650146.pdfPLAN FILE NUMBER
Building Permit Application j,,.1PP'cIm1 "'
side Heavy Lines
NAME (OR NAME OF !3ySINESS) JOB ADDRESS
ke-she 0,
MAILING ADDRESS SIDE YARIX SET BACK
WD
CITY TELEPHONIC NUMBF;R USE ZONE MAP NUMB
PR &
NAME BUILDING AREA LOT AREA
ADDRESS
t ALL BUILDING SETBACKS W 1 _-
14%JIC: TOEAVELINES
CITY TELEPHONE NUMBER
REMARKS —
NA.ME
Ow n v-.+-
ADDRESS Encroachment Permit PERMIT NUMBER STREET GRADE CRECKI
Required
0 YES NO
CITY TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEARANCE KED BY
CHEC
LICENSE NUMBER CITY
STATE LIC EN13M NUMBER N REILARTM
MAZCX iuNru
[] YES [] NO
.24oJE. "q.
6
BUILDING
VALUATION
2
BUILDING PXFMT
FEE
NEW
ADD
DEMOLISH
NUMBER OF STO
3
PLUMBING
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
5
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6 6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
AT=NTION
formation given In 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
lating construction; and 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
relating to Workmen's Compensation Insurance.
WORK 140TED
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION
'ON TURE (OWNER OR AGENT)
DATE SIGNED
'e"
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
L,OT PLAN �TVED
77---
FILE
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7
4
CITY OF EDMONDS, WASHINGTON
13UILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, -and sufficient details to indicate This Spoce Is For
are attached hereto.
the intention to fulfill all requirements of this code City Inspector Only
Application is hereby made for permit to do the following work:
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LoL....................................................... Block ........................................................................
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....................... . .... . ...................................................................... . .. . . .. . . . . . I
........... . .... ;r . . .... . ........ ---- ........ ......
............. . ........................ . .... . ...
..................... ( .....
'e / ....................
at ......... .......
ZS ............... X..* .... e2_1 .............
1. Building, dimensio ....
2. Lot dimensions ................................ X ................................
3. Building will be .............. / ...... stories.
4. Basement ............ .........
5. Oc
.................................................
cupancy of building will be ...... 7�:
6. et from thnenearest a oinind ine.
,5,Z /-7
.......... .......................................
............................
7. Owner ....... �. e .........
8. Owner's Address ............. Y16 . ................................... . ................ . ...............
9. Builder .... . ................ . ......
................................................. . .......... ......
10. Builder's Address. ...................................................................................... . ...................
...................................................................... : ............................
Date .......
0
............... 7
ns
Permission is hereby granted to do the work described hereon, according to the approved plans and specificatio pertaining hereto,
es of the City of Edmonds.,
subject to compliance with the ordinanc
PERMIT N9 861
Estimated cost $ ......
I Life of
date
Plans filed: Yes V._�No 0 �
$ ....... ..............
Dep ildings
City of Edmonds
t. The building permit fee which applicant pays when permit is issued shaU 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 Solo, applicant agrees to pay an I additional fee
of $2.00 for each $1000-00 of such excess cost-
r engineer Is not required by
2. Whenever a contract for construction Is executed for any structure costing more than $1000.00 for which a licensed architect o
the Building Code of the City of Edmonds, tile application for a building permit shall be accompanied by a copy of the contract and a copy of the decii1ed
specifications.
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estimateof
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 men should obtain release from all sub -contractors. The releases should be
%atested by the Department of Labor and Industries. 71e above procedures are requirements of the State Industrial Lururance Ace.
I
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The North 1/2 of the follow'ing �roperty:
A�
488 feet S. and 480 feet E. of N.W. corner of
W 1/4 of N.E. 1/4) �hence.S. 14
8,feet,, thence
IAI
Appl. No.
148 feet, thence W. 120 feet'
E. feet, thence N.
Permit limit, one year
C
to P. 0. B. of,Sec. 25., Twnp 27, Range 3,,
'AP' .-;.k, in�-accordance with the accom,
File J8826�j Re'z'onind
Planning Commission Rezone
Pali, from S-12 to'R-8)
alter Off -St
new
. .................................. ............... Parking .......................
addn repair
P
Occupancy ................................ Const. type ............................... Use zone ...... ........ Fire zonc
Aress.../ .......... Lot ........................ M ........................ Addn ................ .....................
dd'
Lot frontage ....... ............. ........ Are..... 041 4� ........... Septic tank
rear .................. ............
front,...x:�� .. ......... r. side ........ le� ............... 1. side ........ 7 ................
set -backs
Owne .. 14.,terlyA .............. 4 Address..Zqgo� ... eliggy..'e-illif
...........
........ . .
... Address. Tell NoA I!r tO
ui
.7
B der �q
Plansby .................................... ............................. Address ..................................................... Tel. No ........................
Remarks................................................................................................................................................................. 17 ....... ........
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ....... .... ...........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and State laws :regulating
The above is a correct statement, and I agree to comply with all applicable Codes
work.
Siffned Owner/Agenjr-524, ...... ........ Address ............................................ Date.)
J
�PERMIT for the above work is hereby approved, subject to the above conditions,, and to compha= with the ap,
proved plans and specifications, and Building Department notations thereon.
. ....... .... ...... ..
Valuation ...................... ......... Permit fee ...... I�A ............... Recd . .. . ... ....
il.. Da ....... Cv.
te ...... ...... ........................
Building Department, By .................................
installations.
This Permit does not cover Plumbing, Sewer or Electrical
I M