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PERMIT APPLICATIO : 180 DAYS v
PERMIT LIMIT: I YEAR I PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEEBACK F PINK PERMIT FOR MORE INFORMATION
-APPLICANT� ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION APPLICATION APPROVAL
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO:NDEMNIFY DEFEND AND HOLD HARMLESS THE CITY
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TOTAL AMOUNT DUE
RECEIPT
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APPI CATION APPROVAL
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6 �AHF CW%LY AUTHOR ZED AGENT OF
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IN VIOLATION OF LABOR CODE OF THE STATE OF WASHINGTON
INSURANCE AND RCW 18.27._
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WORKMENS COMPENSATION
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ORIGINAL YELLOW: iNSPEt;TOR
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- ASSESSOR
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