670304.pdfIn,
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSIN
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Applicant M
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NEW
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E'SIDENTIA
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NON-RESIDENTIALJ
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SIGN
RETAINING
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WALL
DEMOLISH
ALTER EXCAVATE
FENCE
D OR FILL
( ........ . x .......... rt.)
REPAIR PRE -MOVE
1:1 INSP.
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POOL
FUMBER OF STORIES
NUM33ER OF
DWELLING
UNITS
X" 14U.; PERIM
NUMBER 670304
P7
3ACK STREET SETBACK___ RNA.R YARD SETS
LOT AREA VA%Jju4w UAWAI
13 YES (3 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Pr.
[3 YES 13 NO
13 YES [I NO
AfAly Aigne
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Valuation Fee Receipt No.
I AP " "12- cle &
Plan Check No
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PROPOSED BE
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BUILDING
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PLOTIPL&N (Indicate Building etbackg, abutting streets)
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HEAT & GAS LINE
PENCE
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SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in-
TOTAL AMOUNT DUE
r 0
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 laws regu.
ATTENTION
APPLICATION APPROVAL
lattag construcitilon; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMT
This application is not a permit until
relaUnt to Workmeas Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Vimit One Your (Except DE51OLITIONS which
ONLY TM
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be egglAted in ninety days: MOVED-11 U111111shall be com.
knowledged in space provided.
plate r
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SIONAT (o ER MAMEN DATEJSI NED
rX
ry
INSPECTION
DEPARTMENT
1�7
CITY OF
EDMONDS
DATE
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NOTE: Applicant Subject to Plan Check Fee
Pn 6-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
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ca"quees, etc.) will require separate permission.
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APPLICATI( M WORK PERMIT
Application No. ...s r ..........
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORK— NewlAxWw . ..... ........................................................................... Ground Arev ................................... No. Stories ..... 4.
Plans Submitted .......... ........................................... Const. Type ........ ................ * .... Height .......................
....................................................
Fire Zone ....................
LOCATION — Add ...... 2 ............. .... Use Zone.... 61�� .....
re ................ ............. ... ....
...... ..
Recorded LOL ................... Block. ................... Addn ......................................................................... . ..................... Sewerage..Xl.a.-K.d.?-�
t and Rear .... LN ....... . /� ...... Sides ...... i� .. . .............
idth. ...... . . . ......... Min. Bldg. Setbacks, Fron
Lot AM& ....................................... W ... ... ....
..,000rI12 ......... 2.� .... ...... Address ... ............ Phonejt**'r . ....... . .....
Owner .... ..... . ... . . I -el
Plansby ....... J1!!f- ...................................... Address ........................................................................ Phone ........................ .......
. .... ...... . ................................ Phone ....................... ........
Bldg. by. ..... ................... Address
Plbg. by .................. . ........................................................................ Address .............................. . ........................................ Phone ........................ .......
Heatingby ....................................................................................... Address ........................................................................ Phone ........................ .......
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............................ Address ........................................................................ Phone ................................
Elect. by ................................................................
The above is a correct statement and I agree to comply with all applicable Codes and State Lai
Signed: Owner/Ag Address ............................................................................ Date . .. .... .... ;R�� 3
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PE]U/M FEES
Bldg. $ ..........
z -0
7 ..............................
.......................
Plbg. $ ................ ..................
APPROVED: Heat ....
$ ........................................
Date ................ ( .... Elect. $ ........................................
......................
BUILDING DEPARTMENT Others ... $ ........................................
By ...................................... TOTAL FEE $ ...........
NOTES: No work requiring Building Depart3nent or City Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
....... ...
1 0
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NDS, WASHINGTON
CITY OF EDIVIO
BUILDING PERMIT
ilicint hereby certifies that a plot, plan, drawings, and sufficient details to indicate
jjn tion to fulfill all requirements of this code are attached hereto.
'—fication is hereby made for permit to do the following work:
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........ . .... . .... . .......... . .......... . ...................................................
. .........
....................... ......................................................
....................
..............................................................................................................
.. . ...... .......
. . . . . . . . . . .
.. ........... .... .......... . ............. .. ...... ............... .. ...... ... ...... . .
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . .. . . .
............................ Block ...............................................
. .... . .... . .... . .... . ...... ......... . .... . .......... . .... . .. . . .... . .. .
.. . ................ . .......... . .... . .... . ........... . .... . .. . . .. . . .. .
....... .... . ....
..... . .... . ... . .....
.. ........... : ..............................................
-3 61
[imensions .................. . ............ X ..... :;;Ez .................
...... X ...... ZA10 ...............
jill be ........ ............ stories.
>Z16
. ... .... ... .... .
r of building will be ...........
....... feet from the neaj;est adLoining liw.
This Space Is For
City inspector Only
— ------- -- -
vvner a Addresq ......... ...... . ..... ----- -
Builder
':Z) .. ... - .. . .................
M ...... ........ $A ... 1.1 ..........
BiiildiesAddress. ........ a.171 ...... ........................ . .......... . ...................
.... . .............................................................................................
Date. -z)7 ............ 19A-i�
.................
Permission is. hereby granted to do the work described hereon, according to the approved plans and specifications pertaining hereto.
subject to comp!iance with the ordinances of the City of Edmonds.
PERMIT N9 959
Estimated cost $-A
Life of permit. ..........
1�e ........ I
Plans filed: Yes ER--�"M 0
$ tz
...................................
Received,by',
--------- - -
(Issuing Officer)
Department of Buildings
City of Edmonds
i. 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
$I000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more thin 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 thin $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 shall be accompanied by a copy of the contract and a copy of the demil.,d
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 general contractors who In turn should obtain release from all sub-contructors. The releases sboult! be
Rttested by the Department of Labor and Industries. Tbe above procedures am requirements of the State Industrial Insurance Act.
i
a
BUILBING PEREff Appl. No . ..................................
Permit one year
Ds Building Department
hereby made for a permit to construct the following work, in accordance with the accom-
.18
Two sets are submitted herewith for approval. ;f
Off'st.
. ............................. Parking .......................
......................................
............ ..
nst. type ............................... Use zone ..... e ........ Fire zone ............................
...............
...................
........................ Blk ........................ Addn....
........ Septic tank .........................................................
........ Area ....................................
r. side ............................. 1. side ............................. rear ................................
............
Y
Tel. No.. ...................
.................... Address ... ..............
.............. Tel. No .............................
Address ......................................
................... Tel. No .............................
.... Address .................................
.. .....................................
.........................................................................................
..........................................................................
PIP':
............................
..............................................................
................................................................................
t, and I agree to comply with all applicable Codes and State laws regulating this
bb correct 6tatemen
a ve, is a
wor
S i 6r gent ... Address ............................................ Date...
gned -Own /A ................
proved, subject to the above conditions, and to compliance with the ap,
PERMIT for the above work is hereby aP
proved plans and specifications, and Building Department notations thereon.
........ ...
..... Permit fee ........ ................ Reed. by ... ...............
Valuation ................. ...................
...... Date ................. .... ... 2��l ................
Building Department, By ................................
This permit does not cover plumbing, sewer, or electrical installations, nor does it Permit any work to be
NOTE —
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of strects
and alleys, and plans for future sidewalk development