650153.pdfI
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Building Permit Application I,. Ide 11
N FILE NUMBER =U&�A..
PERMIT
NUMBER 650153
NAME (OR NAME OF BUBINNS15)
ADDRESS
0�,M,7_ V_A1LJ 4Z� __
7E00ftnTCF ADDRESS-
3/ 0
SIDE YARD SET BACK REAR YARD
WEL"IN ONE NUMBER
USE MAP NUMBER VACANT SITE
I
[j YES 0 NO 0
NAME)
BUILDING AREA ARIANCE—N—UMBER
I
ADDREB9`!I'!��
HEIGHT
ALL BUILDING SETBACKS ow
I NOTE: TO EAVE LINES
CITY TFLXk'11UNN �UA=
NAME
ADDRE
Encroachment Permit PEKALL'I" SIREET GR.XDE CHECK
Required
M YES NO
CITY
TELEPHONE NUMBER
SIZE CEME, BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Oil
LOT BLOCK TRACT
E CONNECTION VERIFIED BY
I
BBC. TEST PERMIT NUMBER
FIRE ZONB TYPE OPCONSTRUMON
9'3TREETIMPROVED
1 0 YES [j NO
2�
CTOR REQUIRED
JOCCUPANCY GROUP
YES NO
PLAN CHECKED By
DO
WORK TO BE DONE
No. of SLOGS.
PERIBLOG..
TOTAL FKK
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
NEW
DEMOLISH
NUMB
PLUMBING
0— ADD
3
PERMIT FEE
11
HEAT & GAS LINE
PERMIT FEE
1:1 ALTER
REPAIR
Lj RESIDENTIAL
NON-RESIDENTIAL
NUM13ER OF
DWELLING
UNITS
IS
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION
formation given to 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- THISPERMT
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 NOTED
NOTE: PERMIT LIMIT ONE YEAR
DATE SIGNED INSPECTION
'r"
810, 1
,TATURE (OWNER OR AGENT) DEPARTMENT
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 aelmowledged in space provided.
TO NATURE
/P
kjo�L Z�
4 /W"') CITY OF
22,r'
ii;�� "EDMONDS
PLOT PLAN CHECK & APPROVED PH 6-1107
I 'A"771
ATE V
ep 16
1711M
ij
CITY OF EDIVIOPL-4. WASHINCWTON DEPARTMENLJF BUILDINGS%
A.
BUILDING PERMIT
it hereby certifies that a plot, plan, drawings, and sufficient details to indicate
ition to fulfill all requirements of this code are attached hereto.
6 1
ion is hereby made for permit to do the following work:
....... . .........
..................................................
...................................................................................................................................
.. / .. ... 68F."
..... .... .. ..... .......
... . ..................................................
zl_�
.......... .. ........ _.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c number or lot and block numbers)
1. Building dimensions are.lff.7 ..................... X ..... AZ .....................
7:.7
. ................. X ... e ..............................
dimensions are..
stories in height.
�3. Building will be ........ / ...............
4. Number of basements ...... en4L ............
5. Occupancy of building will be ... .. ........ . .. ... ...........................................
6. Budding vVi feet from rest d 'olneig l9l: line.
b 4% .. .......... .
7. Owne; ... 42�...
................. .. .........
8. Owner's A M..
ddrm..7.1-3 ............ .. ....
9. Builder ........ M_6.t . . ......................... ..............................................................
10. Builder's Address ............................................................................................................
11. Architect or engineer ................................................................. / ......
Date... ............. 19.§;� ;, - 7 PA;
`0
Applicant's Signature ...... .... ................ .....................
i1s enc)
6;ner, or ;
0
W '13
0 Zen! .5
0 0
0
'ZI
P:J
U
0 0
04 -t d pq,
0
00
OR,
L� C11 en PLI
us 4i ow P4 55
0 r4 z
'a .5�
19 0
0.0 0
,�- 2 z
Estimated cost $/z 40 49 10-
GroupNo . ............ .... * ........ * .......... -
Life of permitZ%..0-0-_11.iF..= ........
Plans filed: Yes '130' No 0
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. This. -copy is your receipt for the following fees:
1. Building permit fee ....................................................... .................
2. Sewer permit fee ........................................................... I $ ......................................
3. Inspection and supervision
4. Total ..................................
PERMIT N? 500,.,
$ . 0
.....................................
Re 2
.. . ......... ........... . ........ A . .........
(Issuing Officer)
Department of Buildings
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 $1.00 for each
$1000.00 of cost. If the actual cost of the structure,when finally determined, exceeds the estimated cost by more than 501o, applicant agrees 9qpay an additional fee
of 'j2.00 for each $1000.060 of such excess cost.- I In such event no use permit shall be issued until such "discrepancy fee" is paid.
2. Whenever a contract for construction is'executed foi any structure costing more than $1000.00 for which a licensed architect or enghkeer-is not required by
the Building Code of the City pf Edmonds, the application for n,building permit shall be accompanied by a copy of the coatt-Act and -sr,copK*the') detailed
v
specifications;.
3. Prior to employing any labor or commencing 6r�,
I . notify,th�a Industrial lasurance\\,Division of the Department of Labor and Intlu".)giving an estimate of
the payroll and make monthl Full Instructions should -be obtained%fr6w the oearcst,�office-of'the Depirthicird'05f Nbor'and industries. Before
I _ , , , y rep�ror of payrolls.
final paynient� the -owner shoold*obtain a rilea-se from�' the general contractors who in turn should'obtain release from all)'sub-contractors. The rclea*' should be
sea
%treated by the Department of Labor and Industries. The above procedures are requi;ements of.the'State l9duittial lnsumce�Act.
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