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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THATTHE INFORMATION
APPLICATION
APPROVAL
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GIVEN S CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE 5 REGULATING CONS
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IN 11ULATION THE LABOR CODE OF
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OFFIC LSSIG T RE DATE
IIGNA�l DATE SIGNED
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771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 1 09
FAX
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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Ll BE o.E ON PRIVATE PWROPERTY O.Ll. A., CONSTRUCTION ON THE PUBLIC
GHADLNGIFILL
a S'.E ALKS, DRIVEWAYS. MARQUEES.
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3 SEPARATE PERMISSION.
ESURCHARGE
PE MITAPPLICATION: 160DAYS
PERMIT LIMIT. I YE
SEE BAC AM . PROVIDED WORK IS STARTED WITHIN In DAYS
K OF PINK PERMIT FOR MORE INFOR ATION
ENG. REVIEW FEES
A FHl OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO ss
p PLICANT. ON BEHALF o S
ENG. INSPECTION FEE
THE CITY OF
N ITEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I
LANDSCAPING
ED'C�DS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM A�YAND
INSPECTION FEE
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE 0 REDUCE ANY REQUIREMENT OF A�YCITI ORDINANCE
PROVISION.-
NOR LIMIT IN ANY WAY THE Cl TY SABILITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
�!,PL15ATIFN APPROVAL
GIVEN IS CORREC T. AND T AT I AM THE OWNER. OR THE DULY A.T..T�',��.E. A.E'T�T OF
'R i. .NS uc-
CALL
T� .61.19— bY 1�
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o PLY WITH CITY AND STAT
THE OWNER, IAG E LAW,
REETOC m
TION. AND IN DOING THE Wo SON WILL BE EMPLOYED
RK AUTHORIZED THEREBY. NO PER
u" G —,.,d—,I
KI ' ' ,
—o—id,d.
:,d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION1-
WORKMEN S COMPENSATtD� INSURANCE AND ROW 18.27.
FFI LSSIG
-F.-Alli-SIGNED
(425)
SIGN:2;� �ENT)
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-V��V
DATE#
I I I
RELEAsEm BY
p
FX T 1333
---------------- —
krtfill"I'ON
_
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 - RLE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - ONNER - GOLD - ASSESSOR
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