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ENG. REVIEW FEE
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES
ENG. INSPECTION FEE
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TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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STATE SURCHARGE
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ENG. REVIEW FEES
SEE BACK OI;PINK PERMIT FOR MORE INFORMATION
f'
V+ -APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
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TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. ORTHE DULY AUTHORIZED AGENT OF
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Thip apDllcellon is nNepermil unle.ipned Oy lna
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTPUC
WILL BE EMPLOYED
CALL
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FOR INSPECTION
racaipl iv acknowlodgpG, Pa provided.
-
IN VIOLATION OF THE LABOR CODE OF THE STATE
HSATION INSURANCE AND RCW'.1927,
OFF IALS SIGNATUR DATE
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WORKM.EN'SC
DATE SIGNED
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SIGNATURE ( HE O AGENT) E
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771-0220
R A BY DATE
ENT
EXT 1333
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IT�LS UN AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 _0221
Y
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L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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LOWNER GOLD ASSESSOR- FILE YELLOW
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