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-01-F S ACHARGE
PERMIT APPLICATIOW 1.0 DAYS
PERMIT LIMIT'. I YEAH ' 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
ENO. INSPECTION FEE
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I NORLIMITINA WAY THE CITY'S ABILITY TO ENFORCE AN ORDINANC-U-1-
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6 HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
US
APPLICATION APPROVAL
GIVEN CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUL.INGCOISTFUC-
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TtON: AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMP DYED
RELATING TO
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
RE DATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 21
(425)
OFFICIA SIGNA
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(OW Of 4`6
I DAT!IiSI�TE
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771-0220
I WE
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EXT 333
ATTENtION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR Sl -RUCTURE 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
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E ED. VATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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SEPARATE PERMISSION.
ION: 180DAYS,
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PERMIT LIMIT. I YEAR - PROVIDED W;641( IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C
'APPLICANT ON BEHALF OF HIS OR HER SIOUSE* "11111, ASSIGNS AN" SUCCESORS
N
ENG. INSPECTION FEE
N INTEREST. AGREES TO INDEM IFY, DEFEND AND HOLD HARMLESS THE CITY OF
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ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT BE
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RECEIPT
DEEMEOTOMODIFY, WAIVEOR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
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Y IN R I.
1 ANY AlT.. CITY
PT T 5,�5, 0
OR LIMIT,.
NOR LIMIT,.
0
IHERE ACKNOWLEDGE THATI HAVE READ THIS APPLICATION; THAT THE INFORMATION
By
APPLICATION APPROVAL
E 'ENT OF
GIVEN IS CORRECT. AND THAT I AM TH OWNER, OR THE DULY AUTHORIZED AD
TH.
THEOWNE . I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
IF' 0 PERSON WILL BE EMPLOYED
TION; AND N DO NO THE WORK AUTHORIZED THEREBY N
it
WASHINGTON RELATING TO
mmipt I, uknmg� il 'PacO p-Wod.
TION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICA SIGN URE�'-\ DATE
;M�ATURE (OW GAT ED
'ROM 7T
(425)
2
0/)
f DANE
771-
HE A EDGY
EXT 33
ATTEWION
IT IS UNLAWFULTO USEOR OCCUPYABUILDING 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.MNEA - GOLD -ASSESSOR