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i BUILDING DEPARTMENT I ApplicantF'l11
` PERMIT APPLICATION Inside Heavy Lines
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RESIDENTIAL
NEW
NON-RESIDENTIAL
ADD ❑DEMOLISH
ALTER ElROFII EXCAVATE
REPAIR PRE -MOVE
INSP.
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
S
GAS
LINE
SIGN
RETAINING
WALL
❑FENCE
(.........s......... Ft. )
j�
SWIM
I {
POOL
NO.I IPERM
NUMBIER 7 105119
3 0 - k . , . -
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
3�/4- 1 3-
YES ❑ NO
Plan Check No .................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
tRETAINING
N
iSWIMMING
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.
iced agent of the owner. I agree to comply with city and state laws regu- ATTENTION
lating construction; and In doing the work authorised thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workman's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BDLLDINOS shall be com-
pleted In six months)
A (OWNER OR AGE T) DATE a ONE D INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Su )ect to Plan Check Fee
_ Pa s•uo7
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, aldewalks, drlvawaye,
marquees, etc.) wW require separate peradssien.
YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ No
0
,
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 EDMONDSa WASHINGTO
t�,4a.7rni
BUILDING PERMIT
! A r>>
t rl 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:
rF,l•r... r - ............L..........................„.......................-....-......_.........._.........
......:........:-$.:h4B9Rs.; ..... .................-.:....:..................._.........._.........
. At o................................................................... _......
be. south••100feet„of the north 220 feet Of ...
Y.
east 376 feet of tract l2 u et Sound Machinery
_.... . P g
Depot rive acre trac according to plat {hereof
Lot ............. . ............
"47;
re ords...o f.........
ire(:(ii�deii....�o2'iitde"5 o�ck
liIAU p page
,u,°i
Snohvmiair•CvuYrty; ••State•-vf-Wasiringtvn" : •9�abjerct �tv.........
- •.._•easement... •lastrMwit•-
......datiil.3eptambar..13., .1937,.. rec:oxdad.Aat..1
.1Q37. uol.:.
at.:..„..... .-..... � .�Ys►P of deeds.. Pa
. 100..„0 .... ic.- Ye •,
i!
.. . ................... ..........................._................. .ice..
1. Building dimensions ........ 57!.6!!............ x...... W4!.61!..............
2. Lot. dimensions ........3$fi.Q! :.-.::....x ...-..10U...............
3. Building will be ........1.......::....stories.
4. ,Basement ..Yes ..............
5. Occupancy of building will be ................ nwaer-_.......................................................
6. ........ U.16 �.... feet from the nearest adjoining line.
7. Owner..;.: ...............�rY)8y.....................................................
t
8. Owners Add ...Edman All toll ................
. ....... - .......... _...
9.: Builder ..... .... .... . ...: /��..1
.. .. ... ... . ... ... . ............ _.... _.......... -....
10. Builders Address ............
..............................................................................
Date ..... dune. 22.....................195 i....
I
(Owner or
Permission is hereby granted to do the work described hereon, accordf
subject to compliance with the ordinances of the City of Edmonds.
PERMIT N?
Estimated cost
Life of permit.../ t
Gate
asrning officer) is
Plans filed: Yea No ❑ Department'of Buildings
City of Edmonds
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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 1
$1000.00 of cost. If the actual cost of the`stincture, 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.
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 Euildiog Code of the City of Edmonds, the application for a building permit shall be accompanied by a copy of the contract and &.,copy of the "detailed
Specifications. }
3. Prior to employing any labor or commencing"
work; notify the4ndustrial Insurance Division of the Departmeat of Labor and Industries; giving an estimate of '
the payroll and make monthly reports of payrolls. Full htstritetiotn 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, release from all sub-cotitracton. The releases should be
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act. -
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