690082.pdfBUILDING
DEPARTMENT
PERMIT
APPLICATION
NAME (OR NAME OF BUSINESS)
Hu eAM-M
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MAILING ADDREBS
57
CITY
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174A
Applicant FBI
inside Heavy Lines
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Legal Description oAr&FYi�51101Y Below or Attach Four Copies)
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NEW
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NON-RESIDENTIAL
SIGN
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RETAINING
WALT.
ElDEMOLISH
ElALTER
EXCAVATE
FENCE
Fl
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..... ....
SWIM
POOL
rUMBER OF STORIES
NUMBER OF
DWELLINh
UNITS
,L MAP NO.: PERMIT
e I NUMBER
e.2,
3ACK STREET SETBACh
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690082
VACANT
[3 YES
I
I I
USTING STREET R/W .......... XT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........ .. XT. ............ 17T. —
yw4VU
[] YES
Plan Check No .....................
PROPOSED USE
BUILDING
R�"dleata
Bullding setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
41)
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
iztd agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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 Innuranee.
AUTHORIZES
NOTE: Permit Umit One Year (Except DE151OLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
lIGNATURE (OWNER OR/7ENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fce
PR 6-1107
This permit covers work to be done on privnto property ONLY.
Amy construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
C] YES
Fee
PAI
No.
I 6�7,& 0 W 91fa
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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RECORD OF INSPECTION9.
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it
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Furnace & Fuel Lines.
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Final
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RECORD OF INSPECTION&
Date: Passed':
Drainage
Sewer
Parking
Landscaping
Fire Dept, lit
tr I I'LL- L-' L
CITY OF EDMONDSs WASHINGTON
BUILDING PERMI T
bicant. hereby certifies that a plot, plan, drawings, and sufficient details to indicate
'"'ji6n to fulfill all requirements of this code are attached hereto.
Ig:,hereby made for permit to do the following work:
. ...... ............... ....................................................................................
.. .........
...........
...... 1) ...........................................................
................. ................................................................. . .......... . .........
. .... . .......... . .... . ................ . .... . .... . ...... . .. . ...... . .........
........... . .......... . ....
.... . .................................. . ........................ . . .....................
---- - -- - -----
................ / ............................ Block..... / ................. : .............
.......... * ........... *** .............. . .................... . .... . . .... . ...... . .... . .... . .........
.................................................................................................................
-------------------- _.0 ....... . ...................... . .... . ...... . .. . . .... . .........
... ............. . . . .
......... . .
..../ . .......... .............. V
ding dimensions X ..... ...................
2. Lot dimensions ........... ..............
Building will be .......... ........... stories.
4. Basement ........................
5. Occupa cy of building will be ......... ...............................
* ' line.
6. rom tbe)nearest ad oi 9
L�ee f
............. ................................
71. C ........
8. Owner's Address ....... ........ ... . .. . ............. . . ........ . .......... . ...
9. Builder .........................
--------- -
........................... *** -------------
10. Builder's Address ....................... .................. ........ * ..........
..........
................ 19.j5�7
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? 877
I Estimated cost $Zg,,� I
Life of permit ...............
..... ......
date
Plans filed: Yes t3/No 0
$ ...... ...............................
Received by
(Issuing Officer)
Department of Buildings
City of Edmonds
1. no 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
Sl000.00 of cost. If the actual cost of the structure. when finally determined, exceeds the estimated cost by more than 5v/0, applicant agrees to pay an 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 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 to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving in esdmateof
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 releases should be
nctested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.