690239.pdfC'
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines -FO-13
NAME (OR NAME OF BUSINESS)
I d BID
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Mr'II1fNG ADDREMI
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CITY TELEPHONE NUMBER
17AME
ADDRESS
7701
EX
CITY TELEPHONE NUMBER
NAME
94
79DRESS
CITY
TELEPHONE NUMBEIt
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description Of Property (Show Below or Attach Four copies)
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A 6 It el *V1
ES —RESIDENTIAL El =E
NEW
I
D NON-RESIDENTIALJ 11 SIGN
DA"" RETAINING
F� Ej WAI�L
DEMOLISH
ALTER EXCAVATE PENCE
El OR FILL
REPAIR PRE -MOVE SWIM
M INSP. POOL
ES
NUM13ER OF
DWELLING
UNITS
—NATURE 094WO-RK TO BE DONE
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—
PROPOSED USE
Building streets)
PLOT PLAN (Indicate setbacks, abutting
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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-
lzed agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation or the Labor Code of the State of Washington
relating to Workmen'm Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shoal be completed in ninety days; MOVEDAN BUILDINGS shall be oom.
pleted In six months.)
ITI—ONXTURE (OWNER Olt AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This permat covers work to be done on private Property ONLY.
Any oonstruction on the public domain (curb:, sidewalkst drivewayBp
marquess, etc.) win require separate permIsslon.
ADDRESS :2 /.�/,
0 YARD SETBACK
ONE
— ti
P No.: PERMIT
1 NUMBER
STREET SETBACK REAR YARD BiETBACK
/S I 12Z
1 LOT AREA
1 [3 YES
M I ��CE Nub
i _F —1
B NG STREET R/W ........... FT- DEFICIENCY THIS PROPERTY
*MP. PLAN ST. R/W ....... ... XT.
OF
YES [] NO
Ilan Check No ............
I El YES 13 NO
Valuation I Fee
No.
IUILDING
ILUMBING
1EAT & GAS LINE
PENCE
0
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
c=;7 60
ATTENTION
APPLICATION APPROVAL
THIS PER31IT
This application is not a permit until
AUTHORIZES
signed by the Building official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
DIRECTORIIJ —b!
DEPARTMENT
CITY OF
EDMONDS
C:;�
PR 6.1101
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CITY OF EDMONDS, WASHINGTON
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate This Space Is For
the intention to fulfill all requirements of this code are attached hereto. City Inspector Only
Application is hereby made Zrfor ermit. two do...the following work:
... . ....................................... ......................
.. .... . ..
. .........
...... . . ........... ... ......................................... ... ...... 0..
..........
.............................................................. .......................................................... . .... . .... . ...
....................................................................................................................................
............................................................................................................................... ..... . . ....
Lot....................................................... Block .................................................. "'-
........... . ...................................................................................... . . .. . . .... . .. . . ... .....
....................... . .......... . ................................................................ . .. . . .. . .... . . ... . z
.... . .... . ... . .. . . .........
. .... . .........
........... . ..................
1. Building dimensions ....... LU ................. X ...... I L . . . ..........
2. Lot dimensions ..... 46-0 ............. . ...... 9-�--7 .........
3. Building will be .............. / ....... stories.
4. Basement ........................
5. Occupancy of building will be...14/16�-, .... . ........... . .........................
6 . ........................ feet from thenearest ad' * *ig line.
7. Owner ........... 7. �-- - .. . ... . .... ... ...... . .....................................................
8. Owner's Address ...................... .. .... ... . . . ...................................... . .......... . ...
- I ... . ...... ... .... ..........
9. Builder .......... 02 .1&::� ..... ........ . .....................
10. Builder's Address ........... ... ..... r ... ...... .................
Date ..........
..... ....................
......... .
or
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications pertairting hereto,
subject to compliance with the ordinances of the City of Edmonds.
PERMIT N9 716
Estimated cost .........
............
Life of ........
date
Plans filed: Yes P--�No
0-110
$ ... a ... L-:-� .......
.................
Re
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........ . .
...............................
(Issuing Officer)
Department of Buildings
City of Edmonds
1. The building permit fee which applicant pays when permit is Issued shall he based on estimated case 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 the estimated cost by more than 50/c, 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 at 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 an estimate of
the payroll and make monthly reports of payrolls. Pull instructions should be obtained from Elie 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
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
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