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'APPLICANT. ON BEHALF OF HIS OR HER SWSE. H HE. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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, IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
2 E MONDS,WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS 'ROM ANYANo
INSPECTION FEE
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" ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
X FR M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
11 DEEMEDTO MODIPYWAIVEOR REDUCE ANY SEOUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
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0. NOR LIMIT INANYWAYTHE CITYBABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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APP (CATION 07VAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMP DYED
CALL
Thl, IPPII�11 '� 10 � P-11 "III 1-011d by
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N VIOLATION OF THE LABOR CODE Or THE STATE OF WASHINGTON RELATING TO
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WORKMEN S COMPENSATION INSURANCE AND RCW IBZ7
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ATTENTION
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSP ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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ORIGINAL � FILE YE' CAN INSPYCTOR
C E OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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