670499.pdfKROLL MAP NO.: PERMIT
6 DIIARTMINT Applicant M I NUMBER 670499
4PPLICATION Indde HeaVY Lines JOB ADDRES8
OF BUSINIS11)
13 YES E3 NO
EXISTING -STREET R/W ........ ... FT. DEFICIENCY THIS PROPER7r
YES 0 NO
GAS
RESIDENTIAL LINE
NEW
NOW.
SIGN
ADD RETAINING
El
DEMOLISH WALL
ALTER EXCAVATE PENCE
F OR FILL ( ........ . X ..........
PRE -MOVE SWIM
REPAIR INSP. POOL
NUMBER OF
DWELLING
UNITS
0 YES 0 No
ieeddp Fseirt,;; I
X Valuation Fee Receipt No.
Plan Check No ............ . .......
PROPOSED USE t
BUILDING
PLOT PLAN (Indicate Building setbac Ill g at 5)
PLUMBING
HEAT & GAS LINE
PENCE 0 0 0
It SIGN
RETAINING WALL
SWIM NO POOL
DEMOLITION
PRE -MOVE INSPECTION
gis EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formaUon given in correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state lawn regu- ATTEI'MON APPLICATION APPROVAL
lating censtructIon; 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 This application is not a permit until
rej&ung to WorkmaWx Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DE.'%IOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be Completed in ninety days; MOVED -IN BUILDINGS shall be com- knowledged in Space provided.
pleted In six months.)
"Ifl—ONATURE (OWNER OR AGENT) DATE SIGNED INSPECTION —DIRECTOR'S 811ONATURE
DEPARTMENT
A".0 10 CITY OF
EDMONDS DATWI
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Perallt covers work to be done on private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
FILE 0
marquees, etc.) will require separate permission.
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am
'�=Y OF EDMONDSs WASHINGTON
BUILDING PERMIT
certifies that a plot, plan, drawings, and sufficient details to indicate This Space Is For
f ' uifiu all requirements of this code are attached hereto. City Inspector Only
hereby made for permit to do the following work:
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PaD ......... Block....
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7
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... ........
1-�!�%Wding dimensions ...
,20
............... X ......... .. ..........
ig will be .............. stories.
3;" Buliall
4.' Basement ....... -- - -----------
It be .....
5. Occupas ........
py of building wi
6 ff., ........... eet from the earest adio I
7. Owner ...... .....................
.;7 ......... . .......... . ...
8. Owner's A re6s ...... .. .... ..
9. Builder ..... Yt2a-t .... . --- — --------------------------- - - ------------- ---- ----------------
.4?/Z --;5 04c,47.e
10.. Builder's Address. ... .. ......
. ....... 19 .........
Date ... ..
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I All" /*'-
(owner or his agent)
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 674
Estimated cost $1Y,..bAa 00
Life of permit,..'���..�? ........
date
Plans filed: Yes 2""�No 0
..........
Re d by
........... ..... ...
Department of Buildings
City of Edmonds I
i. The building permit fee which applicant pays when permit is Issued &hall be based on estimated cost of the proposed structure, at the rate of $2.00 for each
Sl000.glo of cost. IF the actual cost of the structure, when finally determined, exceeds the estimated cost by more than M, applicant agrees to pay an additional fee
of $2.00 for each $1000-00 0 1 such excess cost.
2. Whenever a contract for construction Is executed for any structure c0st][111 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 shall be accompanied by a copy of the contract and a copy of the detailed
specifications.
3. Prior go 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 tam should obtain release from all sub-contractots. The releases should be
arrested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial Insurance Act.
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