670173.pdf7.'
�Npl If POSTED ON KROLL MAP NO.: PERMIT 670173
BUILDING DEPPLRTMENT ApplIcaut Fill NUMBER
inside Heavy Lines -TO-1-3tDI)RESS —. 15 7 -'s .
PERMIT APPLICATION
/ y /'�_)
NEW
ALTER
REPAIR
USE ZONE LOT AUNA VAG SITE
[3 YES [3 NO
LINLPP ONE, �U'!�E!'
—ff --iGNT BUIEVIVU ARIANCE NUUBEIF ;W
or
RESIDENTIAL
GAS
El LINE
NON-RUSIDENTIAL I
F� SIGN
RETAINING
F-1 WAIJ
DEMOLISH
F3�(.EL'rx'/�4. 1L.)
EEXCAVATE
l
OR FILL
r_1
PRE -MOVE
swIm3 �7/),
M
INSP.
POOL
g- 0 /
DWELLING
UNITS
1 Btreets)
__TJ
= �M A
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-
ized agent of the owner. I agree to comply with city and Slats laws Milo -
luting 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be Completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
mnequeeg, etcj wriII require separate permission.
i;�SiING'STREET R/W ............ FT- DEFICIENCY THIS PROPERTY 0
COUP. PLAN ST. R/W ............ IT- ....... . . ". — I
RE RKS is
0 YES E3 NO
valuation
Plats Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
CHECKED BY 'Z.
[] YES 0 No
Fee
. 0-0
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS FE1011T
This application is not a permit until
AUTHORIZES
signed by the Building official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DXRECTOR's
DEPARTMENT
�BNATUAW
CITY OF
DATE
EDMONDS
PH 0-1107
FILE
&��l
149�
CITY OF EDMONDSs WASHINGTON
"n ff%1p09%_ IMCIDMIT
A li
pp cant hereby certifies that a plot, plan, drawings, - and sufficient details to indicate
the intention to fulfill all requirements of this code are attached hereto.
ork:
Application is hereby made for permit to do the followl�n w
..... . .........
.........
..... . ............... .............. .. ...... ................
. . ..... ..... "'i '�
, o z4e:�� ..............
. . ... ......
.. .. ......
. . ........... �6
1.% .... . .........
I ....................................... I ..........
T
......................................
............ Block ......
t "7-x,
4� --- - * -- - ------------- U
------------------------------------- ------------------------------------- --- ----- --- --------------------
1. Building dimensions .7.0�n ................... X ................................
2. Lot dimensions ........ V.. a .............. X ..... .........
3. Building will be .......... / ......... stories.
4. Basement ......... 74_0 .....
..................................
5. Occupancy of building will be ....... ... ... ........... ......
6 4 ............. feet from the ncares djoiniqg )ine.
7. Owner ......... ..... ...... ...... . .... ......... .......... IF .......
.. .. .............
. .... .. . ... . ... . .. ..
8. Owner's j"dress .......
9. Builder .............................................................................................. ** ----- -
io. Builder's Address .................................................................................. -- - -----
... & '* ........ *"**"* ..... *'*"* ... ** ....... ...... ......... * ........... ......
Date. . . . .... 1.7 ........ 19
iis agent
This Space Is For
City Inspector Only
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.
Mad 885
PERMIT NOD
Estimated cost $.114.9
Life of permit ....... 4��.
'il'ie 7.
Plans filed: Yes VZNo 13
$A_
Received by
...................................... ..................
(Isming Officer)
Department of Buildings
City of Edmonds
1. The building permit fee which applicant pays when permit Is issued shalt be based�'on estimated cost of the proposed structure, at the rate of $2.00 for each
Sl000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 5%, 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 shoU be accompanied by a copy of the contract and a copy of the detailed
specifications.
3. Prior to employing any labor or cotrunencing work. notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estimateof
the payroll and make monthly reports of payrolls. Full instructions should be obtained from the nearest affice of the Department of Labor and Industries. Before
final payment, the owner should obtain a release from the general contractors who in rurn should obtain release from all sub -contractors. 'rhe releases should be
Ruested by the Department of Labor and Industries. 'rhe above procedures are requirements of the State industrial Insurance Act.
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