640184.pdfMAILING-ADDRUSS /-,/ i�l
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CITY
TELEPHONE NUMBata
USE ZONE
MAP NUM13ER
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[3 YES b NO
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NAME
BUILDING AREA
LOT AREA
VARIANCE NUMBER
I
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
CITY
TELEPHONE 14UMBER
REMARKS
NAME
KV
P
ADDRESS
Encroachme nt Permit PFAULIT NUMBER STREET GRADE CHECKIg
Required
YES [3 NO
14
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE
CLEARA14CE CHECKED By
STATE LICENSE NUMBER
C17Y LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
TYPE NNECTION VERIFIED BY
PERC. TEST
FIRE ZONE7PE 07 CONSTRUCTION STREET IMPROVED
YES 13 N9
Z
0
SPECL&L INSPECTOR RE CCUPANCT GROUP
0 YES NO
PLAN CHECKED BY
J.'
0
WORK TO BE DONE
NO. OF MILD021.
FKR)"Loa.
TOTAL FEE
BUILDING
116,90
1C-_7T_
VALUATION
BUILDING PERMIT
2
FEE
-vurdtosb;R OF STORIE
3
PLUMBING
ErNEW
DE MO
ADD
PERMIT FEE
7jrOTALF9,1,E
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HEAT & GAS LINE
PERMIT I=
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NUMBER OF
ALTER
REPAIR
REBIDENTIA.L
NON-REBIDEN TIAL
DWELLING
UNITS
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
0
I hereby acknowledge that I have read this &PPllc&tl0n; that the in- ATTENTION APPLICATION APPROVAL".
formation given is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws Mgu- THIS PERMIT This application Is not a permit until
lating conxtructl0n; and in doing the work authorized thereby, no person AUTHORIZES
signed by the Director of Building Inspec.
of the State of Washington
will be employed in violation of the Labor Code ONLY THE
relating to Workmen?s Compensation Iusur&acc- WORK NOTED tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
NOTE: PERMIT L1,MIT ONE YEAR
DATE BIG DEPARTMENT RECT ONATURE
BIG URE WN R 0 AGE NED INSPECTION DI
16 2/ 4
ej,., CITY OF
ATE
EDMONDS
P P CHE PROVED
X�o Cl/
PR 6-1107
FILE
L
CITY OF EDMONDSI WAIHINGTON
BUILDING PEFIMIT
Applicant hereby cerrifies that a plot, plan, drawings, and sufficient details to indicate
the intention to fulfill all requirements of this code are attached hereto.
Applf t1* hereby made for permit to do the following work:
0 is h
............................................... I ....................... . .... . ...
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. ...... . .......... . .........
........... . ................ . ...................... . ..........................................................
. .... . .. . . ...... . .. . . .... . .........
..... . .... . ............................ . .... . .......... . .... . ................ . .......... . ....
.... ....... .........
..... . .......................... . ..... . .... . .. ...........................................................
`2 Block ...................................................... ..............
D
. ..... . ....
.. . .... . .. . . .........
. ..... . .... . .......... . .... .
J-
..... . .... . .... . .... . .... . ................ . .... . .... . .... . .... . ..........
at .... .... K . ........ . ...... . ........................
1. Building dimensions ........
X ...... . . .........
2. Lot dimensions ..... ....... X .... 4.1. a'. Q. .............
3. Building will be ........................ stories.
4. Basement ........................
5. Occupancy of building will be ......................................................................................
feet from the nearest adjoining line.
6.
......................
.................................
............................
7. Owner .......... . .
... Q.�n .........
8. Owner's Address ......... /.9.f.,9-6 .... . .......... . ..
. ............ . .... . ...............
9. Builder .... ..................................... ...........................................
10. Builder's Address .................................................................... . ................ . ..................
. .................... . ...... ........................... . ......................
................
A
Date.
...........
&V4�001wnc)ohwxwl�;;��
'bed hereon, according to the approved plans and Specifications pertaining he=W,
Permission is hereby granted to do the work descri
subject to compliance with the ordinances of the City of Edmonds.
1. The building permit fee which applicant pays when permit Is Issued shall be based an estimated cost of the proposed structure, at the rate of j2.00 far each
$i000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 50/,, applicant agrees to pay to 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 estimateof
the payroll and make monthly reports of payrolls. Full Instructions should be obtained from the nearest office of the Department of Laboi 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: 'rhe releases should be
jutested by the Department of Labor and Industries. Ile above procedures Rre requirements of the State Industrial Insurance Act. h
7;
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate This Space Is For
the intention to fulfill an requirements of this code are attached hereto.
City Inspector Only
Application is hereby made for permit to do the following work:
..... . . . ............ . ......... ....... ..............................................
........ . . .. . ...... ...... .. .. ............ .. . .........
..... ... . ................................ ....................................................................... . .......... . .........
........ . .......... . .......... . .......... . .... . ................ . .... . ....
.. .............
..... . ................ . .... . % ..................... . ................ . .......... .......
Lot. ................. "
. ;;-e ..... ............
.................... /P . ...............
. ..... 00-1L-
---------- - -
..... . .... . .......... . ........
..... . .... . .... . .... . .... . . �Z/ ........... . . . .............. . . . ...... . ... . .. . . .........
. ................. .
at.......
.......... X ....... 61) ......
sions ... >1 ......... ...
Building'dimen ......... ..... .
2. Lot dimensions ............ 1,11sr . ....... X ............ Z..713 ....
3. Building will be ....... 4 ............. stories.
4
Basement ..... Aej
will be ......................................................................................
gluilding
5. Occupancy o
6 . ........ . . ifeet from te nearest adjoining line.
-2na . ............. .................... ...... ...............
7
Owner ...... ..... 41
8. Owner's Address ......... -1� k
..............
9 .... ...... ... ............
Builder ........
av
10. Builder's Ad ... .. .. .. .... . .............. ........ . ...................
. ...... ...................................................
...............
'bed hereon, according to the approved plans and specifications pertaining hereto,
Permission is hereby granted to do the work descn
subject to compliance with the ordinances of the City of Edmonds.
1. The building permit fee which applicant pays when permit Is issued shalt 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 mote thin 5%, 2pplicant 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. t
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving in 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 R 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 procedures are requiremems of the State Industrial Insurance Act.
I