21424 95TH PL W (2).pdf-- - - -------
CITY OF EDMONDS, 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.
Applicatiga_is hereby made for permit to do the following work:
..................................................................
........................................ . .........
at.... . ..................................... ................... .. . ..... ....
1. Building dimensions ................... X .... ...............
?
2. Lot dimensions ............. zzt� ..... X....'17 ...................
3. Building will be ... / ......... stories.
4. Basement ...... �_/ ..... 1
5. OCCURP�In7y of building will be .......................... .............. .............................................
6 . ...... ........ f t from the nearest I di * 'n I' e.
e
' E.7. Owynez/A?��6�__E ... . .. ............ ............. . ............... ............... .. ..... ..... ! .......................
45
8. Owneri Address ...... ... ................... ............................. . .......... . .......... ---------- - ---
9. Builder .................... . . . .. ............................................................. . .....................
10. Builder's Address ......................... ................................................ . .......... . ...................
---------------------- ------------------- ................ ----------------------------------
Date....... ! ...... ..........
......... ......... . .....................................................
(own" or his agent)
This Space Is For
City Inspector Only
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 N? 972
7&" ��J
Estimated cost $ZI-1.2 ..................
Life of permit ...........
date
Plans filed: Yes M`__�No 0 1
.............................
R> _.zCe1i.V.ed y
.. . . ........ ....... . . .. .. ..... . ..... ... . ..
(Issuing 04'iffi�ce;r�)
Depaitment of 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
$1000.00 Of Cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 50/c, 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 rcle2ses should he
arrested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial Insurance Act.
APPLICATION C BUILDING PERMIT Appl. No.'�<�ZnK
... .............
CITY OF EDMONDS Building Department 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 Off -St.
alter ................... Parking ......................
epair
Work addn r .................................. ze
Occupancy.... Const. type ......................... % Use zone./.�Z ....... Fire zone ................. ...
AAA--- ......... Blk. .............
Lot frontage ......
Bldg. set-backq —
3
Plans
............. Area ........................................... Septic tan ..........................................................
r. side ........... ....... 1. side ........ ............. rear .. .............
/,, 7e.)
Addres&.//"***3..4� .... ........... .... el. N .............................
0 D 07q
.... ..... Tel. No ..........
................................. Address.6-9 . ... ��R /.6
................. 1. Address .................................................... Tel. No .............................
. .. ................................................................................................................
Remarks ... be done I
on private Property ONLY. ...................................
................. Any ... .....................................................................................
Public domain
(cc"�C, sidovialks, driveways, ...................................................................................
................. 9te-;-)...
Pcrmission.
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/
Ur
_X_�
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.
1--'r 4— (�f�
................. IPermit fee ......
Valuation .......... E .... 8 ...... Recd. b ....... ... ... .. ... ....... .
Building Department, By ....................................... . ev .406: !� / . ; . .............................
U-4 .. i . .................. Date ....... ...... 6Z�
This Permit does not cover Plumbing, Sewer or Electrical installations.