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S'.EWALKS, DRIVEWAY
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PERMIT APPLICATION: le" DAYS
IYE P K iS STARTED WITHIN 180 DAYS
PERMITLIMIT. ROVIDEDWOR
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A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
IN NTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
L�NDSCAFIN 'G
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ALLCLAIMS FOR DAMAGES OF WHATEVER,NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
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FR M THE ISSUANCE OF THIS PERMIT. SSUANCE OF THIS PERMIT SHALL NOT BE
0
PLAN CHECK DEPOSIT
DEEMEDTO MOOIFY.WA$VE OR REDUrEANY REGUIREMENTOFANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S A51LITY TO ENFORCE ANY ORDINANCE PROVISION!
TOTAL AMOUNT DUE
IRI E IPT
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION1 THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
Thl, ppI,. , p,,,,t 11 ig�ed by thl
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Bl,ldllg OfIcial , Nlftl Dopltyl,�d F.11 11�1.0 Id. A.d
TI.N; AN. IN ..IN. THE WORK AUTHORIZED THEREBY� NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
P... PI
i�N,VIOLATIOI 01 THE LABOR CODE OF THE STATE OF
FKMEN:9.COT.YENSATION INSURANCE AND RCW 18,27.
'd,
OFFI I S SIGNATURE ATE
OR AGENT)
ATE SIGNED
(425)
J
771-0220
REL A ED BY
'ATTENTION
EXT1333
USE OR 066UPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS UNLAWFULTO
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- RIGINAL FILE YELLOW-1—L"'
A FINAL
GRANTED. UBC SECTION 109
FAX PINK -OWNER GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN