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BUILDING DEPARTMENT Applicant trill
PERMIT APPLICATION Inside Heavy Lines
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70 41 /6 6'L' ST d • / • U8E ZONE ry
I TELEPHONE UMBER e -S �' Q'
or
GAS
LINE
ElRESIDENTIAL
NEW
❑
NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
❑
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE�^
(:A...-z.......�F't.)
❑ REPAIR
PRE -MOVE
INSP.
swim
POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and otato 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 alndays; MOVED -IN BUILDINGS shall be com-
oleted In six months.) r ejy
Ir('%i/'1
NOTE: Applicant Subject to Flan Cbeck Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pabUo domain (curbs, sidewalks, driveways,
marquees, eta) win require separate permission.
'MAP NO.: PERMIT
I NUMBER 7 104r.0
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES [] NO
Plan Check No.
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMIN3 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
YES ❑ NO
DEFICIENCY THIS PROPERTY
YES ❑ NO
THIS SITE IS LOCATED IN -
ITY nF EDMO lnc I GGA� o
cvo, ,c a
TAX SHOULD BE CODED 31
Fee I Receipt No.
TOTAL AMOUNT DUE
I
ATTENTION APPLICATION APPROVAL
THIS PEnMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
Y THE
WORE NOTED uty; and fees are paid, and receipt is ac-
OR
lsnowledged in space provided.
INSPECTION DIREVPRIB 8I TU
DEPARTMENT �
CtrLcG i�. vl-U� .
CITY OF DATE
EDMONDS �•
Pn 6-1107 7 — /
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CITY OF EDNIONDSs WASHINGTON
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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.
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Aaalication is hereby made for permit to do the following work:
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Lot....................:.................................. Block ....... _...............................................................
1. Building dimensions ................................ x..................
2. Lot dimensions ................................ x..........................
.
3. Building will be ........................stories.
4. Basement .............I........
5. Occupancy of building will be ...................................
6....... l.&.1....... fegl from the ne est "dning line.
oe
7. Owner .............. ............. ....
8. Owners Add / ? / l ."..,�V. .^
9. Builder ........................... ' ..........
10. Builder's Address............ .........
................................................
Date ................... 6�........... 19.
(Owner or his agent)
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This Space Is For
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.
PERMIT N9 •
26
Estimated cost $.. .......
Life of permit ....... /-...�7Z`�'"
date
Plans filed: Yes No ❑
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5...../...±/...........
Re/SgyV e��
(Irsuln Office)
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
Sio00.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than Wo, applicant agrees to pay an additional fee
of $2.00 fur 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 detalled
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. Pull 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 contactors who in turn should obtain release from all sub -contractors. The releases should be
Retested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.