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DING DEPARTMENT Ing�a Applicant
MIT APPLICATION
.. s•;y,,, . (OR NAME OF SUSINEBB)
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DDREBB
P.at ,bow IJ
4. IPCf,-
PERMIT
NUMBER
P 5/
i] YES
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—' EXISTING STREET R/W .... ....... FT. DEFICIENCY THIS PROPERTY
' COMP. PLAN ST. R/w ............FT. ............FT.
REMARKS
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ADDRESS
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CHECKED BY
CITY
TE PHONEI NUMBER
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METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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23-0-iooa51
REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
VERIFIED BY
VERIFIED
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TYPE CONNECTION
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PERC. TEST
PERMIT NUMBER
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(a.
REMARKS
1 A
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FIRE ZONE
TYPE OF CONSTRUCTION STREET IMPROVED
YES i] NO
SPECIAL INSPECTOR REQUIRED OUP
❑ YES *�JQNO
(OCCUPANCY
OAS
❑ RESIDENTIAL ❑
PLAN CREC
BY
THIS SITE IS LOCATED IN THE
❑ ,LINE
NEW
.
®
NON-RESIDENTIAL ❑
SIGN
r
r).Y•1• L SALES
❑ -ADD
❑
DEMOLISH
❑
RETAINING
WALL
REMARKS
TAX SHOULD i;,_c CODED 31.04.
•
ALTER
❑
EXCAVATE
OR FILL
El
PENCE
(FL.)
........ .z.........
❑ REPAIR
❑
PRE -MOVE
INSP.
❑
swim
POOL
DWELLING
UNITS
4
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-
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
will be employed In violation of the Labor Code of the State of Washington
relating to Workman'■ Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
#hall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
plated In six months.)
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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.) will require acparate permission.
Valuation
Plan Check No....
BUILDING
PLUMBING
HEAT d: GAB LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee RecelPt No.
AMOUNT DUE
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14430
TENTION
APPLICATION APPROVAL
rTMAL
DS PERMIT
This application is not a permit until
UTHORIZES
ONLY THE
signed by the Building Official or his Dep-
ORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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AAVID M. CARBON and BEVERLY IARSON, his wife -' , the grantee,
the following described real estate, situated in the County of Snohomish
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State of Washington including any interest therein which. grantor may hereafter acquire; .r.
That portion of the Southeast quarter of Southeast quarter of ; w
Section 23, Township 27 North, Range 3 East, WM,,,described as a>.
sr follows: Beginning at the Northwest corner of Third and Dayton ,
Streets in the City of Edmonds, Snohomish County, Washington, 1A
thence - Northerly along Westerly line of Third Street 10NO;/.V�-�
thence Westerly 119 feet; thence South 44,feet• thenceR�As r �,�..
119 feet to, point of beginning. /O AMOUNT BAIg30 aG' {;f
REC IPT NO.-J.D f
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CITY OF EDMONDSa WASHINGTO
BUILDING PERMIT :{
Applicant hereby certifies that a plot, plan, drawings, and sufficient details to indicate This Space Is For
f the intention to fulfill all requirements of this code are attached hereto. City Inspector Only
Application is hereby made for permit to do the following work:
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Lot.:... ................. Block............................................................... _
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1. Building dimensions :�./. 4':`� ..........x... t.71 ,�......
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2. Lot dimensions '...� .:.......
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3. Building will be ..... ..:........stories.
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4. Basement .......�lD.....:.
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5. Occu zlcy of building w{Il be.. ct_.1.} `............................................... !
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(>, ..,..:. fe t fro the ne est joining line !
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8. Owner'su� y
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9. Builder.:........1x�-1�tx.�..�..�........_........................................ .....................
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10. Builders Address ..................»............... f
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... ....... ...................................._..
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I Date ..... .-.............. ...19
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...................... .............../ . .. ............. .....
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(Owner or his ent)
Permission is hereby grantedto 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.
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
Sl000.00 of cost. If the actual cost of the structure, when finally determined, exceeds the estimated tort by more than 3°/a applicant agree to `pay an additional fee . f
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 Building 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. i
3. Prior to employing any labor or commencing work, notify the Industrial. Insurance Division of the Department of Labor and Industies, giving an estimate of'' I
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 release 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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