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Applicant Fill PERMIT
V
Building Permit Application linside Heavy Lines NUMBER 640325,
NAME (OR KAMM OF BUSINESS) JOB ADDRESS
/0-
MAILING ADDRESS SIDE YARD SET 33ACK REAR YARD
L/
_T=PHONE NUMBILIR USE ZONE MAP NUMBER VACANT SITE
CITY
0 YES [3 NO a
NAME BUILDING AREA LOOT AREA VARIANCE NUMBER
ADDRESS HEIGHT ALL BUILDING SETBACKS PW
NOTE: TO EAVE LINES
CITY TELEPHONE NUMBER RE RKS L'.
NAME
ADDRESS Encroachment Permit PERMIT NUMBER STREET GRADE CHECK .14
Required
YES NO
CITY TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKED By
STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS
LOT BLOCK TRACT
so eL�14'4 /Iac/
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMT NUMBER
See, 3
!PE OF -CONSTRUCTION STRIP T IMP�ROVED
0 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
pj-r Po' --1/0 r, 4/10 0 YES [3 NO
PLAN CHECKED BY
WORK TO BE DONE
NO. Or SLOGs. PRRIBLOG. TOTAL FEZ Z
I -CA t- P6 �j -'S 60kilej., BUILDING 0
I VALUATION
-5-10 BUILDING PERMIT
NUMBER OF STORIES 2 FEE
NEW DEMOLISH
PLUMBING
3 PERMIT FEE
ADD
HEAT & GAS LINE
ALTER RESIDENTLA�L NUMBER OF PERMIT FEE
DWELLING
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
1 PERMIT FEE
PROPOSED USE
6 AMOUNT DUE
I hereby acknowledge that r have read this application; that the in.
ATTENTION APPLICATION APPROVAL
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu.
THIS PERMIT This application is not a pernilt until
lating construction; an: In doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of WashIngton ONLY THE signed by the Director of Building Inspec-.
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
OWNER OR AGENT) DAT INSPECTION
-91—ONATURE E SIGNED DIRECTOR* IGNATURE
DEPARTMENT
4
CITY OF
_D&Tff
p =�PROVED EDMO"S
64N
PR 6-1107 x.:
PULE
V
C
�ITY OF EDMONDS, WASHINGTO
BUILDING PERMIT
nd sufficient details to indicate This Space Is For
es that a plot, plan, drawings, a
requirements of this code are attached hereto.
City Inspector Only
xby made for permit to do the following work:
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B3v1ck .. . ..........................................
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1-v Building*,dimensic
)ns .. .... X....
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Z,R
.'g
R, 'if -A- i .............
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��,�V;� Tji ii,� en . .... x .....
r dim sion .....
in
be ..... &&c ...... stories.
uild. g wlu
W.
as t .... . C . .....
.:Occupancy of building will be ......... JOVAJkr ......................................................
"n"
joining line.
........ ........ fee from the nearest ad
........................................................................
:7. Owner.
.......... . .
.. CAM
. ................ . .......... . ...
8. Owner's Address ........... ...... 9-4
7s
mj�_*.) ... . .............................. . .... . ...............
vie .... do..h.m.
9. Builder .............. 04L
dress ................. 4..,n.Q 4Ms .......... .... ..................
10. Builder's Ad
...............
..... ZAP; .......
7n
C-1
Date .. ............ 1940..
net r
fications.pertaining hereto,
Permission is hereby granted to do the work described hereon, according to the approved plans and sped
subject to compliance with the ordinances of the City of Edmonds.
cost ..
Estimated ........
............................
Life of permit. ... ......... . ...........
date R C hvedjr
L
Y A n'
PERMIT N9 630 Yes VI/ No f'Buildings
Plans filed: Department:o
City of Edmonds.
t Is issued shall be based an estimated cost oftbe proposed structure, at th'e rate of $2.00 for each
,1. The building permit fee which applicant pays when pernal by more than 5clo, applicant agrees to pay an additional.fee
$1000.00 of cost. if the actual cost of the structure, when finally determined, exceeds the estimated cost
of $2.00 for each $1000-00 of such excess cost.
2. Whenever a contra" for construction Is executed for any structure costing more than $1000-00 for which a licensed architect or engineer is not required by;�
cc by a copy of the contract'and a copy of. the detailed
the Building Code of the City of Edmonds, the application for a building permit sball be a ompaoied
specifications. ustries. giving an estimate of
)loying any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Ind
Prior to eml nearest office of the Department of Labor and Industries. Before
,4e payroll'ind makcF monthly tePorts'of POY90113. Fullinstructions should be%obtalned from. the rz 'Th re ease@ should be
h ' - turn -shouI&'obtaa`reI6ii irom� fill 'sub--c00tracto C
C%owner should obtaiti's icleaselimo7the general contractors w 0 in I
final payment,-th d ircratnts of the State industrial 16suiance Act.
Industries. The above proce ores are requ
Attested by the Department of Labor and
Al
V
77� 7
�,.- 1 -`e4
OF BUILDINGS
CITY OF EDMC WASHINGTON DEPARTMIL
BUILDING PERMIT
ifies that a plot, plan, drawings, and sufficient details to indicate
;plicant hereby cert
are attached hereto.
tl�e intention to fulfill all requirements of this code
0 0
eb d f it to do the following work: -zi
Application is y ma e or pe
W
0 caxl .5
cc-/ C/
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.. . . .... . . . . .. . . .. .. . . . . . . . . .. .. . . .. . .. . .... . . . . . . . 04
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.. .. . . .... . . . . . . . . . . . . . :D 0
. ................................................. .. cn C4
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........... . ................................................. CD L
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I I 1 6) >, . 0
L 0
............................................................ ...................................................... V
40
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............................................... ............ ..........
at.................................................................. .............................................................. . ......... 4.
(Street number at lot and block numbers) eq en
01
0
1. Building dimensions are ............ ..................... x ................... ...................
Js
5:
.............................
2. Lot dimensions are ...................... ........... x 0
3.
Building will be ....................... -stories in height. 0
z
4. Number of basements ............... ................
5. Occupancy of building will be . ...................................................................................
6 Building will be ................... feet rom nearest adjoining lot line.
7. Owner .......................................... .................................................................................. Estimated cost $ ................... . .... . .............
OwneesAddress ........................ ...................................................................................
Group No . .......... 7 .....................................
9. Builder ......................................... ...................................................................................
.. ..................................................................................
10. Buildees Address .........................
r, '11. Archite t r eng .......................................................................................... Life of permit ...........................................
c due
c',
peer ..........
'7
D.......... 19
Plans filed: Yes No 0
ate .... zia ... ant's
Ap Zicc (O%er or is agent)
is hereby granted to do the work described hereon, according to the approved plans and specifications pertaining hereto,
Permission ur receipt for the following fees:
bject to compliance with the ordinances of the City of Edmonds. This copy is yo
su
C7 4
........................................... $ ....... 2
1. Building permit fee. ............ ...
2. Sewer permit fee ........................................................... $ ......................................
3. Inspection and supervision fee ........................................ $ ......................................
ire dv
$ . . . . . . . . . . . . . . . . . . . . . . .
4. Total ..... . ....................................................................................... ........... . .... . .... . .... . ...
Received by A"
(Issuing 0
Depaitment of Buildings
PERMIT N? 327 City of Edmonds
AI
t pays when permit Is issued shall be based an estimated cost of the proposed structure. at,the rate of $1.00 for each
The building permit fee which applican ermined, exceeds the estimated cost by more than Wo, applicant agrees'to paii an additional fee
Of Cost' if the actual cost of the structurz-, when finally det
issued until such "discrepancy fee" Is paid.
no use permit shall be
'Ni..0 for each $1000-00 Of such excess cost. in such event
�,.; _L ; t 'required by
cc for construction is executed for any structure costing more than 411000.00 for which a licensed architect or engineer 11,4�O
henever a contra
building permit shall be accompanied by a COPY of the Contract and A copy 61!)Ae�--detalled
Building Code of the City of Edmonds, the application for 2
specifications.
an m
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving Carl Ate Of
ffice of the Department of Labor and Industries. Before
the payroll and make monthly reports of Payrolls. Full instrucdons should be obtained from the nearest o ases should be
I contractors who in turn should obtain release from all sub -contractors. The rele
final'payment, the owner should obtain a release from the genera
vmeare DC and %dustries. The above procedures are requirements of the State Industrizi Insurance Act.
the, Department of Labi
%
Estimated c
0"
............... Group No.
................
................ Life of perml
Plans filed
C.
NMI#
CITY OF
EDMONDSs WASHINGTON
BUILDING PERMIT
WA
pplicant hereby certifies that a plot� plan, drawings, and sufficient details to indicate This Space Is For
the'. intention to fulfiU aU requirements of this code are attached hereto.
City Inspector Only
',0-"Application is hereby made for permit to do the following work:
. . .. . ...... V..1 ................... ..................................... . .... . ...
e. �e�--< . .. ..... ..... .......... /F..4 ......
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.................... Block ........................................................................
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..................... ................ .... ..........
....... . ..... * .................................................................. . .................. . .. . . .... . ...
Kr
�.Yadini dimensions ................................ x ................................
ons ................................ x ................................
fUt,dimensi
*U be ............... ........ stories.
e ent .......... o .......
L
c of building will be .... ................ ............ .......... .......... ...................
'6 a. feet from th nearest adjoininpine.
7 Owner ..... ......
Address...
8 Owner's
........... ............ ...... ......... . .......... . ...
ild
9. Bu er ................
---------- -------
10. Builder's Address ........................ ....... .................... ........... ...... ..........
.............................. ................. ................. . .......................
-Date ......
I Q
. ...... . ...... ........... . . .........
.......... .......
..........
or his agent)
(Owute/
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.
Estimated cost $ . .......................
$ ..... ............................
... ....................
Life of permit ....... 12 date Re> ed
948
PERMIT
Plans filed:, Yes 0 No U�r D ZBufldmgs
City of Edmonds
1. Ile 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
applicant agrees to pay sn'sulditionil fee
$1000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than Se
of $2.00 for each $1000.00 of such excess co6t.
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 requIr ed by
the Building Code of the City of Edmonds, the applic2ticuL far 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 Depattment of Labor and Industries, giving an 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 a tele2se from the general contractors who in turn should obtain release from all sub -contractors. The 'releases should be
nucsted by the Department of Labor and Industries, Ile above procedures are requirements of the State Industrial Insurance Act.
j
kPPLICATIC N &
TV OF EDMONDS
WORK PERMIT
Building Department
ilication No.
2� —0- Limit One Ye
ebklhade for a permit to construct the following work, in waxordance with the accompanying plans
;02
/ ..........................
.. ... ... .. Ground Area ................................... No. Stories ............
....................... ... . . ................. .......................... Const. Type ........................... ....... Height ... ...................
..Fire Zone ....................
.... .......... ......... ................ ...........
... oc ................... Add'n ............................... .......................................... . ..................... Sewerage ....................................
.............. WIdtb_ ........................... Min. Bldg. Setbacks, Front and Rear ................................ Sides ............... . ......... ...
...................
............................... I .................................... Addres
P� N7.
M1111,1..
........................................................................... Address ........................................................................ Phone ........................ .......
..... . ............................................................ Address ........................................................................ Phone ....................... I . .......
A; ".J
. .............................................................. Address ........................................................................ Phone ....................... ........
. .....................
....................... .
.............. Address .................................... ... . .......................... Phone .........
g by .........................................................................
Jv� ...... .
Elect. by ............................................................................... ...................................... ............. . . .
............ Address .................................. Phone ...................
Remarks...................................................................................................................................................... ............................................................ .........
............................................ .
......................................................................................................................................................................................................
..............................................................................................................................................................................................................................................
.............................................................................................................................................................. . ...................................................................... .......... . .
agree to comply with all applicable Codes and State Laws regulating the work.
The above Is a correct statement and I
Address ............................................................................ Date....
Signed: ...... .......
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans,
-and specifications and Building Department notations thereon.
VALUATION PERMT IMES
$ ........................................ Bldg. $ ......... 5;�, ..................... I...
Plbg. $ ........................................
APPROVED: Heat . . . . $ ........... ............................
Date .............. . ........... ....... Elect. $ ........................................
.. ....................................
BUILDING DEPAR Others . . . $ ........................................
E $ ....... ,
By ............ ....... ....................... TOTAL FE .......................
NOTES: No work requiring Bull g Department or City Engineer's Inspection shall be covered before Inspection and approval.
Twenty-four (24) hour tice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.