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t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFO NATION
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771-0221
A FINAL INSPECTION IAS BEEN MADE AND APPROVAL OR A CERTIFI-.
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109
FAX
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DATE RECEIVED
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PERMIT EXPIRES
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AFPLICATIONY� THAT THE INFORMATION
AG NT OF
THE U_ E
OLS RA'THOFIZED
GIVEN IS CORRECT: AND THAT I A. THE OWNER, OR
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AND RCW 18.21.
woR COMPEN SLA
INSURANCE
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(425)
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EXT333
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IT IS UNLAWFUL TO US,E OR OCCUPY A BUILDING OR STRUCTURE UNT L -0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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SEE BACK OF PINK PERMIT FOR MORE INF)AMATION
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ENG. REVIEW FEES
ENG, INSPECTION FEE
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ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A
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RECERT
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GIVEN IS CORRECT; AND THIATT: HAM THE OWNER. OR THE DULY AUTHORIZED AGENTOF
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CALL
APPLICATION APPROVAL
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WORKMEN'S COMPENSATION NSURANCEAND RCW 18.27, 1 OFFICIALS 11GIATU'l
(425) i 1,", 1. , - i
OR AGE T) Y'- —LE,
-ueae-Lp RELEASEDBY
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INSPECTOR
PINK - OWNER GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX