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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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f DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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a PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: ( YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
END . REVIEW FEES
rA 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
f EDMONOS. WASHINGTON, ITBOFFICIALS,EMPLOVEES. AND AGENTS FROM ANYAND
ALLCLAIMS FORDAMAGESOF WHATEVER NATURE. ARISING DIRECTLY SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE. OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
z NOR LIMIT INANVWAVTHECITV'SABILITYTOENFOPCEANYORDINANCEPROVISION.`
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i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT: AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. i AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN GOING THE WORKAUTHORIZEDTHEREBY,NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21,
SIGNATURE WNER OR AGENT_ DATE SIG ED,
APPLICATION APPROVAL
CALL This application is not a Pulmit unlit sign"' by"'.
guildir.O OIIielal or hislho, Deputy: aad F""s — paid. an'
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FOR INSPECTION --- DATE
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771-0220 BED BY DA E
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SIGNS AND PS
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= ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR IN DIRECTLY
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6 OEEMEDT.MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
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IHEREBYAKNOWLEDGETHATIHAVEREADTHIS APPLICATION; THAT THE INFORMATION
OWNER, OR THE DULY AUTHORIZED AGENT OF
ApPLICATIONAPPROVAL
tt.l0ppd by the
GIVEN ISC (iRECT ANDTHATIAM THE
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Th pPlicalwnrs nolapprmlu
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;(ION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
SIN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
rocorPl Is nck-wl-dgad Iq apace P—dod.
DATE
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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DATE SIG EO
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/ 71-V220�._..A
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ATTENTION EXT 333
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
OWNER GOLD ASSESSORINSPECTOR