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THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T.
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVE WAYS, MARQUEES, ETC.) WILL REQUIRE
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RE MIT AIPLICATIOM IIIIIDAYS
PERMIT LIMIT,. I YEAR - PROVIDED IN FIX IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF F HIS 08 HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
IN INTEREST, AGREES T DEFEND AND HOLD HARMLESS THE CITY OF
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2 E MONDS. WASHINGTON, TS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
LANDSCAP NO
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ALOLCLAIMS FOR DAMAGES OF WHATEVER N URE. ARISING DISCOTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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JHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
IS CORRECT. AND THAT I AM THE OWNER, OR THE OUILY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
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TION AND IN DOING THE WORK AUTHORIZ 0 THEREBY, NO PERSON WILL BE EMI DYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON HE L ATING TO
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FOR INSPECTION .-p- llknowlldgld�,, 1— P-10-
WORKMENSCOMPENSATI N INSURANCE AND HOW 16.27
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SIGNATURE Q��O A, �ATE SIGNED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS,BEEN MADE AND APPROVAL OR A CERTIFI-
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RECORD OF INSPECTIONS
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