710109.pdfPOSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Llnes JOB ADDRESS
NAME ( � v �
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STREET B/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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CITY
TELEPHONE NUMBER
REMARKS
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NAME
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ADDRESS
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CHECKED BY
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TELEPHONE NUMBER
METER SIZE I BERVICII BIZID I CLEARANCE
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STATE LICENSE NUMBER 4
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CITY LICENSE NUMBER
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REMARKS
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Legal Description of Property (Show Below or lAttach Four Copies)
TYPE CONNECTION
I VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
FIREZTYPECONSTRUCTION STREET IMPROVED O�CI� IYE
NEW
RESIDENTIAL
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
❑
❑
ALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
(xFt.)
REPAIR
El
PRE -MOVE
INSP.
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swim
POOL
QUMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
XATURE OF WORK TO BE DONE
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PROPOSED USE I
a PLOT PLAN (Indicate Bulldlt
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Plan Check No .....................
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BUILDING
PLUMBING
HEAT do GAS LINE
FENCE
N
ISWIMMING
SIGN
RETAINING WALL
POOL
DEMOLITION
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-
Ized agent of the owner. I agree to comply with city Ind 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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
RON R (OWN:L"T)
DATE SIGNED
INSPECTION
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DEPARTMENT
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CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR g-1107
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.
Valuation
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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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CITY OF EDMONDSs WASHINGT N i
BUILDING PERMIT
^ , Applicant hereby certifies that a plot, plan, drawings, rind sufficient details to indicate This Space Is For
the intention to fulfill all requirements of this code are attached hereto,
City Inspector Only
Applicat/i..on.is hereby made for permit to do the following work:
r r �u i= ' ...�QnS.Y.. .F.�t�t�'�4...�rGs'�Xr .. .• •......•'ts0............... ........... _.........
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i t Lots :...�. j..±-i�Z + �l� .... Block ............... ......b
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.......................... /�•—� Icy/,// 3r
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_ _.............._..__ __ ___...._...._...... 7
_1� �5.....i.l e... f.... _.......... _......___ - ....._.... _..__.......'
..._.. r..... O...Cg?.. ..................
1. Building dimensionsJAC?....................x.-7.._.......��-
a�3 2. Lot dimensions .. Sv&. ..�...- .
3. Building will be .......stories.
4. Basement ......
5. Occupancy of building will be........... ............................. ...........
6......................... feet from the nearest adjoining line.
7. Owner.. .tri...r.............................................................
8. Owner's Address ...M . ...... .G-u' .R_:'�!-1-"ems ....-�.Ft .Cn_... ►,
9. Builder...............................................................--....................................._.....................
10. Builder's Address ..... :......................................................................................................
. . ......... ..
......4.........6 er orMge.
Permission�is
hereby granted to do the woik described hereon, according to the approved plans and specifications pertaining hereto,
subject to compliance with the ordinances of the City of Edmonds.
PERMIT N? 694
Estimated cost
Life of permitfo...I.LS.AQ-G.....
date
Plans filed: Yes O No ❑
': 33 / Z/- /
$•.61c).. � ._.......
(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 $2.00 for each
S100o.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than i%, 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 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 reloase-from all sub -contractors. The releases should be
arrested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
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