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771-0220
EXT1333
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IT IS UNK 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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SEE BACK OF PINK PERMIT FOR ORE INFORMATION
C
ENG, REVIEW FEES
m
;A PLICANT. ON BEHALF OF His OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
R ES G . T
N NTEREST, AGREES
G I E S G
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MONDS.WASHINGT G MTSFRO.
ALLCLAIMS FOR DAMAGE� OFWHATEVER NATUBE.ARISING DI 5CTLY OR INDIRECTLY
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THIS P
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF EAMIT SHALL HOT BE
OEEMEDTo MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF AMY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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INSPECTION FEE
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RECEIPT
TOTAL AMOUNT DUE
APPLICATION APPROVAL
Thi. PP"--"-- '� - - Pi� U� �" "y"
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FOR INSPECTION
r E DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN S CORRECT. ANDTHAT I AM THE OWNER, OR THE DULYAUTHORIZED AGENT OF
THEOWINER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
VON; AND IN DOING THE WORK AUTHORIZED THEREBY, N PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF"WASHINGTON RELATING TO
W 18 27
WOHKMEN�S COMPENSATIO 4 INSURANCE AND PC,
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P[ELEASE. By
EXT1333
ITIS UN[AWFULTOUSEOR OCCUPY ABUiLDING OR STRUCTUREUNTIL
771-0221
INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - PILE YELLOW
PINK -OWNER GOLD -ASSESSOR
'NCATE OF OCCUPANCY HAS BEEN RANTED. UBC SECTION 109
FAX