710066.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME �
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MAILING ADDRESS
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CITY
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Applicant Fill
Inside Heavy Lines
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et ADDRESS
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F CITY TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
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NEW
RESIDENTIAL
LINE
®
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
RETAININGI
ALTER
❑
EXCAVATE
OR FILL
FENCE
G........ xFt.)
REPAIR
❑
PRE -swim
INSP.
D
..........
POOL
DWELLING
UNITS
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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-
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 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 Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1, YRE (OWNER OR AOIyNT) 11 I DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
t
ITED ON KROLL MAP NO.: PERMIT %
NUMBER 710066
ADDRESS
YES
G
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
4
W C.
G
❑YES ❑NO
SPECIAL INSPECTOR REQUIREL (OCCUPANCY GROUP
❑ YES *NO � , 2 .
'r-F D 'ry,t
REMARKS t~ eN a('V,r., ` •
Siilea _ , / r. a� O W C1O4�Y
C ' h-l� 1.►T.S'
/STT-4ca�sp .
Plan Check No.
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMINO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
Valuation I Fee
'57- 5_' a a
No.
g- 0 0 1(s9057
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 apace provided.
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„.:.4 ._ f OR BUILDINGS
. E ED, inDSa. WASHIN RON ., DEPARTM
` BUILDING PERMIT N-
scant hereby certifies that alplot, plan, drawings, and sufficient details to indicate 8 o
�tentton to fulfill all requirements of this code are attached hereto.
pp
tion �tf I's(Aereby ma � � permit• to do the f wing work 3
if y ty,
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(Street number or lot aad block numbere),.�,' IL
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1. Building dimensions 'are ........ .......................X..WM v
Lot dimensions are.............1.6...........x...................... ................. — tn i
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3. Building will be ........... ,1....... -..es in he o U r
4. Number of basements ............................ '�a:7! : i5 ..w. z
y.
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5. Occupancy of building be...--.............. .-�-•• ---• ••
< 6. Building will be. :f'KWt From nearest adjoining lot line.
7. Owner. r7..:..�'rw..J ?....:1._:: ...: ............... ` Estimated cost $. /.. �%..... .
........
8. owner's Address...................^i: `'...,•`�..t ..................., _......................
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9. Builder.........................(Gt:.." c ""_. .._.
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y. Builders Address......................_..........................................................._----- ................_. 1
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1. Architect or engin er ........................... Life of permit
date
Date..
Applicant's. Signature ....................................... ...................... e......._......
Plans filed: Yea `❑ No ❑ '
( n or his agmq
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications pertaining hereto, 1
subject to compliance with the ordinances of the City of Edmonds. This copy is your receipt for the following fees:'
}
1. Building permit fee ........................................................ $ ..............
2. Sewer permit fee............................................................$ ...................................... `
3. Inspection and supervision fee ........................................ $ ......................................
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4. Total.........................................................................................................._.........._...... $.....:....._...............
Rec+�* ed bj�,
(Issuing OlEc
PERMIT N° 324 Dfsp ent of Buildings
• Ci f Edmonds
i
1. The building permit fee which applicant pays when permit is issued shall he based on estimated cost of the proposed structure, at the rare of $1.00 for each i
51000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated tort by more than 5%, applicant agrees to pay an addittoaal fee
of $2.00 for each $1000.00 of such excess cost. In such event no use permit shall be issued until such "discrepancy fee" is paid.
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 bj j
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
j
specifications.
t�Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Department of Labor and Industries, giving an estimate of j
'roll and make monthly reports of payrolls. Full instructions should be obtained from the nearest office of the Department of Labor and :Industries. Before t{
e'yment, the owner should obtain a release from the general contractors who in turn should obtain release from all sub -contractors. The ,releases should he
A by the Department of Labor and Industries. The above procedures are requirements of the Stale Industrial Insurance Act. i
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