660292.pdf0
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UILDING DEPARTMENT I Appilealtit 011
PERMIT APPLICATION I inside Heavy Lines
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1 DEMO SRI PENCE
RESIDENTIAL NUMBES, OF
ALTER 1:1 DWELIJNG
REPAIR I R NoN.RESIDENTIAL UNITS
I hereby acknowledge that I bavo read thin application; that the In-
formation given is correct; and that I am the owner, or the duly author -
,zed 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'D COMPeamtl a Insurance.
(Except Demolitions which shall
NOTE: Permit Umit One ;ear be completed In ninety days.)
DATE SIGNED
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NOTE: Applicant Subjcct to Plats Chcch Fce
This Permit covers wor done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquee%, etc.) will require sepsrate permi5sion. .
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[3 YES 0 NO
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BUILD 4G PERMIT
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MIT FEE
PERMIT FEE
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HEAT & GAS L12NTE
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PER MIT FEE
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SIGN PERMIT
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DEMOLITION
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PERMIT FEE
PLAN CHECK
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FEE
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ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
pit 6-2107
new
CITY OF EDMONDS, WASHINST4
BUILDING PERMIT
A li=tthereby certifies that a plot, plan, dmwings, and sufficient details to indicate
thpp
e in on to fulfill all requirements of this code are attached hereto.
Application is hereby made for p i to do tile following work,
---- ........................
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ling dimensions ............ ;—.
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dimensions ............ x
ding will be .... ..... stories.
ment ....... oeY ...........
5; Occupancy of b
uilding will be .....
..............................
6. ...... eet from the nearest adjoining line,
7. Owner ........ I
. ....... . ......... .........
8. Ownees Address ............... �.!i
441-,
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'9.. Budder ... . .... . .... . ...........
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10. Buildees Address ............... %�A-t
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let or his Agent)
City lftsp"hw On it
Permission is hereby granted to do the work described hereon, according to the approved plans and Apecifititjohd p4,fWt&ig hetdb,,
subject to compliance with the ordinances of the City of Edmonds,
PERMIT No
622
Estimated cost .5,/
Life of permit..
Plans- 44 go 0
12, ov %r-
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ker Wed by
0"tring 6ffi i
DePafirheA6 of &ildllio
City d Bdmoh&
1= buildfixW pectuir lee, m
hich applicant pays when PM,r Is Wued shall he busod on equmited en-W nf* the Pro:loscd structum, at the I fatd of V.661, f6i, e46,
lf due 'fto�l cost O"ber sfru=M when finally derevenined. exceeds the mituated cow by more than 54%, vpfi
,of r-20 for �dl $1000-000f =cb e=mw can.. cant' agre" toy pay all additl6dor f1w
Z.. Whenever a"Concrace for Construction Is execured for any
the Budding Gade, of the City of Untunds, the application, .. structure crAtfog more, than $1W6,04 Inc which a licensed prchirece or
spacEficada=- a building permit shall be accompanied by 2. copy, of the engineee 14* ride egeiillra'b�
contracr and x eeloplp 61( the' MAW.
tbet L=yroM and enak aaT labor Oc'cufflOwdog work, socify the Industrial Insurance Ilivi4ion orthe [�Vafferellf Of LS"f and Industries; OvIng A", egentiale'ei'
monthly repom of payrolls, Full: ituetrUcclof's should. be obtained front the neireirt officer of the Department of Lame and fi"Ulerrk
fi=L PxYmc:14- the owner should obtain a release from the general contractors who in curn should Ohralff release from 211
go'e'a"d by' the Departnues"' of Labw and rnduwries� The 2mvv Prncedures 2r r"iulr rx of the J0h-Mntr2CtOrT. nie ref6set %m;bfW&r
enven State Industrial Insurance Act.
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