700558.pdf0
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME
7 JV elor
-MAILING AVDIVESS
i le
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0 CITY
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14 ADDRESS
A CITY
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s &
STATE LICENSE NUMBER
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Legal Description or 1-r7pe—rt
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Applicant FIR
Inside Heavy Lines
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NEW
RESIDENTIAL
GAS
LINE
NON-R
F
SIGN
0
RETAINING
WALL
DEMOLISH
ALTER
r_1
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
E] REPAIR
F-1
PRE -MOVE
INSP.
SWIla
POOL
NUMBER OF STORIES
NUMBER OF
-e-
DWELLING
UNIT13
_ttv
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT.
(j YES
'<�o
X1
PERMIT
NUMBER
E3 YES 0 NO
DEFICIENCY THIS PROPERTY
[3 YES 13 NO
4
NATURE OF WORK TO BE DONE
An
Valuation
Fee
Receipt No.
&L
rlan Check No .... V .... %,..
BUILDING
5114
Ile
t4�
PROPOSED USE
PLUMBING
PLOT PLAN (IndlFate Build—Ing setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
formation given Is 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.
ATTENTION
APPLICATION APPROVAL
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
TIH8 FERIVUT
This application is not a pernilt until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
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.)
.
BIG (OWNER AGENT) DATE SIGN ED
INSPECTION
DIREC
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1
DEPARTMENT
40-0
2�?
CITY OF
_2
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
r) 0
PH 6-1107
This Permit covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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C
I�ITY OF EDMONDS, WASHINGTON
BUILDING PERMIT,
A plicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
d !e intention to fulfill all requirements of this code are attached hereto.
Application is hereby made for permit to do the following work:
..... ... . ... . ... .
-6 ............................. .. . . .... . ...
. .......... . .........
. . .......
Block..
1. Building dimensions ................................ X ................................
2. Lot dimensions ................................ x .......... ......
3. Building will be ........................ stories.
4. Basement ................. ......
5. Occupancy of building will be .......................................................................................
6. fe from the...ne d'oifung.line,
................................
7. 01 . . ........
8. Owner's Address ........ .... ..... ..... .............................................. . ...................... . ...
9. Builder ....... .. . ....... ... . .. ...
.... . ...................
10. Builder's Address ...........................................................
--------- - -
- L;1
Date.. ............ 19A3
4? .....
z1-
his
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7161 C In r^V
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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.
I
PERMIT NO. 541
Life of permiL ................ dat - a ........
I Plans filed: Yes ID
Re eiv by
(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 S2.00 for each
$1000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by mote than 5%, 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 strucciawcostins more thin $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 pimit 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. 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-contisictors. Ile releases should be
notested.by'the Dep�!!rncnt of Labor and Industries,. rne above' procedures are requirements of die State Indiistrial lusunm�eAcc.i
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