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escri lion FEE Description FEE
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DATE
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ATTENTION
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ALL C�AIM S FOR DAMAGES OF WHATEVER MijURF ARISING DIRECTLY OR INDIRECTLY
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMINT 01 ANY CITY OR.I."E
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt
IHEAEaY ACKNOWLEDGE THAT I HAVE REAG THIR APPUCATION: THAT `nIE INFORMATION
APPLICATION APPROVAL
arvEN OORFECr. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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RELATING TO
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FOR iNSPECTION
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IN VIOLAT ON OF THE LABOR ODE OF THE STATE OF WASHINGTON
woruMEWS COMFENSATION INSURANCE &No RCW 1027.
OF.07SIGNATILI-E GATIS i
SIGNATURE (OWNER ORB �AGE (425)
ATF SIGNED
2 771-0220
ATTENTION EXr 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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