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PERMIT APPLICATION: ISO DAYS
PER
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ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE OF
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ENG. INSPECTION FEE
-A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
L OF
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
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REC
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
A�PLI,.�ATION
IP" IOVIL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE WILY AUTHORIZED AGENT OF
CITYANO STATE LAWS REGULATING CONSTRUC-
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THE OWNER. 1,AGAEE TO COMPLY WITH
AND IN 00 NO THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE E-P -YED
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IN VIOLATION OIF THE LABOR CODE 0 ' THE STATE,OF WASHINGTON RELATING TO
FOR INSPECTIO ,-d-
WORKM ION INSURANCE AND RCW 18.27.
OFFICIALS ION U -2�1 /DATE
(425) /m
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GNATU E 10 AGE�
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In
771-0220 RELEAS 0 By DATE
ATTENT16N
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INS P ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLO INSPECTOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINY, - OWNER GOLD - ASSESSOR