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PERMIT APPLICATIOW 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDE. WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A FHI OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT THE INFORMATION
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GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT
REGULATING CONSTRUC
TKEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS
NO PERSON WILL BE EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED THEREBY,
OF THE STATE OF WASHINGTON RE LATING TO
IN VIOLATION OF THE LABOR CODE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS ERMiT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
CHARGE
PERMIT APPLICATION: 160 DAYS
AR - PROVIDED ORK IS STA TED IiiLTHU'l III. DAYS
& PERMIT LIMIT: I YE R
ENG. REVIEW FEES
SEE BACK 01 PINK PERMLIT FOR MORE INFORMATION.
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECT ON FEE
;APPLICANT.
N INT REST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
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MONDS,WASHlNGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAN
INSPECTION FEE
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RECEIPT
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
PLAN CHECK DEPOSIT
III DEOEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OFANY CITY ORDINANBE
0 NOR LIMIT IN ANYWAY THE CITY�S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
RECEIPT
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READTHISAPPL. CATION; THATTHE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORREC AND THAT I AM THE OWNER, OR ThIE DULY AUTHORIZED AGENT OF
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This apPilsat, 11 "11 P11111 ,J,l 1.,ld by th,
STATE LAW REGULATING CONSTRUG
THE OWNER. I AGREE TO COMPLY WITH CITY AND S
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE.
E OF WASHINGTON RELATING TO
F O-R INSPECTION Ps.. p—ld.s.
IN VIOLATION OF THE LABOR CODE OF THE STAT
WORKMENS COM PENSATION INSURANCE AND RCW 1B.27.
0 GNATUR DATE
DATE SIGNED
(425) lLf4 0 03
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771-0220
ELEASCD BY
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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