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PERMIT APPLI �ATI N: IIIII DAYS
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ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MOREINFORMATION
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCES-Fl
HOLD HARMLESS THE CITY OF
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TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT HAV E READ THIS APPLICATION: THAT THE INFORMATION
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6ENT- DATE SIGNED
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771-0221
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GRADINGIFILL
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STATE SURCHARGE
SEPARATE PEOISSDOON. —
PE MITAPPLICATION; 180DAYS
KI iTHIN 180 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED WOR SSTARTEDW
ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
CITY OF
I,q P,
LANDSCA NO .1,
INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE
EMPLOYEES. AND AGENTS FROM ANY AND
E EDMONDS, WASHINGTON, ITS OFFICIALS.
ALL CLAIMS FOR DAMAGSSOFWHATEVER NATUR E.A ISINGDIHECTLYORI.DIRECTLY
RECEIPT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PEAMIT,SH LL NOT BE
PLAN CHECK DEPOSIT
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TOTALA OUNTOUE !�L Z
APPLICATION APPROVAL
APPLICATION: THAT THE INFORMATION
I HEREBY ACKNOWLEDGE THAT: HAVE lEA. THIS
CORRECT, AND THAT AM THE OWNER. OR THE DULY AUTHORIIEO AGENT Ill
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GIVEN IS
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IN VI DF HE LABOR E OF TH STATE OF WASHINGTON
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WOR P 9SATION INSURANCE AND RCVl 18.27.
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FICIALS SIGNATU DATE
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6IGNATUF;rER 01 AOE011 DATE SIGNED
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771 -0220
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EXT 333
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IT IS U$LAWFULTO, USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINALINSPECT ON HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL PILE YELLOW - INSPECTOR
GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER