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Applicant Fill
Inside Heavy Lines
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ...........X-r.
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
0
DEMOLISH
ALTER.
❑
ORFILLEXCAVATE
CE
(.EN...x......... Ft.)
❑ REPAIR
n
I 1
PRE -MOVE
INSP.
^❑
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POOL
DWELLING
UNITS
NE n
f
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 ownee. I agree to comply with city and state lawn 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': Compensation Insurance.
OT permit One Year (Except DEMOLITIONR which
:ball b comps d In ninety days; MOVED -IN BUILDINGS shall be com•
oleted n six onths
NOTE: Applicant Subject to Platt
This Permit covers work to be done on private property Uru.x.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
710235
YES Q NO
DEFICIENCY THIS PROPERTY
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
0 YES ❑ NO
SPECIAL INSPECTOR REQUIRED
YES NO
IOCCUPANOY GROUP.
PLAN CHECKED BY THIS SITE IS LOCATED IN THE
.ITv nF FnNnnrvns i nr.Al 4A1 F
REMARKS TAX SHOULD BE CODED 31.04.
Plan Check No............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE a,
I I �.n� ICGdl
` .
if
ATTENTION APPLICATION APPROVAL
TIUS PERMIT 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 ex.:
WORK NOTED
knowiedged in space provided.
INSPECTION DI OR'8 I NATU 11 )
DEPARTMENT /J,/ / , /
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CITY OF DATE
EDMONDS
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PH 6-1107
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° CITY OF EDMO:+, WASHINGTON - DEPARTMENT 4P BUILDINGS
'BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate 91019
the intention to fulfill all requirements of this code are attached hereto.
f
q tion is hereb Ir permi o 0 ollowing work: O aI
p ! ..•• ........ ` law
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............................................................ :::::::::::::::::-......-.t
..............................................................................................:.........._........................._...._...
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(Street number or lot and block Dome"
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•--••••....................
1. Building dimensions are ........ x_...? s� ran .r1-.
2. Lot dimensions are ....... lt................
.........stories in height
° ° O
3. Building will be ....... g z
4. Number of basements ......................... [ ;
5. Occupancy of building will be ........, 4r:9 !- C...._. ? -, +,.........................
o�
6. Building ��..... f t fro r joining lot line. cost
1' • Estimated $••�r�� C'•
7. Owner._. .G .... ...........1--_.....-.•....................................
8. Owfler a Address ....... . ........ W.... . o..........._....
ezI • ±R`
Group N
9. Builder .................. -.....- ......- ; 1
10. Builder's Address ...................................................
.............................. Life of permit ........................................`
11. Architect
o�JJrr engm=...............................................
date
Date .............I✓�•.....
.._.. ..........1.. !
,� Plans filed: Yes No []
' ....._.... .__. ..
Applicant's Signatur ...... wrier or t>
• hereto,
rdinpermission is hereby granted to do the work described here
of Edmonds. This. copto the yisyour receipt roved Plans dfor ethe followingegff=:
subject to compliance with the ordinances of the C ty
1. Building permit fee ................................................
2. Sewer permit fee ....................................................
$..... ........................ a
$.. ... ... ......... .....................
3. Inspection and supervision fee .................. �--
$ ...
4. Total _.............................. Receive
C� .. ..... ....
.. .............
(Issuing Officer)
Department of Buildings
PERMIT N° 399 city,gf Edmonds
The building perms applicant agrees to Pay
an additional fee
on
cost of
1.
c tee which applicant pays when permicdis issued e[ermiried� exche eeds theestimatedcostbyby more than
structure, at the rate of adds for each r
$1000.00 of coat. If the actual coat of the strutture, when finally _ +
of $2.00 for each $1000.00 of such excess cost. In such event ao use Permit shall ba Issued until such "discrepancy my fees is paid. r.
Permit sbaB be accompanied by a copy of the contract and a copy of the detailed
2. Whenever a contract for consttuttioa is executed for any structure costing more than $1000.00 for which a 1)amtd architect or engineer is not requireddetailed
by.
the Building Code of the City of Edmonds, the apPliattloa for a building- i
ate of
specifications.
3. Prior m emPtoyinuthl reporttrof pay ollangFullrk, notify iouructionstsh uld bielinsurance obtained fromvthe nearest office of the D partmentof Laborrsand vIndustriing an u�Before
t fro
the:paytoll and make m Y I
final and and
nt. the owner
o! labo�Iarid Industries. the �bave procedure are requirementstof the StaterIntdussstrial insurance Attin all nttots. The releuss should be .
attested by \ �� •_c "� *��
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APPLICAT " N & WORK PERMIT
�_. Application No. 3.141 —,......
CITY OF EDMONDS Building Department Permit Limit, One year
{
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORK —New/Addn. .....n........... QQ
/ \ C/i't d ,i tF t-.......!....0 lZ C 14 ......................6...... Ground Area ................................... No. Stories.:. /..
Plans submittedS KET.C..%.......................�................................................................. Const. Type.AlK0.7F
..�2•../..M�..EHetght....l S
....... s..
y
LOOATION —Addresa..6 Fire Zone..(........................................................
........... Use Zone4"
.Pollock. ... L .i.... Add'n....Sr. ziY...... �..... :0 /Y O ND 5 ..... Sewerage .... ...........................
Recorded Lotf—
Lot Area........... 71.................. Width..C.��............ Min. Bldg. Setbacks, Front and Rear ............................... Sides........... ............
Atowner ...... t �� �e.......� `.,7..... .'.................... Address �........ Phonel '.:. `. G..O� /
...... .................
Plans by .................
_...... .................................................................. Address................................................... .............. Phone ...................... "
Bldg., b y..................................................................................... Address........................................................................ Phone........... ..................... >
Plbg. by ................................................................................ Address ........................................................................ Phone ,
Heatingb ............................ Address..........................................:. .. Phone
Elect. by .................:.... ........................................................ Address ........................................................................ Phone ...............................
1
Remarks .. " k
....... .................................................................................._..................................................... ......... ......
..... ..... ................................................................................................................. ................ ..... ...... ..... .... ..........
..................................................................................................... ..................................................................................................
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
A.
�Z
Signed: Owner/Agent �� :`.:�:........... Address .. ................ -... ....:....... .......... Date...
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with ,the approved plans ' ' r
and specifications and Building Department notations thereon.
VALUATION PERD1'ZT FEES 4 + +
'a `
Plbg. .... $........... .....
yis; t r;
APPROVED: Heat
9�3Date ................................... Elect. .... $ .........................
BUILDING DEPARTMENT Others ... $ ........ ......... i 1
ft., Herbert„ Bldg. Inep.�%�"'"� .3
By...............................................................................�. TOTAL FEE $ ......... i
tm t Cit E tion shall be covered before ins ection and a royal , 4
NOTES: No work requiring Building Depar en or y ngineer s mspec p pp
Twenty-four (24) .hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, p g, driveways, s. sewer, water and street connections.
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EDMC��IDSs WASHINGTON —DEPARTMENT OF BUILDINGS
BUILDING PERMIT
�r Y
t a lot plan, drawings and sufficient details to ind
icate �
'r b' t,'r a' + r� iY p cant hereby certifies that P P 'this code are attached hereto. U
,Ehe`intentton,to fulfill - all requirements of
do the foll6wing work: 4
r a ma e'for permit to O a S
„7iApheation is hereby »....._..
. .: ................... a„ 04 �'}
)0.t'frtt /,.� er'fy lfrF�x (� �, r�,� f'U9'J'.0 •1a�•'Y"1/:.r1:.:.: ! .. ....................................
.....
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0
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... . .............................................»................................... 'b b
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j... ........ ............................... .......... ».....».............. it 0%r GL a a 3 �,
»............... %` ,".................................... a i
. t�» o +� q Xtn�
...:.•"L�......................,>,..». FG •:.L •� Gat.....» • •.....•.. (Sumber or lot and block numbers) p.r rq f• .
H m 40 ►�
• • ........ ........... X•»-.»------ .......»... _.........
• vi '"
1. Building dimensions are-...........
oaX....................... w o
2. Lot dimensions are ........................:.... O
/ sto'es in height. .:g 4. Z
/ 3: Building will be ...........................
4. Number of basements ................................
willbe . ............................
S. Occupancy .�j �i
of building »
will be ...................feet om nearest adjoining lot line. Estimated cost $....� e. 0-C..••»....
6. Building ...........
......................
..............................................
7. Owner ......................................... ... ;•
_Owner s Address........................................................................................................ ,
..._.......................................................................
Group No..................................
. - 9: Builder.................................. ...._ �� o�•i •- r ,
1o. Builder's Address.. Life of permit....................
..................................................................... dam
11. Architect or eer..................... 1
Date ........z! . ......�a ..............19........ r� ' Plans filed: Yes:1 T�' ❑
M~
..-........
Applicant's Signature.........................(owner or his agent)
p hereto, ( .
is our receipt for the following fees:
Permission is hereby granted to do the work described hereon, Edmonds Thisto the copy approy d plans and specifications pertaining
subject to compliance with the ordinances of the City x
1. Building permit fee ............................................... ..
......................................................... ..$........................
2. Sewer permit fee ..........
....$......................................
3. Inspection and supervision fee .............. ....... $... civ/.LReeb
4. Total ...................._-
y
....... . 1*
r
,
(Issuing Officer) `
Department of 'Buildings
City of Edmonds
PERMIT N° 333
when Permit is issued sbaE be r each
bated on estimated coat of the proposed structure, , at the
Pay anfadditional
ddi oonal fee
"^ he bulldfas permit fee which applicant pays
'f cot. if the actual
wcs ofthe structure, Ins cheventlnodusepesmit shall be issuedlun[ildsucht by
fee"�b paid.
r
` r each S of the detailed
ite
7 application for a building permit shall be accompanied by a copy of the contract end a co.�y
'v.:eaeves a contract for construction is executed for any structure cotda6 more than itooapar for which a licensed acconta or and
engineer is not required by
tb� «tding Code of the City of Edmonds, the app
giving m estimate of
the De atmeat of Labor and industries, B Befora
aloes of P industries. .s
Divl and
Insurance Lnb of
specifications. ties! Into of
Pa
3. Prior to employing any labor or commencing work, notify the Indust
the Payton and make monthly reports of payrolls. Full Instructions should be obbe
tained from the nearest office of theallsDepartment
the payment, the owner sit off �bori and release
from the above P sedates are requicements of the Stcontractors who in cufu should aterIndu trial from
Act.radon. a �e �O�d
�,
%tested by the Department
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CITY OP EDMONDS. WASHINGTON � �, ` '
BUILDING PERMIT �•
Applicant hereby certifies that a plot, pinn, dr;lwings, and sullicient d
the jgtetition to fulfill all requirements of this code arc nttacjled hereto.
etails to indicate
APPlicatinn is lierebY made for e
/� �3 P relit to do the following work:
�*•..•,, .... �:(•,t11.1.............(Grp!-�.t.-.i�•.........�,.l.l!1,. j............................................_.........
": �d� .. ........ , .... ..
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Sjil rx...r................................. �....�........
.1j . ..........
r .. �y ....�.............
U ..... .... •
p p �% �.
. ,. ....'{i.K.rK
�. 4w>a � ,rt . �...._... ...._...._..__........
...
,�� .....�.v.:
...
�;g4 �� :- �• >��►aad;ag dimensions � �.........................................._...._..
�.�,� „ 2, �t c�i�nettsiaas t2............ ............ ....................
�.. .../..l..
a= . F �. � kil �i�diu ....x.....• ..CJ...
�"��3 � ��.��F � �. �1s�Gllealt ties. �
�c ,4-. • �- bl. ...... .
�v,F ,�t � � 5 S. Occu ncy of �
17<'"` ,, 6..�...15�.. s ell l M.....�^ .� .....:. ........
�,, ��. , � tee4 tl;:e 1 ....
tad oin' ................
i � • P�Vr�er.... � �. J ulg lltle
' t••� ��'' Addx , e
........
.... .
Q• $ui(�t � ... ... ..
_ .....
...
iQ, $udder's d - ............._.
' A less.. - .......
............. .
.. _.. 'Yn.a�-�-� ...._..
�%J
(owner of his agentl - - � -
k'ermission, is hereby granted. to• do the work dest:ri
subject to coniplianCe with, the Ixd hereon.. accoltlin }
ordinancts of the City of Edmonds. g to the approved. I' S`` �
P ans and specifr'cttions_ �
s; I
�> i
Estimated cost � -t�JO �... � � _ r,
G i
i
Life of Permit:.���.
�ps,
Plans. filed: Yes. L( No [j ..
DePal7,ment of. Birildin ( !
1, a'!tn building. Petmic fee, whf City af'F,diti �`. � ! '� i
S1gQU•Oq of� cost. If th ac �.aPPlic:tn[. PdYs, whrn � � �� ids'
of 32.Oq fot rach.g10Q0,Oq of suc6��roxc fie, stru�ttur, when Prtmic �. issued shtdl. 6n,6 i
fin++lly decerrnin ate. an csumated cost of. the: ro os
2• Whenever a coatran, fot coustrutt a is �.. eaceads. the .•..:...... P p ed: srrn � ,
ooacbymoredtaa;lg'o,,applleant- acrhe�ratr:aFg2,00'for-rarh 1
ehq,Bail�iag.Ctkla of tbn �reutrd.for,aa �:eo
�P4ClfICAttOnS.. Cfty. of Bdmoada,. the, aPPlicttioq fur scruatttr; costittg� mutt, than: $1000.00 for whi Pay a°: addiclonal.fea � �
y ma�monthly �t - aunwan wo .building. Prtmic shall 6r ac�Panied. bl., ��' licensed. or: engiarrr:.Ts, aae.ret�ired• �
3 Pt;Qt w etaploying :tn labor>o , co Py of the
�15 Pa [uL: and toPy-of � ��
lE.. rt4 ao ' aad.� a: �hy: � .
final,paymcnt,.the.ow�aet y,rnlwccs�ofPaymlls•.Ftdt�•' -°�thr.tndustriallaaurance.Divisio
><acstrJ b th .should obwin. a rdeasr, from. thr grnaru(cp�Wd ha: o n of the Depamnmt. of� j
Y, e_Departtaentof.Lahot.andlnd bcatnrd'from-the;nearaG,,atSca;oi�. Lahorand. ;
ustries.., a'he Haan -who ia:�tntnc.shoutd. obi �dO��'•�°1pS�,an.�m.�.,. I .i
attovn procedu<q,.arr-re4uicrmmtaof the Sam�relnae-From at�as�Or��'�fec.._g�,�..
tart. 7adttsrri� �,10[saceArs. rs" aha ��+,ithnold...6e
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