670206.pdf9
nniinimr. DEPART ENT I A nlle=t M
PERMIT APPLICATION
F 11JUXU41NO
(OR NAME 0 INk" 01 49
W-ILWO ADDREN
7�t _NU
CITY 1111MR15RI MI3&R
A�_' P /V1 0 1( 0 1
0 YES
STUEZiA M/ "
EXISTING STREET R/W ............
.)=nCI=CY THIS PROPERTY
FT- r
a
COMP. PLAN ST. R/W ............
Fr- ........
---..ED BY
SIZE
CLEARANCE CHZCKIID By
RE 1XIMS
3ENSE NUMBER
C
CENSE NUMBER
—6/ — 4(
1"� I/ 1
91
CONNECTION
VERIFIED BY
ription of Property tunow Below or Attach Your CAVION)
L io t I
PFUMT MM13ER
Im
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
DEMOLISH
RETAINING
WALL
El ALTER
EXCAVATE
OR FILL
r
PENCE
( .......... X . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
JUMBER OF GTOMES
I
NUMBER OF
DWELLING
UNITS
c .6 (
r t 10
0 YES
plan Check No ...........
BUILDING
PLOT PLAN (Indicate Building setbac Streets) PLUMBING
BEAT & GAS LINE
FENCE
t ION
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
pRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 186W& regU- ATTENTION
IaUng construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State Of Washington THIS PERMIT
relating to WorkmaWN COMPOnsatiOu Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE3101ATIONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in Six months-) INSPECTION
T) DEPARTMENT
7 CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check- Fee PR 6-1107
This Permit covers worK to . done ao private Property ONLY
Any construction o1a the public domain (curbs, sidewalks, driveways,
marqueeg, etc.) will require separate PermllslOn-
YES r] 110
Z� - I.,
Fee
[,-4-, 0 d 1.� 7g,
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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00181 BUILDMG PBEff Appl. No. ---� ..................... . .....
C-
Permit lurut� one year
MONDS Building Deparhmat
the ccom
is hereby made for a permit to construct the following work, in accordance with a
specifications, Two sets are submitted herewith for approval.
Off'st.
alter
--in - -) ....... ........ 46.�.. . .......... Parking ......................
air .. .. �--CAto
ne .... ............ Fire zone ............................
. ................. Const. type ................................ Use zo
. ................. Lot ...... ............ Blk . ........... ....... Addn.. ..........
... ........ ............. -g�
Septic tank .........................................................
........ Area ......
---------------- .............................
........... ... .. ..
'Aacks ...... . 1. side .............................. rear ...............................
front ........ ............ r. side.
Tel. No... . ..................
Address. ... 4"e ......
Y.� ............
............
2-2-
... Tel. No.e
....... ...... Address ... .. ...........................
..........
.....................................
............ Address .................................................... Tel. No .............................
Plans b .........
y .................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remarks ............
.................................... .............................................................................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent,"
......... 2dress/./49e/ Date ........................
................
PEMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap,
proved plans and specifications, and Building Department notations thereon.
ra 0
............................................... Permit fee ....... �r .. . ................ Recd. by....6..
...... .. ... ......
Valualion.*d 0 C)
Date .......... �.=./.Imk.7 . ......................
Building Department, By ..........................................................................
sewer, or electrical installations, nor does it permit any work to be
NOTE This permit does not cover plumbing,
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development.
V
a
F;V
1_�INDS, WASHINGTON DEPARTM�w OF BUILDINGS
CITY OF EDMO
BUILDING PERMIT
i i cant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
itention to fulfill all requirements of this code are attached hereto.
ication is hereby made for permit to do the following work:
. ............................................... . .......
..................
.............
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . "r . . . . . . . . . . . . . . .
. ....... 777* ............ :72V7 .....................
M. N jr .............................
............................ ............................ : ..................
(Street number or lot and block numbers)
"l. Building dimensions are .......... ze .............. X .................... ..................
2. Lot dimensions are ............ 4P_ .......... X ...... ............................
3. Building will be ........... / ............. stories in height.
4. Number of basements ........ ........
5. 0 ...................
ccupancy of building will be ............. A ......... ........ t�
?0t
-Buildingwiilbe ..... r�4 feet from nearest adjoini . ot line.
Owner .............. . .................................
................... ...... .... .
. . . .......................................
Owner's Address ....... ...... ..... . . .........
......... ..... 00-0 ........
Builder .......................... C
............... o .......... ............................. 0 ........ 0 .......
10. Builder's Address
11. Architect or engineer .................. . W ............ ......... 0 ..........................
0
103
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....... 11 Estimated cost s ..... eddllt:�_ _Z:1 4C.1
........ 111=ZZ7 ..................
Group No.
Life of permit. ................ ... * ............
Plans filed: Yes 13 No 0
Applicant s Signaturel ...........................................................
(Owner or his agent)**""*....
'bed hereon, according to the approved plans and specifications pertaining hereto,
e ion is hereby granted to do the work descn
bject to compliance with the ordinances of the City of Edmonds. This copy is your receipt for the following fees:
1 L. ho� �zaa I
1. Building permit fee .........
2. Sewer permit fee ..............
3. Inspection and supervision
4. TOW ..................................
PERMIT N? 348
$ ......................................
. ...... $ ....... Ile!
..................... . ..........
(lesuins Officer)
Department of Buildings
City of Edmonds 1 11
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 01.00 for each
,00.00 of cost. If the actual cost of the structure, when finally deternilned, exceeds the estimated cost by more than Solo, applicant agrees to pay an additional fee
2.GO for each $1000-00 Of such excess cost' 'a such event no use permit shall,bP issued until such "discrepancy fee" Is paid.
Whenever a contract for construction 12 executed for any structure costing more thin $1000.00 for which a licensed architect or engineer Is not required by
the Building Code of the City of Edmonds, the application foe a building permit $hall be accompanied by a copy of the contract and a copy of the detailed
specifications.
3. prior to employing any labor or commencing work. notify the Industrial Insurance Division of the Department of Libor and Industries, giving an eschnateof
the payroll and make monthly reports of payrolls. Full instructions should be obtained (cum the nearest office of the Department of Labor and Industries. OZ
ould obtain a release from the general con who in turn should obtrAn release from all sub -contractors. no telex Ltd
final payment, the owner sh 1. N �
d dustric raq thit Irlate i6dustrial'Ins cc Aar,
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BUILDING PERMIT
indicate
Applicant hereby certifies that a plot, p an, drawings, and sufficient details to
the intention to fulfill all requirements of this code are attached hereto.
A.�ftl* #4� in iprn.1%v rnmelp- fnr nprmit to do the followine work:
....... . ................. . ................... . .............. . . .... . .......
. . ......... . . . . .. . .......... . ..... . ....... ................. ...... ...... . .... . .
Lot....................................................... Block ..........
1. Building dimensions ................................ X ................................
2. Lot dimensions ................................ x ................................
3. Building will be ......................... stories.
4. Basement ........................
5. Occupan�y of building will be ......................................................................................
6 . ........................ . f9et f"m the nearest ddjoin' H
�ag.. 1. n e.
7. Owner ....... . ....
....... . ...
8. Owner's Address. ......... / .............
9. Builder ........... .......... . ............................................................................. . .... . ...............
10. Builder's Address ....................................................................................... . ...................
............................................................................................... . ...
Date.. ...... ...................... 7
........... z
at or his agent)
This Space Is For
City Inspector Only
FAM
09
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.
PERMIT N9 726
L--��
Estimated cost ..................
Life of permit. .............................
date
Plans filed: Yes 11 No
.. ...............
Receivedilby .4
Department of ]Buildings
City of Edmonds I
1. The building permit fee which applicant pays when permit Is Issued sball be based on estimated cost of the proposed structure. at the rate of $2.00 for each
$IoGo.00 of cost. if the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 3%, 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 $10GO.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 detalled
specifications. * '
3. Prior to employing any.labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an 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 poentl contractors who in cum should obtain release from all gub-cownctors. The releases should be
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
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