650254.pdfIF
Applican
Building Permit Application I Inside Heavy"Ines
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NWA94WIX Douglas 23ad Crain
MAILING ADDRESEI
115 2nd Ave. No
CITY TELEPHONE NUMB
Edmond., Wash.
NAME
ADDRESS
CITY TELEPHONE NUMB
Water Heater Exclumige
115 2nd Avee No
11447 120th Ave, N, E.
Required
YES L] NO
0 Y,
Q
CITY
Kirkland, Wash.
—
TELEPHONE NUMBER
VA2-( 5089
I
METER SIZE
SERVICE
STATE LICENSE NUMBER
Cri-x I'lulsNaz NUMBER
REMARKS
LOT BLOCK TRACT
TYPE CONNECTION
PERC. TEST
FIRE ZONE TYPE 0
SPECIAL INSPECTOR
[j YES NO
PLAN CHECKED 13Y
9Q
WORK TO BE DONE
Gas P#ing
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
NEW
DEMOLISH
NUMBER OF STORIES
PLUMBING
ADD
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
ALTER
RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
1
5
DEMOLITION
PERMIT FEE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply With City and state laws regu-
lattng construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor "o of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
PLOT PLAN CHECK &
FILE
61 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
PERMIT
NUMBER
YES [3 NO
�,OT AREA VA-RIANCE NUMBER
L BUILDING SETBACKS
NOTE: 'T
0 EAVE LINES
I
APPLICATION APPROVAL I I
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 acimowledged in space provided.
IREPf 40r
�S,
CITY OF EDMO�,A. WASHINGTON - DEPARTME OF BUILDINGS
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate 00
the intention to fulfill all requirements of this code are attached hereto. Cd V
PA,
0
Application is hereby made for permit to do the following work: C &, r, 5
..............................................................................
at .... Ilq= ......... 0.
(Street number of lot and block numbers)
1. Building dimensions are....147 ...................... x ....... C.0 ........................
2. Lot dimensions are ......... 02 ................. ...... X�
.X ....... /.: .. :e ....................
3. Building will be ....... 1--.) ............... stories in height.
4. Number of basements...9111-de ........... ..
in will be ........... ........ .. ........... a
5. Occupancy of build*
6. Buildingf-wil.1 be Jr, .. ... . feet fro earest adjo' ing lot line.
7. ......
,8. Owiier's ;Address ........ .. .............. . ...... ... .. . ......
9. Builder .................. ALtanx-r—A .. .............. . ......................................
Address ...................................... .. .............. 6. /00., ......
10 Builder's I
11. Architect or engixieer .... �-:* ..... .... . ........ 41 ------ -
. .......
Date .... .......... 1
. . . .. ................ .. .. ............
Appli�411 (OwaWor 'hi X�
'�e
'fon I 'described reon, according.
__.Termiss is hereby jranted-to�4o.the-w6rk'
subject to compliance with the ordinances of the City of dmonds. T
I Buiidi ermit fee� .... .............. $
.................... 0
.................... �-J
. . . PQ
.................... JS 04 0
04
Cd
.......... . ......... An ;Q 0,
4 In* 94
...114
..................... 0
rZ
..................... a
U
.......... . ......... a 0 0
-B *t -t 'PQ
..................... ri.
..................... A
0 -0
S2
44
9W
40 P4 (n
0
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r. 0 0
14-2 .0
z
....................
�: .......... Estimated.pst $..e ........ r.. ..........
..................
...................... Group No . ................................................ I
......................
...................... Life of permit.4
are,
Plans -,filed: rYM,
D es 0
%0 7 Z
to the appFoved-plans.and specifications pertaining hereto,
his *'copy is I your rece ipt for the following fees:
.507 7 17
r.... . ........
7
2.1 Sewer permit fee ............................................. ................
$ ......................................
-3.'� ldghe;Etion and supervision fee....,1j..,..`,7
.........
$ .........
..... .
4. Tota�� ...... .......
............... .......
V
'N?
A14
6'
PERMIT
612
V
Receiv 2
...... .. . .... . .. . ..........
C (Issuingloili car)
11�_�Departin t� of\&�'ild . ings.1
<City 'of 2mon
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
il000.06,bf ct6si.� if the actual cost,of thelit`ructurel,whc�h fin%:Illf'datermined.'exceeds,thi estimated cost by more than 5-yo, applicant agrees to pay an additional fee
of $2.00 f6F each $1000.00 of such 'i'mm cost. In su�h event no use permit shall be issued until such "discrepancy fee" is paid.
T, 9
2. VV�cney'"or a coutra6t4oTiopumalon is ax"!ed fpr soy. s"rture costingmorp than $1000.0o.for. wltich,j,,IlSen�ed. architect or iugIne#.,Isn9t regulted by
the Building Code of thi City ofWmondi, tfie'allplicattiod'for it buhdIn9�beAWit shall,16 scdumpankd*, a copy of the 6ntrac� and"a' copy of 'the detailed
- .19 apci�cat(0#4
3. Prior to employing any labor or commencing worlZ, -notify- tbe, Industrial In"surance Division of the Department of Labor and Industries, giving in estimate of
the payroll and make monthly reports of payrolls . Full Instroctions ihould be obtained from the nearest office of the Department of Labor and Industries. Before
final payment, thitownir should obialn Is relea.se from the, general contractors who In turn should obtain release from all oub-contractors. 77he releases should be
arrested by the Departmen't of Labor and Indtfittles. The'sbova'procedorej`aii requirements of the State qndustrial, Insurance Acj�_:_
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