EDMONDS Building Departmmit Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom-
panying plans and specifications. Two sets are submitted herewith for approval.
new w" alter Off -St.
Work addn repair .............
................................................................................................ Parking . . ...... . ...........
Occupancy ................................ Const. type ................................ Use zone ... )5::�d ......... Fire zone ...........................
Address........... Lot ....................... Blk ....................... Addn ......................................
Lot frontage .................. . 74? ............. . Area ........... 47 `9 ....... Septic tank ...................................... . .................
Bldg. set -backs front ......... Ngi!;;� ....... r. side ............... 7 ........ 1. side ............. 7
........... rear ........ ... .........
lei
4�ei_ 00
Owner-� ��A. Address..//=4,t," ............. Tel. No ......... . ..................
Builder ...........
....................................................... Address. ................................................... Tel. No .............................
Plansby ................................................................. Address ................................................... Tel. No .............................
Remarks..................................................................................................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
'W
Signed Owner/AgentXe;�'�... . . ... .................. 40.1—Z—Address ............................................ Date.. .............
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. �2
Valuation .... J.4 .. .............. ..... Permit fee.._:Z.,8 .................. Recd. by.4_.'�p . ............ .. . I .... .
Building Department, By ....... .. 16 ................ Date .......
70 Z6 - - ..................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OY . .......................
................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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CITY OF EDMONI)Ss WASHINGTON'
BUILDING PERMIT
Applicant hereby certifies that a Plot, plan, drawings, and sufficient details to indicate
the intention to fulfill all requirements of this code are attached hereto.
Applicat, hereby made for permit to do the following work:
.............................................................. to .... ..........
.............. X ... . ....... .. ...
..............................................................
I . . . . .......... . .........
.......................................................................................................................... .......... . .........
................. . ................ . .... . .... . ...... . .. . . .... . .........
........................................................................... .........
.. Block ..... �7.,et
This Space Is For
City Inspector Only
------ ---------- 9 - . , , , & , 1� . . . . . . . . . .
Z,�z ..: ..
............ ...... ........
at ............ 4 ................
1. Building dimensions ...................... 24�rx .................
2. Lot dimensions ................... ............. ........
3. Building will be ......... :2 ........... stories.
4. Basement .......... �TA .... : ...
5. occupancy of building will bc ................. ��l ...... ..................................
6 . ................ �2 ........ �et from the near�st adjoining line.,
7. Owner .......... . ...................
X
......................... . ..........
8. Owner s Address ........
............................
..................................................
9. Builder ............................ 'IC5� C4-1
10. Builder's Address. ................ ............................. : .................... . ..................
...................................................................................................
Date ..... .........
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 1032
Estimated cost $ ... / dwe 6" ulj
................
Life of permit. ............
Ate
Plans filed: Yes BZN0 El
$....
Received b J
�4 ---- ---- - ---
DepartmenJ4 Buildings
City of Edmonds
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. U 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 $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 at commencing work. notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estfinateof
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-contr2clars. The releases should be
r,ttested by the Department of Labor and Industries. 7te above procedures are requirements of the State Industrial Insurance Act.
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