650179.pdfJ
I
...............
Permit
;a*
NEW
ADD
0
DEMOLISH
j
I
Required
M YES
U ALTER I bSRESIDENTIAL NUMBER or
r_1 DWELLING
REPAIR n NON-RESIDENTIAL I UNITS I
I hereby acknowledge that I have read this application; that the in.
formation given in correct; and that I arn the owner, or the duly author.
Ized 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
PLOT
APPROVED
FILE
[3 YES
[3 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT I=
HEAT & GAS LINE
4
PERMIT I=
DEMOLITION
PERMIT FEE
61 AMOUNT DUE
uuluulou
PERMIT
65-01-79
NUMBER
REAR YARD
VACANT SITE
[3 YES 13 NO
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
E] YES [3 NO
'toup
I P-271
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLV THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt Is acknowledged In space provided.
INSPECTION
DI CTO 8 ATURE
DEPARTMENT
CITY OF
FIDATE
EDMONDS
100
PH 6-1107
x
0
0
BUILDING PERMIT
CATION pl. No.
A
p
vear.
VIF EDMONDS Perm.
Building Department it limit, one,.'-7,,.
"is h
APPUCATION. ereb th
y made for a permit to construct the following work, in accordance with,
W,, P anyin plans and specifications. Two sets are submitted herewith for approval.
9
Off -St.
new Vloo�ter
...... . .........
.............................................. Parking
,Work addn repair ............. 1* ......
Fire zone� ... 5 ..................
Occupancy .............. ............... Const. dpe. ............. Use zone..'an-6= .......
Address................................... ................................ Lot.&q. Blk ......... .......... Addn-7� .........
Lotfrontage ........................................ . i�xea ........................................... Septic tank .........................................................
Bldg. setbacks front ..... 160 ... . .... r. side ......... ........... 1. side ........ ..... rear... 1._z ........
........ . .
Owner.. Address. ................................................... Tel. No ...................
......... . T ......
Builder...................................................... a ............. Address. ................................................... Tel. No .............. ...............
d Address .................................................... Tel. No ..............................
plans by ................................................................
Remarks........................................... ....... .......
this
is a correct statement, and I t I with all applicable Codes and State laws. regulating',
cl 1
The above
work.
Signed Owner/Ag .... Address ............................................ Date . ......
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with -the. aj�
proved plans and specifications, and Building Department notations thereon
.............. Recd. by. .........
Valuation .............. .............. Permit fee ........ /I
Buildmig Department, By ................ .... L Date .........
........ ................... ...... 1k: .. ..... .................. .
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .........................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
F:
t.J..
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f
CITY OF EDMONDSs WASHINGTON
o�
BUILDING PERMIT
�`p` jp� li, 6 a"n't, hereby certifies that a plot, plan, dra-,yings, and sufficient details to indicate This Space Is Far
�.e; irlten'tion to fulfill all requirements of this code are attached hereto. city Inspeclar Only
��pplication is hereby made for permit to do the following work:
................ e
................ . .............................................
. . .........
................................................... . .... ... . .........
....... . ............. .....
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I ......................... .... . ................ . ...................... . ................ . .... . .... . .. . .. . .. . . .... . .... . ...
..... . ....... .. . .. . . .... . ...................................................................................................... . ........
........................ Block. .......................................................................
LoE ...............................
. .... . .........
. ................ . .. . . .. . . .... . ...... . ....
. .......... . ..... ....................................................
. ................ . .. . . .. . .... . .. . .. . . .. . . .........
. ..... . .... . .......... . .... . .... . ...................... . ......................
.... .. ....... . X ................................ . ..................
. .......... . .... . .... . .... . ..... .. .. . .... . .......... . ........ . . .. . . ...... . .... . .. . . .........
at.223 ... .. P
risions ................................ X ................................
1 B 'I ing dime
uld
2. Lot dimensions ................................ x ................................
B 'Id' will be ........................ stories.
ul Ing
4. Basement ........................
.........................................................
5. Occupancy of building will be .............................
6 . ........................ feeyfroin the nearest joining line.
. .. .................. ......
7. Owner..'. 1/t
.. .. . .....
. ..........
aer's Address c.;J, ...................... :;7(
8. Ow . ............
9 uil 7- ........... .................... . .....................
.. B der .......... . . ---- --
...... ...................................... . ....................
10. Builder's Address ... . ..
........................ ............................ ........................................ . ...
Date .. !a ........ 1:3 ................... 19.5�
or hi ;f VE
Permission is hereby granted to do the work described hereon, according to the approved plans and sp"cations pertaining hereto,
Edmonds.
subject to compliance with the ordinances of. the, City of
C
A;S . ...............
Estimated cost . .. ..
�z .. ................... ....
Life of permiL...
date .... R by
.................... . ........ . .. . .... . .... . ..
(Issuing Officer)
City of Edmonds
Plans filed: Yes 0 No Department of, Buildings
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
StO00.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more thin 5411o, 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 shall be accompanied by a copy of the contract and a copy of the detai I led
specifications.
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving in 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 release from the general contractors who In turn should obtain release from all sub-contractott. The releases should be
diatested by the Department of Labor and Industries. 71c above procedures ore requirements of the State Industrial Insurance Act.
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