21710 95TH AVE W (2).pdfCITY OF EDMONI)Ss WASHINGTON
BUILDING PERMIT
nt hereby certifies that a plot, plan, drawings, and sufficient details toindicate
the intention to fulfill all requirements of this code are attached hereto.
in
Application is hereby made for permit to do the follow g work:
V,
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....................................................... Block ....... . ......................
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. ............ .................................
1. Building dimensions ................................ X ..........................
2. Lot dimensions ................................ x ................................
3. Building will be ........................ stories.
4. Basement ........................
5. Occupancy of building will bc ............................................
6 . ............. . eet fro t nearest adjoining line.
Jner
.0 . . .......................... C ......
7. Ov
Iner s dre ......... .........
8. Owner's A dress ................................. . ... ... ... z
9. Builder ............................ . . . . .. . . .. . . . .. . . .... . . .... . . . . .
10. Builder's Addres& .................................................................
1 -17 1z
This Space Is For
City Inspector Only
I ;
Permission is hereby granted to do the work descrl5id hereon, according to the approved plans and specifications pertaining hereto,
subject to compliance with the ordinances of the City of Edmonds.
PERMIT N9 ' 903
00
Ir" 15— 1�
Estimated cost $../ ....................
Life of permit- .......... � 2Wdl-V -
..................
date
IPlans filed: Yes No [] I
$ ........... ......
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R7/(
(Issuing
Department 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
Sl000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than W,, 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.OD 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 estimateof
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
attested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial Insurance Act.
APPLICATION F BUILDING PERMIT Appl. No . ....... ........ ......
CITY OF EDMONDS Building Department Permit limit, one.yeai
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom
panying plans and specifications. Two6ets are submitted herewith for approval.
new#/" alter Off'st.
..................................................... Parking ....... z .........
Work addn repair .... * ............. .. ... ................
Occupanc�-,-,----7--/ .... 6 ............... C t. twe ............... :�� ........... Use zone ......... V�::.Z.... Fire zone ...........................
....... Blk ........................ Add
Address ......... ................... Lot ........ .....
.......................................................
Lot frontage... ....... ................... Area ........................................... Septic tank .. 1�
Bldg. set -backs — front ........... !i?�F ...... r. side ............. �7..l ........ 1. side ............................. rear ............. ......
... .... .....
.................
Owner .. Cae:'o .... 141 .... Address. ...
....... ..........................
Builder............ .. ' . . .................................................. Address ................................................... Tel. No .............................
Plansby ................................................................. Address .................................................... Tel. No .............................
Remarks.................................................................................................................................................................................
The above is a corr ect statement, and I agree to comply with all applicable Codes and State laws regulating. this
work.
Signed Owner/Agen ..... . "-r4*- .......
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.
Or
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Valuation ........
...... / ..................................... Permit fee ....... iz�!2 ................. Recd. by
Building Department, By ............................ Date ............ .........................
.......................................... ... ..... ...
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final OY . .......................................
This Permit I does not cover Plumbing, Sewer or Electrical installations.