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t- S CHARGE 5.
M IOU DAVIS
PER IT APPLICATION
PERMIT LIMIT'. I YEAR, PROViDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS END. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCA ING
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IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZE. AGENT OF - Th.l,ppji,,,,, I, , p,,m,t e.fil �,glld by thd.
STATE LAWS REGULATING CONSTRUC CALL
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�IGNATURE<Rlj(�N,16E�F_ (425) 1 _� Q I A VQ A A
771-0220 LEASED BY
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL .
771-0221 �
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK OWNER GOLD - ASSESSOR
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DESCRIPTION OF WORK TO BE INSPECT
A I field inspection was conducted to determine compliance with approved plans. Final approval denotes that
signed Department to the granting of:
there are no ob ctions from the above
Final approval of the described work
GRANT FINAL PROJECT APPROVAL
IONS NOTED
GRANT PROJECT APPROVAL WITH CONDIT
OUTSTANDING ISSUES
FINAL INSPECTION
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SSIGNS AND SUCCESOR
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STATE LAWS REGULATING CONSTFUG-
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THE OWN ER. I AGREE ToCOMPLY WITH CITY AND
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FOR INSPECTION
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IN VIOLA[ ION OF THE LABOR CODE OF THE STATE OF
WORKMEN S c�KyrioN iN�IRANCE AND FCW 11,11,
(425)
oFhCIALS SIGNATURE CAT
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771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
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FAX
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