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1 EREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAT' N APPLICATION APPROVAL
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SEPARATE PERMISSION.
PERMIT APPLICATION: 1800AYS
PERMIT LIMIT'. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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IN NTEREST, AGREE TO :NDEMNtFY. DEFEND AND HOLD HARMLESS THE CITY OF
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON ILLBEEMPLOYED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTI,
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DATE SIGNED
(425)
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,�MENTION
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