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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN ICU RBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
GRADINGIFILL
STATE SURCHARGE
PEnMITAIPUCATI-N: ISD DAIS
PERMIT LIMIT: 1 AS - PROVIDED WORK IS STARTED WITHIN 18D DAYS
YE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, REVIEW FEES
END, INSPECTION FEE
P 'APPLICANT, ON S"ALF 01 HIS OR HER SPOUSE HEIRS, ASSIGNS AND SUCCESORS
INTERES1. AGREES To IN NIIY� DEFEND AND HOLD HARMLESS THE CITY OF
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PLAN CHECK DEPOSIT
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NORIPAI IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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TOTAL AMOUNT DUE
HEHLBY ACK—WILEDRE THAT I HAVE SEA. THIS APPLICATI.Nr THAT THE NF RMATION
W AGENTOF
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DATE SIGNED
(425)
771-0220
.................
EXT 333
ATT�NTION
11 IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI L
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
OF OCCUPANC Y HAS BEEN GRANTED. UBC SECTION 109
FAX
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,IF
DATE
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PLAN
RECEIPT
OUNTOUE
I HEFIE8Y ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT TH61,1FORMATION
A PLICATION APPROVAL
GIVEN S CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENTOF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
bll IPPIll �.g by 11.
CALL Dopul,
TION: 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
FOR INSPECTION ipt i-k-lodald �l IP-c8 Pmldcd
WORKMENS COMPENSATION INSURANCE AND NCW 18,21.
OF ICA t'i, E DATE
6..T�l D E SIGNED
(425)
SI.7�URE (OWN-
d 3// /0,�,
771-0220 REL��
ATTENTION
EXT 333
'a,- -�� __-3
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF
- ORIGINAL FILE YELLOW INSPECTOR
PINK -OWNER GOLD-AESESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
5198
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