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ENG, INSPECTION PEE
-ARPLICAN`I� ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Ij IN INTE EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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ALLCt.AIMS FOR DAMAGE OFWHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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RECEIPT
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PLAN CHECK DEPOSIT
DEEMED To MODIFY, WAIVE OR REDUCE ANY. OUIREMENTCFANYCTYORDMANCE
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TO ENFORCE ANY ORDINANCE PROVISION.'
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TOTAL AMOUNT DUE
RECEIPT
1-57261
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
I N VIOLATION OF THE LABOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFIC S SIGNATURE DAT,
SIGN OlkAG5NT) DATE SIGN7 (425)
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ATTENTION 17/-7 EXT1333 AELEASED BY U-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl- FAX
_ _ ?/gRl�GNlNAlOWNLl YE.LLIDOW , INSPIOT01
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ILIL kl-e, t 1-4 K ER -ASSE Son