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CITY OF EDM�rIDSa VlIASHINGTON — DEPARTMT OF BUILDINGS
{ �r
3 BUILDING PERMIT'``'
:
t .pt� catit`hereby certifies that a plot, plan, drawings, and sufficient details to indicate i
tendon to fulfill all requirements of this code are attached hereto. °qq s
oIi is hereby made for permit to do he following work: a °i o f543
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.I --__••_•...•- --_•_••_-_.•••_-•••__•••-_......•..... • ••••.••••• • ••.•••••.•.•••_ ••_...••••• •'•. ' t A 5
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94 •
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�N� •N� ", ,Il
(Street number or lot and block numbers) ` ,.`e., W }
4-. M
r / 1:. Building dimensions are..............4L.........x.........-..:�!.............. y A W a W
� / 0 w.'b
2. Lot dimensions are...........f?..ez......x.............. G .:,d_...._......... 5'"
3. Building will be...:..........� s cries in height. o O
I
4. Number of basements ................ t....... - - " o z t
S. Occupancy of building. will be . ,'_r:,:.. c '1:::: f'............................................
6. Building will be .....`.........feet from nearest adjoining lot line.
7. Owner -.............
Jj t - G, t.::.............. Estimated cost $ i
....................................................
........_ . _.....
-Owners Address ....... ...................... .
9. Builder .......................... ,.....
/ ......... Group No.......
10: Builder's Address ..........•......................................................................................
11. Architect or engineer ..........................................................._........_............................. 'v
Life of permit. .....of...d ......... �
date
f ...
d
Date .......1.: -...:-��...................19.
Applicant's Signature...... �G!U::��.'.':�.`.':�:..1 �..; � Plans filed: Yes No ❑
(Owner or his agent)
c
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: #
,
1. Building permit fee ....................................................... $ .................. `.......
2. Sewer permit fee............................................................$ ......................................
3. Inspection and supervision fee ........................................ $ ...................................... .-- d CV
4. Total...................................................................................................._...._...._...... $....._✓�.....
Received by
PERMIT (Issuing Ufficer> ........... '
N° 332 Departm of Buildings t
City of dmonds ; 1
,The building permit fee which applicant pays when permit Is issued shall be band on estimated con of the proposed structure, at the rate of =1.00 for each
of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by more than 3%a, applicant agrees to pay an additional fee'
.'.J for each $1000.00 of such excess con. In such event no use permit shall be Issued until such "discrepancy fee" Is paid.
. 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 br.
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 derailed
specifications. II
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. 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 subcontractors. The, releases should be
uuued by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act.
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bPPLICATION BUILDIM� PERMIT .. ..�
�Rlsy `i`'., tlt � T
r�f y No. i
C �►PPl• �
a3 x2 z c'w
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CRY OF EDMONDS Building Department Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance 'with the accom i
i " a parrying plans and specifications. Twos"" are submitted herewith for approval.
t_1
e V t t
new falter Off-St.� � f
Work addn repair ......................
........... "r..........�:X•' ....... Parking
Occupancy .... Const. type ............................... Use zone. �2..... Fire zone
P Y •• ..........
N r ,
h� .......
Address .... t��. .......... Lot .................Blk :....... .Sddn.. .
4r.. E , ,
Lot frontage. ................ ....-.......... Septic tank .......................
Area ....
Bldg. set -backs — front ... r. side ............................. 1. side.............................. Year....
r r Nrj1, 1 Owner- •.. .. pZvZ 2•.,/ ........ - �'��
..... .. ..... ... ' ..... Address .... ... .... Tel. N . �...
Builde¢�e.a-/ t?TCr.. Addn'e' `�'�!Tel. No .
1` ..
lane
Address........ Tel. No.
µ„ ......................................... Remarks .
..................................- ....
The above is a correct statement, and'I agree to comply with all applicable .Codes and; State laws regulatang'this
work
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Signed Owner/Agent ........:........ ....-._.. .............-_. Address.............................................. Date.l..... ;
,• 1
PERMIT_ for the above work is hereby approved, subject to the above conditions, and to compliance with the ap• ' t
proved plans and specifications, and Building Department notations thereon.
Valuation .:..........�.......... Permit fee... �!..� - Recd. by.
S
Buildmm" Department, By ...........:.: 1" ......................................... Date....:... �.1..... r, ....,�.
I
INSPE
CTION RE
CORD
4
` Fdn, OK :::......... ............ Frame, OK ...... . Final OK ............ ..................::.
This Permit does not cover Plumbing, Sewer or Electrical installations. �
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