640211.pdfPermit
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(3 YES 13 N 0
TELEPHONE NUMBER
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0 YES C] NO
PERMIT
NUMBER 640211
0 YES
ALL BUILDING SETBACKS
NOTE: TO EAVM LINES
[] NO
0 YES [3 NO
Z
WORK TO HE DONE
NO. OF BLOCS.
TOTAL FKX
I
BUILDING
VALUATION
el
2
BUILDING PERMIT
FEE
NEW DEI&LISH
NUMBER OF STORIES
PLUMBING
3
PERMIT FEE
0— ADD
4
HEAT & GAS LINE
PERMIT FEE
E] ALTER I E3—RESIDENTIAL
NUMBER OF
DEMO TION
1, 0
FREPAIR
DWELLING
UNITS
1
NON-RESIDENTIAL
5
PERMIT FEE
—9R-0FOl
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given Is correct; and that I arn the owner. or the duly author.
ized agent of the owner. I agree to comply with City and state laws rvgu-
THIS PERMIT
This application is not a permit until
latIng construction; and In doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
tion, or his deputy; and fees are paid, and
relating to WorkmeWs Compensation Insurance.
WORK NOTED
receipt is acknowledged In space provided.
NOTE: PERMIT LIMIT ONE YEAR
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--WRECTOR'S SIONAT)URE
/
INSPECTION
FUGNAT7URE(;WNE)R OR,#GENT) LFA-A� SIGNED DEPARTMENT
njr�
CITY OF
DATE
PLOT PJAL.N C87* APPROVED
EDMONDS
PR 6-1107
FILE
�'APPIJOATION BUILDING PERMIT
BuIMIng Department
CITY OF EDMONDS
Appl. No . ......... ........ S7 . .....
permit limit, one year
APPUCATION is hereby made for a permit to construct the following work, in accordance With the accOm,
p I any ing plans and specifications. Two sets are submitted herewith for approval.
97,1 1 Off'st.
new alter 11 xe'--*Z-Ve .................... Parking . . ...... . .. . .......
.. ..............................
..................................
Work addn repair ....
0 1 ccupancy ................................ Const. type ............................... Use zone ..... C i�� ......... Fire zone ......... :5 ............
............. Addn ................................
Address........... .......... ............... : ..... Jot ....... . ................ Blk ...........
Area ................................
Lot frontage ....................................... ........... Septic tank .................... I ......................................
Bldg. setbacks front ............................ r. side ............................. 1. side ............................. rear ...............................
..........................
. ...... 'rel. No ...
Owner.'6'�.d-- ... Address...; .... A-2 --- ..... .....
.............
Builder.......................................... . ....................... Address. .......... ......................................... Tel. No .............................
Plansby .................................................................. Address ............... .................. Tel. No ............ ...... a ........ 7
Remarks.................................................................................................. .................
The ab I ove is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
wor1L
00-1
Signed Owner/Agent ....... .................................................... Address..,, .................. ..... Date .. o2vq
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.
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Permitfee ......... V-.40 ................ Recd. by ...... ......................................... .
Valuation ...... 146--r . ....... ................ or
.. ..... .. ;�q. ...................
Building Department, By ....................... . ................... Date.
.........................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK
Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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CITY OF EDMOk--a. WASHINGTO N — DEPARTME4-t-OF BUILDINGS
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate 00
the intention to fulfill all requirements of this code are attached hereto.
0,2*0 Q
0 i�
Applic%tion is hereby made for permit to do the following work: C .4
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............................................................ . .........
'Z & * AM
.. . . ...... ...... ....... I ..................................................... 04
........................... ......... ej g= I i
414 ..................................................... 4 .-S & 1
. . ...... r--� ------ (Street number or lot and block numbers) JI e,
1. Building dimensions are,;?A ... * ................... X ..... z
2. Lot dimensions are .................................. x .................
3. Building will be ............. ............ stories in height.
4. Number of basements ..................................
5. occupancy of building will be ................................
6. Building will be ................. f fro near djoi
7. Owner ................
,:7
8. Owner's Aoe2 .....
9. Builder.. --- - ---- �E . .. ...... ......... . ............
Cd :
5 0
............. Cn
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0
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0
ata -A
.............. -B 04 8
.............. M0 0
00
... . .........
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lot line.
.............................................. 11 Estimated cost $ ... 11040 ....... .............
Group No.
10. Buildees Address. .......................................................................................................... *
ii. Architect or engineer ...................... ............................................................................ Life of permit... ...:t ......................
date
Z,
Date.. q..V,.4f . ......... 19 6`iz
;_7' Plans filed: Yes No [I
A
Applicant's Signature-e
.. ...........................
!7
:0&. 40er or a agent)
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. This copy is your receipt for the following fees:
q
$-X ..............................
1. Building permit fee ...............................................
$ ......................................
2. Sewer permit fee ....................................................
3. Inspection and supervision fee ........................................ $ ......................................
4. Total ................................................................................. ameamww�040 .............. . .... . .... . ......... $.Or? ............................
R ' db
.... Aga../%7.
.............. . .
(Inuing officer)
Department of Buildings
City of Edmonds
I. 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 $1.00 for each
$I000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than Wo. applicant agrees to pay an additional fee
of $2.00 for each $1000-00 of such excess cost. In such event no use permit shall be issued until such "discrepancy fee" is paid.
2. Whenever a contract for construction is executed for any structure costing more than $1000.0o.for which. a licensed architect or engineer Is not ceikuls�d by
a pem copy of 'the contract and a copy, of, the'detalled
the Building Code of the City of Edmonds, the application for a buildl g r it shall be accompanied by a
specifications. a rules g in an estimate I
3. prior to employing any labor or commencing' work, notify ghe.Industrial insurance Division of the Department of Labor a d Indu iv 9 0 -
ustries. Before.
the payroll and make monthly reports of payrolls. Full'instructions 'should be obtained from the Inearest office of the Department of Labor and Ind
final payment, the owner should obtain afelease from the general contractors who in turn should obtain release from all sub -contractors. The rel should bo
attested by the Department of Labor and Industries. Ilie above procedures are sequicements of the State In4.T1tj1%lq1nsuffVce Act.--,,
PERMIT N? 394
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