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PERMIT EXPIRES
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NUMBER 20
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OWNER NAMEINAME OF BUSINESS
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FEE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE EUBLIC
GRADING1111-1-
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL R QUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATI N: 1.0 DAYS
PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I.lA�N.Tj0A.l ITT." HIS OR HER SPOUSE HEI RS. ASSIGNS AND SUCCESORS
NIL FEElEA INDEIANIFI DEFEND AND HOLO HARMLESS THE CITY OF
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LAN CAPIN
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LS, EMPL FROM ANY AND
OMCoNDS,WAHlA.GTON TFSWHFICIAE OYEES.ANDA ENT$
INSP TI NFEE
A LL I. FOR. AG�E,lo ATEV R NATURE. ARISING DI-C ILI —1- --
THIS PERMIT SHALL NOT BE
RECEIPT
DEPOSIT
FROM THE ISSUANCE OF THIS PERMIT. A I SSUANCE OF
DEEMED TO MODIFY. WAIVE OR REDUCE NY REOUIREMENTOr ANY CITY ORDINANCE
PLAN CHECK
'OR LIMIT IN ANY WAYTHE CITY S ABILITY TO ENF RCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE RE EGO -7,t 2:)
THIS APPLICATION; THAT THE NFORMATIO N
APPLICATION APPROVAL
I HERE Y ACKNOWLEDGE THAT I HAVE READ
DULy.AUTHOlIlEC AGENT F
AND THAT I AM THE
T- �PPI-11- 111-1 A Fo' -.I .,,od by Ih,
GIVEN8 COWER6 STATHE
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THE OWNER. I AGREE To COMPLY WITH Ty AN TE LAW ECUATING CONSTRUC
CALL
CALL
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DOING N EMP LOYED
TION. AND IN T E WORK AUTHORIZED THEREBY. NO PERSO WILLBEL TO
RE ATING
FOR INSPECTION
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IN VIOLATION OF TH LABOR CODE OF THE STATE OF WASHINGTON
H
ATE
WORKME� S COMPENSATION INSURANCE AND RCW 18,27.
IIGN T
(425)
OFF IALS StGNATUR
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771-0220
EL�ASED By
EXT 333
7 IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CFRTIFI�
ORIGINAL - rtl E - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
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Occupancy *stablished by this
S31BISI
IAL
BY:
dOF
THE
cap Of &MOUN
c e-of" trup
DEPARTMEN'T BUILDINGS
R UMWF(M G CODE SECMN
-Permit
7029 21e� St. -Permit 00
Att
OcciiIpancy established bythis co4cate: DWalling Units: —N/A** No. stodes:'l
T pe a Ion: 11 N Basermiont: Mom
SNWS1
(Per
maximum 4B.C. io02)
R at knes.
OwrAw of Building:
THE I T ota AS BEEN WE REQUIREMENTS 00 THE j_49_7EDIWON OF
OCCUPANCY AND THE USE FOR WHICH THE
THE UNiroRm BUILDING COOE AS A00
PROPOSED OCCUPANCY IS CLASSIFIED. Vf
Issued tehI11111 2001
By:...
1_. y dw" d oo"ww, w ��m s b�" P
by CIN .1 E� Wd% OftW.
M ITT, T HIM M$
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