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THIS PERMIT AUTHORIZIES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading Recording Fee
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PERMITAPPLI.O.: ISIDDAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ANT, ON BEHALF
'APP110 NT, ON BEHALF F His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation Plan Chk Deposit
IN INTE ST, AGREES TO I DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ITS
430 Receipt #
a EDMONGE, WASHINGTON, OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECT -
Fire Review
ALL
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
Fire Inspection let Amount Due
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DEEMEDT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Landscapemsp. Receipt # 1'q ")S-3
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
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WORKMENS COMPENSAYOWTIISQ�ANCE AND Now 18.27.
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771-0220 RELEASE BY D E
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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ORIGINAL - FILE YELLOW - I'MSPECfOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWInIf GOLD - ASSESSOR
10101
INSPECTOR
DATE APPROVED
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
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SEPARATEPERMISSIOW
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OE MITAPPLICATI N: TWDAYS
PERMIT UMM. I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection
'APPLICANT. ON BEHALF 0 HIS OR HER SPOUSE. HEIFIS. ASSIGNS AND SUCCESORS
at!� M ig lion
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11, INT1111T.A.1EES TO 11 DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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In. Ris!.F
ALL CLAIMS FOR DAMAGES QFWHATEWER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE 01 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEEMED TO MODIFI, WA VE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Landscapeinsp.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN 19 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OFWASHINGTON RELATING TO
FOR INSPECTR
WORKMEN'S COMPENSATION INSURANCE AND RCW IB,27. -A
(OWNi. OW tEN`q�/ [DA�T�, G
(425)SIGNATURE
771-0220
ATTENTION
M 1333
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.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10101
Description I
FEE
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Recording Fee
City SurchargTe�5_')
State Surcharg
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
7777
and Foes ive paid. and
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