650349.pdfM ,
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
NA39EI (0 14 15 OF is a?
PHONE NUMBER
I
[3 YES E3 NO
BUILDINE4
PERMIT 650349
NUMBER
13 YES C] NO
10 YES 13 NO
r GROUP
I I
R1 �L
ow
I
BUILDING
VALUATION
L
0
WORK TO)�E DONE
2
BUILDING PERMIT
FEE
70"
0
3
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
El
L A3
NEW
ADD
DEMOLISH
SIGN
10
0 FENCE
NUMBER OF STORIES
5
SIGN PERMIT
FEE
6
DEMOLITION
PERMIT FEE
ALTER
REPAIRI
-
RESIDENTIAL
NON-RESIDENTIAL
Ro
NU E F
LLING
UNITS
7
PLAN CHECK
FEE
8
AMOUNT DUE
?�J
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn regu-
iaung construction; and In doing the work authorized thereby, no person
win be employed In violation Of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance-
(Except Demolitions which shall
be
NOTE: Permit Limit One Your completed In ninety days.)
SIGNATU (0 R OR AGENT) SIGNED
4-Y J
ATTENTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
APPLICATION APPROVAL
This application is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
DIRECTOR'S SIGNATURE
Z7
NOTE: APPficant subject to Plan Check Fee
This remit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
marquess, etc.) will require separate Perm!56ion.
PH 6-1107
FILM
L
. .... .....
oe
V.
'i, :L 0outh Fdmonds Wesh-
317 5th AVO.
I
10
G TY OF EDMONDSs
I
WASHINGTON
BUILD ING
PERMIT
ifies that a plot, plan, drawings, and sufficient details to indicate
11411 requirements of this code are attached hereto.
7 made for permit to do the following work:
. ............................................................. . .........
Block ....... �7 ..
................... i� .............................
This Space Is For
city inspector ORIYJ
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. .. . .. . . . .. . .........
............................. ................ ........... ... . . .. .....
........... . ..
....... . .... .... . ....
. . .......... .
2b, .......... .... ........ . ..................
6 .......... ..
X ..... 7 ... 6 ................
I. Building dimensions
a
...............
2. Lot dimensions .... X ... ....................
3, ing ;will be ...... ............... stories.
Bu
...........
asement
5 0 of building will be ..... ....................................................
ccupancy
. ...... �.Q ........... feet from the nearest adjoining line.
-7 ... all-ur, A
Owner.
............................................................. . ..... ---- - ---
8 0wri 1
er a Address ........ ��i
. .......................... . .....................
9. Builderliff-LL ...
10. Builder's Address. ............ .............................................. 0 ...... . ...................
...................................................................................................
Date..J.0 .. .................. 19."
a gent)
(Owner or J
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications Pertaining ha-eto.
subject to compliance with the ordinances of the City of Edmonds.
4.7/
Life of permit.... .1-A .......
I date
PERMIT N? 633
R -v
(Issuing Officer)
Department of Buildingps
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 $2.00 for each:
$1000.Oo of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 5clo. 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 requited by
the Building Code of the City of Edmonds, the application for a building permit shall be accompanied by a copy of the contract Ind 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 estimateof
the payroll and malce 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-contractots. The releases should be
Ruested by the Department of Labor and Industries. The above proceduzes are requirements of the State Industrial Insurance Act.
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