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SEPARATE PERMISSION.
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P MITAPPLICATION: 18DDAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED ITHIN 10 DAYS
ENG. REVIEW FEES
SEE BACK 0 OR MORE INFORMATION
ON BEHALF OF HIS OR HE A SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
E MONDS� WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM,A,NY AND
D LYORIN RECTLY
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
I
DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIREMENTOIANY C TY ORDINANCE
NORLIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDMANCE PROVIS10-
TOTAL AMOUNT DUE
RECEIPT
aN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFOF.ATIoN
APPLICATION APPROvAL
GIVEN IS CORRECT, AID THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUI-ATING CONSTRuc.
CALL
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IN VIOLATON OF THE LABOR C Dt
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFIAA SIG�A_TUFT DATE
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(425)
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771-0220--�
Rffr-EASEDBY-- DATE'
ATTENtION
EXT 333
ITIS UNLAWFULTOUSEOR OCCUPY A BUILDING OR STRUCTUREUNTIL
771-0221
A FINAL INSPECTION HAS 13EEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - 'ILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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