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- MNra
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines ;
0
C .
1, ,
U..
PERMIT / I U J I I
NUMBER
rLsgT `3e, . "Z .
3EET SETBACK
IREAR YARD SETBACK
O
r AREA
VACANT SITE
` f
I ❑ YES )4NO
VARIANCE MHER
/-AREA
EXISTING STREET R/W ...........FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
ADDRESS CZ
5k In
CITY TELEPHONE NUMBER
s L�ANon woo cL 1-7-7 6.5 - 8835
or
PERC. TEST
PERMIT NUMBER
I
-
O
REMARKS
.i
FIRE Z TYPE OF CONSTRUCTION STREET IMPROV:
-
I❑YES [:I NO
-
BPEOIAL INSPECTOR ttEOPiTRET r nnnrTDt u..v .......,
RESIDENTIAL
CI
GAS
LINE
❑ YES
FLAN
.,
NEW
CHECKEI
ADD
NON-RESIDENTIAL
f
SIGN
DEMOLISH
RETAINING
WALL
REMARKS
ALTER
EXCAVATE
FENCE
OR FILL
❑
)
REPAIR PRE - swim
❑
IN PMO�
POOL
QLGy
NUMBER OF STORIES
7D
I DWIN ELLLLGG
UNITS
z
Plan Check No ..................
BUILDING
I
PROPOSED USE
PLUMBING
a
E
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
Ni
ISWIMMING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In.
TOTAL AMOUNT DUE
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
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
TWS PERMIT
relatlag to Workmen's Compensation Insurance.
AUTBOBIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TBE
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORN NOTED
pleted In six months.)
SIONATU (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
R7
OITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
This Permit coven work to be done on private property ONLY.
PR 6-1107
Any coustruction on the publto domain (curbs, sidewalks, driveways,
marquees, ate.) wilt require separate paralsslon.
THIS SITE IS LOCATED IN THE
TAX SHOULD BE
7,
&C�' 1.04,
�x7?_-x10
Fee
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.
FILE
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Or.1 Date.Pasae�
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`- CITY OF EDA► rlz WASHINGTON — DEPARTMEI OF BUILDINGS
BUILDING PERMIT
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate a
the intention to fulfill all requirements of this code are attached hereto. A °qq
Application is hereby made for permit to do the following work: a 6 U
o LEI o .5
%.�5'�:..'.......................................................................... ` °'
............ ............................................................ t ro E i
......................................................................................................................................... ye. _ ate.
............................................................................................................................................... �aa a
............................................................................................................................................... q d o o
Cn
............................................................................................... S is ° V.
a1 *t 0
.............. .................. .�
jf �o0
at...... T 'C'lii� +r/ •.•..................................................._......... d N 2 o N 'w
.••-•-••.---•••---••- (Street number or lot and block numbers)
4-. •-+ N M
8 o p,
1. Building. dimensions are... x... ..r......................... a Eg W a
,<°wb
2. Lot dimensions are .......1..?%v.............. x.......... a..!? ........................... .t3 •5., zn ] � 1
3. Building will be.........................stories in height. °q o9 0l
4. Number of basements ........ .............. /1 , 4- z
S. Occupancy of buildi will be .... ...... tJ..........................................................
6. Building "4k-
f et from nearest adjo{'I1ing I line.
7. Owner....... µ !� .Lf .. Estimated cost $ ' P O 0
8. Owners Address. ... .....�i(1 .,w. l,/1.....................................
9. Builder.......... rn .4............................................................_..................... Group No.... .
10. Builders Address ............................................................................................................
11. Architect or en ineer......................................••••••........................................................ Life of permit J! date
Date..- / -l•/- ..h.. y....19..
•' /
Applicant's Signatu ......... ........... .......... Plans filed: Yea o ❑ '
(Owner or his agent)
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:
c� O
1. Building permit fee ....................................................... $.Cp. .......................
2. Sewer permit fee ......................................... ............ _..... $ ......................................
3. Inspection and supervision fee ....................................... $ ...................................... 00
4. Total $ ... .._ ...............................
Recefl by i1
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 $i 00 for each
$IOoo.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated cost by mote than 351b, applicant agrees to pay all 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 tonstructlon 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. detailed:�.�.'�
specifications.
3. Prior to employing any labor. or commencing work, notify the. Industrial Insurance DivLIon 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
boat_ payment, the owner should obtain a release from the general contractors who in turn should obtain release from all'sub-eonuactors. - The release should ba
attened by the Department of Libor and Industries. The above procedures are requirements of the State_;Industrial Insurance Act.
i
1 li J.
K
9
CITY OF EDMON; WASHINGTON - DEPARTMENuF 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:
u....% .......
..15� ...........................................................
at ...rC:T^�� .1............L..(..!!..!. ...............................
(Street number or lot and block numb,e,rs)
1. Building dimensions are.,t2Q...................... x-.!;; , .s�.........................
2. Lot dimensions are.................................x..............................................
3. Building will be ........I ...............stories in height.
4. Number of basements ..................................
S Occupancy of buildin will be ............................. _..................................
6. Building will b .../.. feet from nearest adjoining lot line.
7. Owner...... :.
8. Owners Address ............. `.`:s�l.L?'•-_•............................................
9. Builder.......................................................:.................................................
10. Builders Address.......................................................................................
11. Arc 'tect or engineer...................................................... .......................
Dat....e.......... .I..........4 ... 19.1�..
Applicant's Signature.... 1........... ...... ...
9oJq
o .
a5�
U
a.
20
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Iry
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e i �
1 f r 0
i to
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.t 04 : 3
tV en
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P.
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.................... Estimated cost $....4l1.d .�—
...........
.................... Group No......................................
Life of permit .....................
date
Plans filed: Yea .0 No B_
Permission is hereby granted to do the work described hereon, according to the approved plans and specifications pertaining hereto,
subject to compliance with the ordinances of the City of Edmonds. This copy is your receipt for the following fees:
1. Building permit fee ....................................................... �..`.:::��...............
2. Sewer permit fee............................................................$ ......................................
3. Inspection and supervision fee ........................................ $ ......................................
4. Total.........................................................................................................._.........._........ $.. .............................
(Owner or his agent)
PERMIT N4 487
(Issuing Officer)
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 $1.00 for each
$I000.00 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. Ice 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 $1000.00 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 detailed
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. 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
attested by the Department of Labor and Industries. The above procedures are requirements of the State Industrial Insurance Act:
it4ftz!'ts Nfrn '' ` ' ` ttS S TM{1
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" AP �N & WORK ,
.1 PERMII Application No.
CITY OF EDMONDS Building Department Permit Limit, One Year '
.' APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
1
/ ....C�4,��.�1 .r!......................... Ground Area........ No. Stories
WORK —New/Addn.......�.,C1.....L� ��
Y ; ............ Hei ht.... ... f
r
Plana Submitted Const. TYPe... ,,, �—�— ... g
4'l { Addresa LOCATION — ..���...��... r�••••••••••..
Use Zone../../...C........ Fire Zone.....
...rFrT...r<.•c..Sewerage- ,
r' J
Recorded Lot .... l. .......... B1ock....L�.......... Add'n...,��� .. ._.................
t
I 1a,
. /
... (�
". ��........�.- Sides. � I ,
Lot Area ...............X......�............ Widtls.....�.L?............. Min. ldg. Setbacks, Front and Rear... ....... ........ » t.J
!c !
Owner...^'�f.:C`JCa Address..% ............................... Phone..,<1 .. O/U/
.............. Ad ...................................... ......... ....... hone....... ....... ..... {
Plans by: ..... ............................................................... dress..
" qX" u .�<`` i Bldg. by...... f...!'.1.�2 f•.. ............................................ Address.......................•......................................... Phone.. !
4.. 7.
Plbg. by......................................................................... ..... Addresa.............................. Phone.. ..
`1 4, = Heating by. ..... Address ....................................................... ........ ......». .
............................................................ Phone .
f1,t i a�
...................... Address................... .......... Phone................................
Elect. by... ... ..... ..... ..................................................
t � �
Remarks ........................................................................................................... .... i
.... ............ ....
_ ........................................................................................ ........ 1
I I ' .......................». ........»e ... 'S
}
......... ....... ................................................................................................................................................. ....... ...... ........
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work. }
I. .-. 1�.+�1.t<i? .v.... Address ..... �.��....I&L�i.ZQ.L.1�fUtl................ Date...L....»
l•
Signed: Owner/Agent ........
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
rrVALUATION PERMIT FEES {{
$... T//.......................... Bldg. .... $.................................. j
JJ�
Plbg. ....$...................................... ,
APPROVED: Heat ....$........................................
A/ Elect. .... $..............................
Date.. ....... 1... ....!!....................................
BUILDING DEP TM T Others ... $............... . j =
{
Wm. Herbert eP• TOTAL FEE �.......�.........
By................................................................................
$...............
fi