640261.pdf0
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9 PLAN Fly, NUMBER BUILDING
Fill PERMIT
Lines NUMBER
JOB ADDRESS
NEW DEMOLISH
ADD
ALTER F-1 RESIDENTIAL N LER OF
DrE NG
REPAIR Q NON-RESIDENTIAL UNITS
I hereby acknowledge that I have read this application; that the In-
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 regu-
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to WorkmeWs Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
PLAN
I
FILE
4caat,
Required
r-1 YES
YES 13 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
640261
MAP NUMBER
VACANT SITE
1
0 YES [3 NO
LOT AREA I
VARIANCE NUMBER
BUILDING SETBACKS
NOTE: ALLEAVE
LINES
j4
PERMIT NUMBER STREET GRADE MECX::
I
01
YES
kNCY GROUP
WRIMILD0. TOTAL FKK
APPLICATION APPROVAL
This application is not i permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged In space provided.
I
j
7
A
C .
CITY OF EDMONDS. WASHINGTO
................
BUILDING PERMIT
and sufficient details to indicate
Applicant hereby certifies that a plot, plan, drawings,
the intention to fulfill all requirements of this code are attached hereto,
ti
Applica on is hereby made for permit to do the following work:
. . .......... .. ... .... ....... ..... ...................................................... . ...... . .......... . .........
. .....................
....................
.... . .................. ...................................................................
01:,
............ ........
.. . ............................. ....................... ..................................................................
........... ......... .............. .. ....... ..........
.. . ...................... . .... . .... . ................
. ..... . ................ . ...................... . ........................................................................ . .......... . .. . ....
Lot....................................................... Block .......................................................................
... . .... . .... . ................ . .... . .......... . ...................... . .......... . ........ . . ... .. .
.2
..... . .... . .......... . .......... . .......... . .......... . .. . . ................ . .... . .. .
..... . .... . .... . .... . .... . .....
.... ....... ......
.. .... ... .... ...... ... . ........ ... ........... ...... ....... ...... ............ . .................. . .. . . .... . ..
1. Building dimensions .................. Z15! ....... X ................................
2. Lot dimensions ................................ X ................................
3. Building will be ........... L .......... stories.
4. Basement ........................
Occupancy of building will bc ..... ............ ..... 1�� ...............................................
6 . ........................ feet from �he nprj,�_,.a�oin' line.
7.'Owner ...... ........ ...
. .......... . ...
8. Owner's Address
9. Builder .............. ....... . .... . ...............
.. .. ..... ..........
................. . ...................
io. Builder's Address ...... 7 .. ...... : ... :,:
/ . .. . .......................................................................................... . ...
Date-.I*� I
.................
or his agent)
This Space Is For
City Inspector Only
MR
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? 865
q�a
Estimated cost $1-161-1- �- ..........
Life of permit .......... 4�1 date -
Plans filed: Yes El No
Ed
Department 4d Buildings
City of Edmonds I
1. 7be 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 thin 50%, 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 detalled
specifications.
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estim, 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 turss should obtain release from all sub -contractors. The releases should be
Kaested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.