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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH S PERMIT COVERS WORK TO
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SEPARATE PERMISSION.
PER MIT APPLICATION: 18B DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND S CESORS
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IN I NTEREST, AGREES TO INDEMNIFY, DEPEND AND HOLD HARMLESS I
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�BIUTY TO ENFORCE ANY DROINAICE PROVIll—
0 NOR LIMIT IN ANYWAY THE CITY 5
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATI N
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GIVEN IS CORRECT, AND THAI � All THE OWNER, OR THE DULY AUTHORIZED AGENT 01
THE OWNEA� I AGREE TO COMPLY WITII CITY AND STATE LAWS REGULATING C.NSTAUC
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I N VIOLAT ION 0, THE LABOR CODE OF THE STATE
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OFFICIALS SIGNATURE DATE
(425)
771-0220
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ITISUNLAWFUL OUSE OR OCCUPY A BUILDING OF STRUCTURE UNTIL 121 1
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A FINAL INSPE CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI I PINK OWNER GOLD -ASSESSOR
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ENG. REVIEW FEES
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
THE CITY OF
IN INTEREST, AGREES TO :NDEMNIlY. DEFEND AND HOLD HARMLESS
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o 'S ANY ORDINANCE PROVISION.
CEIPT
RECEI
W OR Ll MIT IN ANY WAY THE CITY ABILITY TO ENFORCE
I
TOTALAMOUNTDUE
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APP ICATION APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN 11 CORRECT, AID THAT I AM THE OWNER, OR THE OLLY AUTHORIZED AGENT 01
T`� ,_ i� A p., u�jfl by
THEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
D
CALL -1 Offi-I -1 D.pull! -d F— — I Id. -V
TION, AND IN DOIN THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY
WASHINGTON RE ATING TEO
FOR INSPECTION
I N VIOLAT ION OF THE LABOR CODE 0 THE STATE OF
WORKMEN S COMPENSATION INSURANCE ANDRCVV IB.27.
OFFICIALS SIGN URE DATE
(425)
771-0220 RELEASED BY
F-x I '333 '
-7�E-NfION
61)(LCL-
U
IT 13 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE NTIL
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771-0221 IN4PECT6R
PPROVAL A CERTIFI-
A FINAL INSPECTION HAS BEEN MADE AND A OR
ORIGINAL- FILE YELLOW
GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK. OWNER