670306.pdfI IPUS1616PIVIV 90 16 F 1% IS I 11116 91 1 Applicant Fill
PERMIT APPLICAT I Inside Heavy Lines
AkBa.,a�
MAILING ADDRESS
0
")_A LIPLrr S�T r
CITY
TE-LEPHONE NUMBER
1
106-7.
NAME
Le-6- /A
ADDRMSK_
NUMBER
ILEPHONE
Loq
NAME
AL- CLwJ57(2 - CO
ADDRESS
2,S-Z-1 -5T
CITY
TELEPHONE NUMBER
8
-6ewr� r
I LA. -2>-77+�),
STATE LICENSE NUMBER
73— C:) i Z6G.
CITY LICENSE NUMBER
I
Legal Description of Property (Show Below or Attach Four Copies)
z
& 0 T
GAS
NEW RESIDENTU LINE
10
NON -RESIDE TIAL SIGN
ADD
RETAINING
F� DEMOLISH F3 WALL
ALTER EXCAVATE PENCE
F� OR FILL El ( x Ft.)
........ . ..........
PnE_MOVE SMM
REPAIR
1:1 INSP. POOL
OF STORIES
NUMBER OF
DWELLING
UNITS 0
0EZA-) T>09(z-nT1C:)W_�rS
0
Z"I 4L-T67Z
PROPOSED USE
y -5
PLOT PLAN (Indicate Building setbacks, abutting streets)
&O.C.P0
N
.ir//
EXISTING STREET R/W .......... . FT.
1,400:'
0 YES 0 NO
Plan Check No ............
II ��_ - �� �0 4E:4�=' -
I hereby acknowledge that I have read thin application; that the in-
formation given Is correct; and that I am the owner, or the duly author.
land 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
will be employed In violation of the Labor Code of the State of Washington
relating to Worlamen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DE310FATIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
plated In six months.) I
NOTE: APPlicant Subject to Plan Check Fee
This Pern-at covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ete.),will require separate permission.
BUILDING
--lRue
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FULL
TOTAL AMOUNT DUE
ATTENTION
THIs PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 6-1107
PERMIT
NUMBER 6703Q6
ACK
VACANT SITE
E3 YES (3 NO
VARIANCE NUMBER
Aw
DEFICIENCY THIS PROPERTY, 0
1z
STREE
13 YES
Valuation F as
00
a
MOD
APPLICATION APPROVAL;
A
This application is not a permit until
signed by the Building Official or his DS13-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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A—&%;uy ca:rLines rnar a plot, plan, drawings, and sufficient details to indicate
1,11-_ intention to fulfill all requirements of this code are attached hereto.
Application is hereb
ade /for permit to do wing work-
..................................
.... . ......... 0
0
.............................
........................................................................................................
................................................................................................................................................
for
.............................. L
. ......... S 0
a - I >%
................................................................................................................................................ -M 119 �n
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..................................................................................................................................... . ......... d 0 UD
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w............... #..# ................. ...... ..................... ................ # .................................... # ...... 0
....................................
6 s
at............. ## ........... ## s�� r.
. ....................... ............... . .....
(Street nUn&e'r or or an o numbers)
C14 rn
1. Building dimensions are .. # ............... X .... 0
.......... ................. P4 U.)
2. Lot dimensions are .... # ...................... X Z,
3. Building will be ............................ stories in height. 0 D
r: 0
4. Number of basement� ......... # d
0
5. Occupancy of building will be ............................. ....... ...... ...............
..........
Building wiU be ............. . .... feet from nearest d* fitiiig I t line.
-1 .0 CL
7. Owner .................. ........... ....................... ...... Estimated cost
. ig �0 ....
8. Owner�s Address .... ................
.,%,fBuilder ..............................
.. / .... ... ...................... . ....... ............. Group No. ...................
10. Builder's Address ...... # .......... .............................
...............
11. Archi �t or
t eer ..... .................................
......... .............. Life of p
ermit... .......................
Date .........
7.. .,. . .... date
7 ......... 19
-cf
t r
Applicant's Signatu
Plans filed:
...... . ..... Yes
1 0
(Owner or his W;; -_ I I :C i. i
Permission is hereby granted to do the work described hereon, according to the approved plans an
.Subject to compliance with the ordinances of the City of Edmonds. d specifications per�g ereto,
This copy is your receipt for the following fees:
1. Building permit fee ..............................................
......... ....................
$ .............
2. Sewer permit fee ...........................................................
3. Inspection and supervision fee ....................................... $ o
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S�
4. Total
.............
Received b
Y'4
—4a.P4., iR ..... .
PERMIT
N? 326
permit fee 4
0
- 1. The building which Applicant Pays when permit is issued shall be based On estimated cost of the proposed Structure, at the rate of $1.00 for each
$1000.00 of cost. U the actual cost of the structure. when finally determined. exceeds the estimated cost by more than 5 4.
of-$2.00 for each $1000.00 of such excess cost. In Such event no use permit shall be issued until such "discrepancy fee 0/0, applicant agrees to Pay an additional fee
Is paid.
VN ;never a contract for construction is executed for any structu
re cutting more than $1000-00 for which a licensed architect or en8laeu IS not'reqUired by
�g Code of the ary of Edmonds, the application for a building permit shall be accompanied by a copy of the contract and a copy of
derailed
'L rior to employing any labor -or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industrks, giving an
the payroll and make monthly reports of payroll,. Full instructions should be obtained from the nearest office of the Department of Labor'and Indui&I"'.4L':bdmj,
natefed by the Department of Labor and Industries. (1, -
final Payment, the owner should obtain a release from the general contractors who In turn should obtain release from all sub -contractors. "a
The above procedures are requirements of the State Industrial Insurance Act.
TY OF EDMONDS, WASHINGT
BUILDING PERMIT
es, t a plot, plan, drawings, and sufficient details to indicate This Space Is For
ents. of this code are attached hereto.
City Inspector Only
y�made for permit to do the following. work:
. ... .. ........
-A* .......
..... . .... . .................... .....................................
............... Tz.K.
. . . .. ...... .................................................................
. . . .........
... ..................... . .................................................................. . ...... . .
7 . .... . .......... . ...... . .. . . .... . .........
. ........ ............... . .... . ............................
............................................... . ..........
.......... . .... . .........................
.W.?� ............................. Block .... 4?::��-3 ...................................................
. .........
. .... . .... . .... . .......... . ........................................ . ...................... . .. . . .... . ...... . .... . ....
. . .. . . .........
................... . ...................... . ...................... . .......... . .....
.................... . ..... ------ - - -----
................................................... ......... ....
at.... . ...... ..... -- -----
1. Building dimensions .. ............. X ...... 5�� ......................
2. Lot dimensions ........... Ko ............. X ....... I.J..a ............
3. Building will be ....... / .............. stories.
4. Basement ........................
5. Occiapzincy of building will be .................. .... ................ ...........................................
6. ................... feet f in the nearest a in' g line.
7. Owner .......... . ..... . . ....... .. ............... ..................................
. .......... . ...
8. Owner's Add ........... .. . ... ...... .. .. ...... .. ... ... ........ ....................
9. Builder ...................... . ...................................... ....... . ..... 7 ........................ . .....................
10. Builder's Address ....................................................................................... . ...................
.......................................................................... . .......................
Date...... Y .................. 19
..........
vne
'bed hereon, according to the appro7ed plans and Spec cations pertaining ereto,
Permission is hereby granted to do the work descri ifi h
subject to compliance with the ordinances of the City of Edmonds.
I . 11
:x
Estimated cost $-4.0.0.0 ........
LC-1
$.:.-.? .............................
Life of permits�e._ �...
R
date
653
PERMIT N9 enaLAment,6f Buildings,
Plans filed: Yes R`�No El
D
Cii� of Edmoridi�,
J�
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 mote than 501o. applicant agrees to,pay an'additional fee
of $2.00 for each $1000.00 of such excess cost.
2. Whinever a contract for construction Is executed for any structure costing more than $1000.00 for which a licensed architect or eagineer,19 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 PU the detailed . .......
specifications. j.
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Departmentof Lab r and Industries, giving in estimate of
0
the P2yt0I1 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 Men should obtain release from all sub -contractors. The releases should.be 4
attested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial Insurance Act.
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