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SEPARATE PERMISSION.
SrATE SURCHARGE
PERMIT APPLICATION: 18B DAYS
PERMIT LIMIT: 1 AR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
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�APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIAS. ASSIGNS AND SUC ESORS
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N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS
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ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTO—IN .......
OF THIS PERMIT SHALL NOT BE
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I HEREBY ACKNOWLEDGE THAT I HAVE FEA. THIS APPLICATION� THAT THE INFORMATION
AI)PLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COM�E.SATION INSURANCE AND RCW 18.27.
0 IALS SiGNATUR DATE
DATE SIGNED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
'RIGINAL 'NSPEOfOR
MADE AND APPROVAL OR A CERTIFI-
0 FILE YELLOW
A FINAL INSPECTION HAS BEEN
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