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L, N L IRS. SSIGNSANDSUCCESORS
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HE A
IN INTEREST . AGREES To DEFEND AND HOLD HARMLESS THE CITY OF
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BE. T M.. Y W
on LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
A��Ll ATI�N APPROVAL
GIVEN S CORRECT. AND THAT I AM TH E OWNER, OR THE DULY AUTHORIZED AGENT 05
T IF p.,.ItiI.i9,Ib I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C ONSTRUC
PERSON WILL BE EVE LOYED
CALL �'II "I". P pIY:,PdFo,s - Puld'..
ED THEREBY, NO
TION; AND IN DOING THE WORK �UTHORIZ WASIN
OF THE STATE OF NGTON RELATING TO
FOR INSPECTIO N .'p "K'SP, p ... P-ld-
IN VIOLATION OF THE LABOFYCOPE
WOEIMENS COMP11SATIQNINSUPANCE AN. FCW IS21
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EIG7 �GWNEFOIIA&V I DATE S19NE
(425) '11000
771-0220 6AA
A-ftENTION
EXT 333
1�� (pill, lot)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL, -.FILE - YELLOW I I�SPEAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1P9
FAX PINK, OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS,,
INSPECTOR DATE APPROVED
SETBACKS ................
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FRAMING ...................
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FIRST FLOOR FRAMING
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Wall Insulation ..........
Ceiling Insulation
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SHEETROCK NAILING
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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