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POSTED ON KROLL YAP NO.:
PERMIT
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BUILDING DEPARTMENT
Applicant Fin
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PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK STREET SETBACK
REAR YARD SETBACK
MAIL( O ADDRESS
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USE ZONE LOT AREA
VACANT SITE
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TELEPHONENUMBER
❑ YES ❑ NO
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HEIGHT HUILDIN6 AREA
VARIANCE NUMBER
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NAME'
PLOT PLAN APPROVED
ADDRESS
4`w
STREET R/W
`r'47
N UMBER
EXISTING STREET R ............FT.
DEFICIENCY THIS PROPERTY
CITY
TELEPHONE
COMP. PLAN ST. R/W ............FT.
............FT. p
REMARKS
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NAME
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ADDRESS
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CHECKED BY
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CITY
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TEM91PRONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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TYPE CONNECTION (VERIFIED BY
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PERO. TEST ( PERMIT NUMBER
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41 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVJ
d I I ❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
❑❑ GAS ❑ YES ❑ NO
RESIDENTIAL LINE PLAN CHECKED BY
❑ NEW ...�
❑ NON-RESIDENTIAL ❑ SHIN THIS SITE 15 LOC ATl f? IN THE .._. - - . LOOAI- SALES
- ❑ ADD RETAINING REMARKS
❑ DEMOLISH ❑ WALL TAX SHOULD Be CODED Sl,d4.
❑FENCE
ALTER ❑ ORFILL
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❑ REPAIR n IN P. n SWIL
DWELLING
UNITS
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Plan Check No ..... ..............
BUILDING
PLUMBING if
HEAT A GAS GAS LINE
FENCE
SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
Fee 1 Receipt No.
TOTAL AMOUNT DUE f _)
I hereby acknowledge that I have read this application; that the In- L Y/ "J
formation given to correct; and that I am the owner, or the duly autho:r-
Ized agent of the owner. I agree to comply with city and state laws regu. ATTENTION APPLICATION APPROVAL
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 This application is not a permit until
relating to Worltmen's Compensation Insurance. AUTHOIgIZEB i
o1vLY TsE signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINOS shall be com- knowledged in space provided.
pleted In mix¢onths.)
NOTE, Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) NW require separate permission.
INSPECTION D OR'S BID U
DEPARTMENT
CITY OF DATE
EDMONDS
PR 6-IIe7 1
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CITY OF EDMONDSa WASHINGTO
BUILDING PERMIT
t f 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.
y. Application is hereby made for permit to do the following work:
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.................. ........................................................................................................................................... _....... , u•-w
`!y � ......................................................... ...... ............... »................................... .............
Lot........................................................ Block........................................................................
wri"11
...................... ...... .................. ...... ...... ...... .................. ...... „................. .............................
1. Building dimensions ........... :Q2f.... �......x.... f ................
2. Lot dimensions .................../..e..... x..... ...............
3. Building will be ........................stories.
4. Basement ........................
S. Occupan.0 building will be..............................:...............................
(. .............tom... . f frvg1 the ne adjoi ' g line.,
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7. Owner...,..:......'...�'......................
8. Owner's Address..... 1....1.......l��..—.............. ......................................
9. Builder....:........................_._......__.........................
10. Builders Address......................................................................................_..................:
(Owner or his agent)
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. i
f.
PERMIT N° 884
Estimated cost $.-z3 .......
Life of permit.......... ........
duc
Plans filed: Yes 1�No ❑
$.. ... ............
Re i ed
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..._...
(Issuing Officer)
Department of uildings
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
$1000.00 of tort. If the actual cost of the structure, when finally determined, exceeds the estimated cost -by more than S%, applicant agrees to pay to additional fee y
of $2.00 for each $1000.00 of such excess cost. i.
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 contras and a copy of the detailed
specifications. ,
3. Prior to employing any labor or commencing work, notify the Industrial Insurance Division of the Departent of Labor and Industries, giving an estimate of
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the payroll and make monthly reports of payroll. 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 release from all sub -contractors. The releases should be
xsested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.