670360.pdfBUILDING DEPARTMENT Applicant Flu
PERMIT APPLICATION maids Heavy Lines
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COUP. PLAN ST. R/W ... . ....... FT.
NO
DFMCIENCY THIS PROPERTr
W07 X, 677 /2, PERO. TEST PERMIT NUMBER
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Q FIRE ZONE TYPE OF CONSTRUCTION STREET ImpporE
[3 YES [3 NO
SPECLALL INSPECTOR RZQU11
[���LED OCCUPANCY GROUP
F� ALTER
E] REPAIR
YES [3 NO
RESIDENTIAL
D
GAS
LINE
NON-RESIDENTIAI,
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
OR FILL
( ........ . x .......... Ft.)
N,
IPNR,EP-movE
swim
POOL
DWELLING
UNITS
Plan Check No..____
BUILDING
uIlding setbacks, abutting streets) PLUM33ING
I —A
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
A16 Wr awl NG 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-
tzed agent of the owner. I agree to comply with city and state laws rogu-
ATMNTION
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
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORXZE8
NOTE: Permit Limit One Your (Except DE,,%zoumoNS which
ONLY THE
WORK NOTZD
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
plated In six months.)
JIGNATURE (OWNER R E DATE NED
INSPECTION
DEPARTMENT
0
CITY OF
KT
N E.- Applicant Subject to Plan Cbeck Fee
Pit 6-1107
This Permit covers work to be done on private property ONLY.
Any constsuctlon on the public domain (curbs, sidewalks, drIvewaym,
marquees, etc.) will require separate permission.
Fee
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
t is
Uty; and fees are paid, and receip ac_
knowledged in space provided.
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A
GITY OF. EDMOND�o WASHINGTO
r.;
.... .. BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
This Splue Is For
;the intention to fulfill aff requirements of this code are attached hereto.
City Inspmtor Only.
Application is hereby made for permit to do the following work:
...... .... ............... . ............................................... ....... ..........
.............................................................................................. . .......... . ...
........... ................................... . .... ................. ......................................... . ...... ......... . . .........
. ..... . .... . ................ . .......... . .... . .... . .... . .. . . .... . .... . .................... . . .... . .. . . .. . .. . .. . . .... . .........
.... .... .......... 9 ........ . .. . .....
......... ... ........ ...
Lot..... ................. Z ............................ Block ... ..... .. .............. ........
........... . .... . .... . .......... . ................ . ...................... . ... . ...... . .. . . .... . .........
................................................................... .... . .. . .. . . .... . .........
. . ......... . .
at.
U ...... X ....... 2--Z
i.',B ilding dimensions ................. . . ... A . 4,
'2. Lot dimensions ................................ x .......................... ......
3.1 Building vriU be ......... I ........... stones.
4. Basement .......................
ccupancy of build will be ....................................................................... . .........
.5. 0 ing ....
the�iearest adi 'ning line.
6. Z feet from
7.: Owner .... . i./.. ... ...............
8.
Owner's Addr6s ......... 7-P-4t...... .......... . ...
9. Builder .... . ........... . ...... ........... ........ .............................. . .... . ...............
10. Builder�s Address ...... ......................... ........................... . ...................
.... . .... . ........ . ........................ . .......... . .............. . .......................
117
Date . ....... .... ...
......... . .
Permission is hereby granted to do the work described hereon, accti�4ili o the approved plans and spec�fications pertaining hereto
subject to compliance with the ordinances of the City of Edmonds.
eo
Estimated cost $ ... A . . .....
$-
Life of pennit. ........ J6� ............ .....
Re
due
C
0
tie 'J",
PERMIT N 817
Plans filed: Yes M--'�No E3 De t of dm*ga
Ci o mon
car)
partmen dii
t of
ty f Edmon
1. The building permit fee which applicant pays when permit is Issued shall be based an estimated cost of the proposed structure, at the rate Of $2.00 for each
$1000.00 Of cost. if the actual cost of the structure, when finally determined, exceeds,tbe estimated cost by mute than We, applicant agrees to pay an additional fee
of $2.00 for each $1000.00 of such excess cost.
for which a licensed architect or engineer Is not required by
2. Whenever a contract for construction Is executed for any structure costing more thin $1000.00
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 detailed
specifications. T';'
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Induntles. 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 tura should obtain release from st! sub -contractors. no releases; should be
sittested by the Department of Labor and Industries. ne above procedures are requirements of the State Industrial Insurance Act.
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