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680521.pdfBUILDING DEPARTMENT Applicant Fill PERMIT APPLICATION Inside Heavy Lines NAME (OR NAME L,ew,� _WFIE[RUG ADDRISSO TELEPHONE NUMBER — �7,(,�- DRESS UITY f P /4 0 AIA-5 UWATE LICENSE NUMBER '0; V 7,2 �Z 4 or 714� I - /VZVM P/e_ t�1,6iv-1 I RESIDENTIAL GAS D NEW LINE 31TON-REBIDENTLAL SIGN ADD DEMOLISH RETAINING WALL ALTER EXCAVATE OR FILL PENCE PRE -MOVE Ft.) amm REPAIR INSP. POOL DWELLING UNITS 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 regu. lating construction; and In doing the work authorized thereby, no Vernon will be employed in violation of the Labor Code of the State of Washiington relating to Workmen's Compensation Inaurance. . NOTE: Permit Limit One Your (EXcePt DE510XJTIONS which shall be completed in ninety days; MOVED-JIN BUILDINGS shall be com- pleted In six months.) 7�'—;&,'7 NOTE: Applicant Subject to Plan Check This Permit coven work to be done on private propexty ONLY. Any oonstruction an the public domain (curbs, sidewalks, driveways, — noes, e4c.) will require separate permission. RN EXISTING STREET COUP. PLAN ST. R/W .... ...... XT. [3 YES 13 NO Plan Check No... BUILDING PLUMBING BEAT & GAS LINE PENCE SIGN RETAINING WALL SWIMMING Poor, DEMOLITION' PRE -MOVE INSPECTION EXCAVATION OR PILL TOTAL AMOUNT DUE ATTEPMON THIS PZR3HT AUTHORIZES ONLY THE WORK NOTED INSPECTION DEPARTMENT crl!y OF EDMONDS PH 6-1107 PERMIT NUMBER 680521 rl YES DEFICIENCY THIS PROPERTY Valuation 13 YES NO I A. n n I 14TT APPLICATION APPROVAL This application is not a pern-at until signed by the Building Official or his Dep- uty; and fees are paid, and receipt is ac. knowledged in space provided. 7� — 'el — &0, 4.1 f.p V., p 4 4 i 1 4 fir .... . ...... -X. OLi. WASHINGTO N DEPARTMEI� OF BUILDINGS CITY OF EDM BUILDING PERMIT Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate r. 0 the intention to fulfill all requirements of this code are attached hereto. 0.0 Application is hhereb maccle for permit to do the following work: W ZJ 1 0 WC1,4 S1 ............................................. 0 ........... .... .. ................. Y. . .. . ... P . . .. .................... ..... . ... .......................... ..... .. .. ... .. .... Z ......... 4 a .. .. ..... ......... ... .......................................... fj.. . ..... ... ....... ........................................................................................ ................................... I ................... 5.2 ........................................................................ U) 5. 0 En ............................. ......................................................... 0 .......................................................... 0 PA ................................................................................................................................................. U Pq 0 0 0 ........................................................................... . ......... .......................................................... . .... . ............................................................................. .......................................................... W A 0 undersi C-4 ................... :.:.::: ..................................................................... U 0. 4 ;L4 at...... �6 . .. ...... ...... *** ......... (Street number or lot and block n P4 0. B � 140- 04 04 C0 L Building dimensions are ...... .14 ................. X.�i.11-1.2� ......................... ro 2, Lot dimensions are ...... ............... X ..... .............................. 0 )ht 0 3. Building will be ........................... stories in heig 'o z 4. Number of basements ...................... 5. occupancy of building will be ....... 1; ....................................... 6 Building will be ................... feet from nearm adjoining lot line. ............ . 7. Owner ...................... *"** ....... * ........ *­ ........ ...... ­­* ............. ...... Estimated cost 8. Owners Address ....................................................................................................... . ... Group No . ................................................. 9. Builder ............................................................................................................................ 10. Builder's Address ............................................................ 11. Architect or ;A Life of permit .......... . ........ eng C ... ........................................................... . W-P date .................... I Date .... AX .././ .......... 19 Yes Plans filed: No 0 ........................ Wplicant's Signatu .......... i V;;Cr .. 0 r -,W,; .. agent) Permission is hereby granted to do the work described hereon, according to the approved plans.and specifications pertairung-her L eto, subject to compliance with the ordinances of the City of Edmonds.. This.copy is your receipt for the following fees::- ..................... Estimated c ............................... Group NO." ................................ ........................ Life of perrl Plans filed J h a ;n; . ............... g 1. Building permit fee ............................... ....................... $ ...................................... 2. Sewer permit fee ................ ........................................... ................................... ...................................... $ ............................... 3. Inspection and supervision fee.. 4. Total .......................................................................................................... . .......... . ........ .... . ...... I.R%(iv&�-b 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 $1-00 for each $I000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 5%, applicant agrees to pay an additional fee 3 cost. In such event no use permit shall be issued until such "discrepancy fee" Is paid. of $2.00 for each 111000M of such execs Ired by Whenever a coot are than S1000.00 for which a licensed architect or engineer Is not requ 2. ract for construction is executed for any structure costing m op the decalled of the City of Edmonds. the application for a building permit shall he accompanied by a copy of the contract and a c y of the Building Code specifications. ommencing work. notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estimate Of 3. Prior to employing any labor or c the payroll and make monthly reports of payrolls. Full instrucdons should be obtained from the nearest office of the Department of Labor and Industries. 'Before in turn should obtain release from all sub -contractors. lie relesses should be final payment, the owner should obtain a release from the general contractors who quirements of the State ndustrial Insurance Act. latested by the Department of Labor an Industries. The above procedures are cc with the accom, LICATION is hereby made for a permit to construct the following work, in accordance APP plans and specifications. Two sets are submitted herewith for approval. panying Off,st. new alter ...................... Parking Work addn repair zone ...... .......... Fire zone ...... .................. :r ....... Const. type ......... -V� .............. Use Occupancy ;.5 ....... Add .............. Lot.�51 Address ......... ...... septic tank .. AU-0-4A' ................ ............... 4 . . . . . . . . . . . . . . . . . . Lfrontage .......... .............. Aff ea .......................... ot ..... rear ....... ..... ........ 7 ... 7 . ............ 1. side. -backs .......... Bldg. set f t. r. side... e ............. . Tel. No-Z:7- Address .... . //.� ........ ...... ............... owner .. aPI - �- Tel. No .............................. ...... Address ....................................................