640468.pdfME
OR .
9
a
3
Applicant
It A plication Inside Heav
'I TELEPHONE NUB
LEPHONE NU!
TELEPHONE NU
p
LICENSE I
TE ENS CITY
BLOCK TRACT
'Ate'.
NEW DEMOLISH
ADD
;"o .-
C_ I
Required
rl YES NO
111 ALTER L�J, RESIDENTIAL NUMBER OF
DWELLING
F� REPAIR NON-RESIDENTIAL I UNITS A
I hereby acknowledge that I have read this application; that th in-
formation given is correct: and that I am the owner, or the duly an or-
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 Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
I y
FILE
[3 YES [3 NO
PERMIT b4U4bO
NUMBER
ET BACIC
REAR YARD
&AP NU 15ER 6'A_.ANT SITE
YES N 0
f—RI
LOT AREA
A ANCE NUMBEU
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
51
PERMIT FEE
6 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged in space provided.
van D!�, Blcli. Official
/;l�
N
I
0
APPLICATION BUILDING PRNIT Appl. No.
CITY OF EDMONDS BulMing Departmmt Permit lmiuit� one year
APPUCATION is hereby made for a permit to construct the following work, in accordance with the accom-
panying plans and specifications. Two sets are submitted herewith for approval.
alter Off -St.
new
....... Parking ......................
repair ..... . f
Work addn .... 4V .. ....
Occupancy ... Const. type ....... V.� .................. Use zone ....... ..... Fire ne .. Z .............. . ...
.W) �-C� 'ev-, ,* �, _�
...................
Address .. 5ce ........................ Blk ....................... Addn ..... ................................
Lotfrontage ....................................... Area ........................................... Septic tank...5— ........ A.� ...................................
.............
Bldg. setbacks — front ......... 1.5 ........... r. side ........ 5 ................ 1. side ..... ......... rear .... L I
Owner..................................................................... Address. .................. ...... ...... Tel. No .............................
23
. ................... Address..A_ ..... Tel. Ne*e ...................
Builder.4P, ..,W)
Plansby .............................................. 7 .................. Address .................................................... Tel. No ........... I ...................
_V�o
The above is a
work.
Signed Owner/
statenfenrt� �and e Codes and State laws regulating this
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.
Valuation ................ 5 ... 0-- ec ...............
.. 0 ............. R d. by.
.............. Permit fee .......
lie ....... Date ...... . .......................
Buildin2 Department, By ................. ............ ............
9
INSPECTION RECORD
Fdn, OK
Frame, OK
Final, OY . .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
9
I
CITY OF EDMONI)Ss WASHINGTO(PNI
BUILDING PERMIT
A I*Cant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
attached hereto.
e interition to fulfill all requirements of this code are
is hereby made for permit to do the following work:
PP
....................... ................................................................................................. . .....
......................................................................... . .......... . .........
I .............
..... . .... . ..................................................................................................... . ...... . .......... . .........
...... . .... . ................ . .................................. . .......... . .... . ...................... . .... . ...... . .. . . .... . .........
......... . .. . .....
..... ......... . ................ . ................................................................................
Lot....................................................... Block ........................................................................
1. Building dimensions ................................ X .......................
2. Lot dimensions ................................ x ................................
3. Building will be ........................ stories.
4. Basement ........................
5. occupancy of building will be .........................................
6 . ........................ feet from the nearest adjo, ' g line.
7. Owner ........ E,0- ........ . ..
8. Owner's A� ress ......... IVZ--f:�,
bd ................ .......
9. Builder ..... .....
10. Builder's Addrm .... ffv.40-4 ...... .....
Date .... z /// ............
...........................
.......... . .......... . ...
C.. . .....................
This Space Is For
City Inspector only
Is
(Owner or his 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.
PERMIT N? 853
Estimated cost ..........
Life of permit .................
Plans filed: Yes Wo"No 0
49 "1
..........................
R, c 'Veda buy
- ---- - ---- - ---- - ---
(Issuing officei)
Department of Buildings
City of Edmonds
1. The building permit fee which applicant pays when permit Is issued shati be based on estimated cost of the proposed structure, at the rate of $2.00 for each
$10o0.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more thin 501o, 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 &hall 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 estimate of
the payroll and make monthly reports of paytoffs. Full instructions should be obtained from the nearest office of the Department of Utbor and Industries. Before
final payment, the owner should obtain a release from the general contractors who in turn should obtain release from all sub-contmctors. The releases should be
Ruested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial Insurance Act.