680228.pdfBUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION 1][nalde Heavy Lines
NAM (OR NAjdE um- BUSINESS)
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_9A_1LJNG ADDRESS -
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CITY TE UMBER
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NAME
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ADORE 58
CITY INN rn urq� U=D.
NAM
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CITY —TELEPHONE NUMBER
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13TATE =ENSE NUMBER —1 CITY �L'CENSE NUMBE'R
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Legal Description Of Property (Show
Below or Attaca vour uupwa,
L4 c N
P D;7-4
I(el AC7Cj,,0P,x1q71
1"L
1� 7)17-er �117,\ L9A_ A,( A A(
a B
El RESIDENTIAL E] LAINE
IAL
NEW 10 NON.RESIDENTJ [:] SIGN
EIADD RETAINING
DDEMOLISH El WALL
DALTER EXCAVATE PENCE
0 on FILL X
SZ .... x ..........
1:1 REPAIR PRE -MOVE M
R INSP. �`IPOOL
DWELLING
UNITS
6 MAP NO.*. PERMIT
NUMBER
7-*Z—, f`
EXISTING'STREET R/W ............ FT.
COMP. PLAN ST. RIW ............ FT -
I hereby acknowledge that I have read this application; that the in-
formation 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 laws r8gu-
latlng 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 Workmen's Compensation Insurance'
NOTE: Permit Limit One YOur (Except DE51OLITIONS which
shall be completed in ninety days: M0VZD-IN BUILDINGS shall be com-
pleted in six months-)
NOTE: APPlicant Subject to Plan Check Fee
Tide Permit covers work to be done on private property ONLY -
Any construction an the public domain (curboo sidewalkso drivewayos
marquees, etc.) will require separate permission.
C] YES
TYPE
W=9
Plan check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTXON
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
MAXONDS
ra 6-1107
REAn YARD SETBACK
VACAN
�Ms
NOE flumm�
DEFICIENCY THIS PROPERTY
(3 YES 13 NO
z
W
No.
1 /0, " VqK_0
APPLICATION APPROVAL
This application Is not a pernAt until
Signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
linowledged in space provided.
FILE
I
Date Passecl
Drainage
Sewer
Parking
I-andscaoing -------
CITY OF EDMONDS, WASHINGTO�i
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
the *intention to fulfill all requirements of this code are attached hereto.
Application is hereby made for permit t o do the followin g wor k
..... . ...................... . .... . ............................. . . .... ..... I ............ . ...... . .
e'j —S�m .............................................................................. . .......... . .........
..........
........ ................................................................................................................ . ..........
. .........
. .... . .. . ........ . .. . . ....
......................................... . .......... . .... . ........................................
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....................... . ...................... . ...............
Lot....... I .................... : ......... M ............... 4/4
....................... . ............................................................. .. . . .... . ...... . .... . .... . .........
....................... . .. ................... ::� .... . ............................ . .. . .... iZ71 .. ....
Fnat.-JI .. . ... ..... .. . . ... z / ........ . . ... . ..
i. Building dimensions ...... 4-9 ................ x .... 12Z ... 0 .................
... 7 X ....... // ............
2. Lot dimensions .... . Y ................
3. Building will be ........ J ............. stories.
4. Basement .... :::�Q
'5. OCCUP725of buildingwill be ..... 11'.n.0 .................................................
6 . ........................ feet from the nearest adjoinin 2ine.
7. Owner ......... .......
8. Owner's Address ..... ........ 40 ..........
9. Builder ...... ...........
.. . .......... . .......... ..........
10. Builder's Address ........... ................................................. . ...................
...................................................................................................
Date ..... 1. 2--'1
...................... 19 .......
. ............
(Owner or his agent)
This Space Is For
City Inspector Only
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 W? 697
Estimated cost
Life of permit...6.m..o .........
date
I Plans filed: Yes d No 0 1
0--�
$ ... J2.. /-./ .....................
Recc*ved by
V
— ---- — ---- — ---- — ---
(issuing Officer)
Department of Buildings
City of Edmonds
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 $2.00 for each
Sj000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than Wo, applicant agrees to pay in 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 $1000-00 for which a licensed architect or engineer is not requited 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 to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estittkateof
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 -contractors. The relems should he
arrested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
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