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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
01 THE PUBLIC
BE DONE ON PRIVATE=TY ONLY. ANY CONSTRUCTION
DRIVEWAYS, MARQUEES, ETC.) WILL EQUIRe
DOMAIN (CURBS. SID
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 100AYS
PERMIT LIMIT. 1 YEAR. PROVIDED WOR KjS STARTED WI HIN 181) DAYS
SEE BACK OF PINK PERMIT FOR MORE INFO MATION
;AP Fo F HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
PLICANT ON BEHAL OLD HARMLESS THE CITY 01
AGREES TO EFEND AYEEE,
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ALLCI-AIMSFORDAM E�OFWHATEVER NATURE AR ECTLY
ISSUANCE OF T PERMIT SHALL NOT BE
DEPOSIT
PLAN CHECK IT
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT
DEEMED TOMOD-, WAIVE OR REDUCE ANY REQUIREMENTOF ANYOTY ORDINANCE
NORQMIT IN ANY WAYTHE CITY S A61LITY TO ENFORCE ANYORDINANCE PROVISION'
TOTAL AMOUNT DUE
RECEIPT
ACKNOWLEDGE THIS AppLKAT,,,,Y THAT "E,EN�lo
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IN VIOLATION OF THE LABOR CODE OF TH E STATE OF WASHINGTON
WORKM EN S COMPENSATION INSURANCE AND RCW 18.27
OF CIALS SIGNATURE DATE
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771-0220
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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