710300.pdf9, .,
BUILDING DEPARTMENT Applicant011
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
8
I
Do — C;
3'5 0'1, 0 G.a/•)'7 0n L/ s
A Y
NEW
RESIDENTIAL
GAS
LINE
ADD
❑
NON-RESIDENTIAL
SIGN
RETAINING
❑
DEMOLISH
❑
WALL
ALTER
EXAVATEl ORC
CFILL E
CE
(�...N...xFt.)
..........
REPAIR
—1
I l
PRE -MOVE
INSP.
�''j
I `
SWIM
POOL
DWELLING
UNITS
_6
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES NO
/C- $ (7 — /.0 • — / /
Plan Check No .....................
BUILDING
PROPOSED USE
PLUMBING
HEAT A GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
ISWIMMING
•
PENCE
SIGN
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 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 laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale 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.)
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
PERMIT
NUMBER
�V
mew.•rx,n5viyeasc+xaw®6�wtinXNN'tl.V
71 O. i
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
THIS SITE IS LOCATED
TAX SHOULD BE CODED 31.04.
Valuation
APPLICATION APPROVAL
`I
This application is not a permit until 1
signed by the Building Official or hie Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided
(ATU (E AOE DATE SIGNED INSPECTION DIREC OA'B SIGNATURE
n DEPARTMENT
+� /� CITY OF
EDMONDS D
NOTE: Applicant Subject to Plan Check Fee — a�-
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate perm158108-
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CITY OF EDMa"W , WASHINGTON — DEPARTM t "�OF BUILDINGS
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate
the intention to fulfill all requirements of this code are attached hereto.
Application is hereby made for permit to do the following work:
(Strat uumbrsr or lot and block numbers)
1. Building dimensions are .................................. x.......................................
2. Lot dimensions are. ................................. X ..............................................
3. Building will be ...........................stories in height.
4. Number of basements. .................................
S. Occupancy of building will be......................................................................................
6. Building wi�llr pbe►......5,,........f� from nearest adjoining lot line.
7. Owner .-••--•i5�/e-•-.-....*--•--- .............................................................
8. Owners Address. ...........................................................................................................
9. Builder.............................................................................................................................
10. Builders Address............................................................................................................
11. Architect or engineer .......................
(Owner or his agent)
Estimated cost $....Z.....�.D..�............
Group No.
Life of permit ...........................................
date
Plans filed: Yes r No'p
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. This copy is your receipt for the following fees:
b�
1. Building permit fee ....................................................... $....`..........................
2. Sewer permit fee............................................................$ ......................................
3. Inspection and supervision
4. Total ..................................
PERMIT N° _ 413
Received by
.............................................................
(Issuing Officer)
Department of Buildings I
City of Edmonds
1. The building permit fee which applicant pays when permit Is issued shall be bated on estimated cost of the proposed structure, at the rate of $1.00 for each
$1000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 5%. applicant agrees to pay an additional 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.b0 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 Itisuiance Division of the Department of Labor and-Iudustries, giving as estimate of
the payroll and make monthly reports of payrolls.'' Full instructions should be obtained from the nearest office of the Depaitmetit 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 subcontractors. The releases should. be
guested by the Department of Labor and Industries. The above procedures ere requirements of the State Industrial Insurance Act.
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