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P MITAPPUCATi N: 180DAYS
ER
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PERMIT LIMIT. I YEAR. ROVIDEOW RK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFO MATION
PLICANT. ON BEHAL F HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;A DEFEND AND HOLD HARMLESS THE CITY OF
NFINTEREST. AGREES AND
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NOT BE
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I ACKNOWLEDGE THAT I HAVE READ THI S APPLI'ATI�lly. THAT THE "FORMATION
HEREBY
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WILL BE EMPLOYED
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'SCOMPENSATION INSURANCE AND PCW 1B.27.
DATE S, N
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771-0220
1 EAS D BY
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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-FILC YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR