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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
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PERMITAPPLICATI N: 1800AYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
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IHERE Y ACKNOWLED(31 THAT' HAVE READ THIS APPLICATION: THAT THE INFORMATION A!121_115ATI�N APPROVAL
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WORKMEN'S CO INSURANCE AND RCw 18.21.
,XXkSATION OFFI IALSSI NATURE
SIIIATU,:r:�� A DATE SIG ED (425)
— 7 .5 s- 0 771-0220 ELllSl Y DATE
ATTENTION EXT 333 -------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL -0221
A FINAL INS 771
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