640323A.pdf"—�7' --7
PLAN FJ
Building
Permit Application
App cant FIII
'
I Heavy Lines
n,,,,.
N,�Xlll (OR NAME OFJ�USINESS)
JOB ADE
MAILING ADDRESS
SIDE YA
Cl Y
TEEMPHONE NUMB.
USE ZE
3 3
C5V
NAME
ADDRESS
HEIGHT
CITY
TELEPHONE NUMBER
REMAR3
NAME 4Z
g-i!n
ADDRESS
-Encroact
Required
YES
TELEPHONE NUMBER
METER
STATE LICENSE NUMBER
CITY LICENSE NUMBEER
REMAR
LOT BLOCK TRAC!r
Y7/
r
jor
7
Z oe 02 103 4 O'A
-Z�
WORK TO BE DONE
NEW DEMOLISH NUMBER OF STOR
ADD
ALTER Q RESIDENTIAL N R or
DrELING
F-1 REPAIR 9 NON-RESrDENTIAL UNITS
A� leo* e-rr 61V Z-
I hereby acknowledge that I have read this application: that the In-
formation given is correct: and that I era the owner, or the duly authw-
lzed agent of the owner. I agree to comply with city and state laws regu.
latins 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 Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
e e2,-� (
Lak-;6�
PLOT PLAN CHECK & APPRovzrj/
I
FILE
YES
NO. or aLoGs.
PKRIBLOO.
TOTAL F99
j
BUILDING
VALUATION
0
BUILDING PERMIT
2 FEE
4
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
DEMOLITION
5 PERMIT FEE
6 AMOUNT DUE
F
ATTENTION APPLICATION APPROVAL
THIS PERBUT This application Is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
MTE SIGNED
INSPECTION
DEPARTMENT
4/- lel
CITY OF
EDMONDS
PR 6-1107
Life of permiLE...' .......... Z ................. . .......
.... Received b
Y
............... . .... . ...
(Inuing officer)
PERMIT N? 859
Rans filed: YesjO/No 13 Depanment of Buildin
98
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 s%, applicant agrees to pay in 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 thin $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 my labor or commencing work, notify the Industrial Insurance Division of the Debartment of Labor and lodustrics. giving an estimateof
the payroll and make monthly reports of payrolls. Full Instructions should be obtained from tte nearest office of the Department of Labor and Industries. Before
final payment, the owner should obtain a release from the general contractors who In men should obtain release from all sub -contractors. The releases should be
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
.4