BLD20160926 FRONT.pdfi 14 j/ �
iii � I
„iiia a c1l
FJll,UO L.X,D INC
1
P0 Box 312,29
Ur Ar,Tv u 1917A Cl RSI nI..
[AGREE TO COMPLYWITHCIT AND Sl A`rE LAWS REGULA:FIING,WNSi RIJCI'llON AND IN DOING THE WORK, AllJl"I"E OIlI,' ED,
THEREBY, NO'PFRSON WILL BE EMPLOYED D I"N VIOLATION OF THP LA'ROR CO,DF OF THP .WATE OF WA'.SI;IINGI UN R LATI NC'T'Cp
WORKMEN'S COMPENSATFON INSURANAND Wr 27;;
"11.11S APPLICATION IS NOT A PEIJMIT IUI'NT"IL SI&.4htD BY THE BUILDING CDn;IcIAL OR HI MER. DEPUTY AND ALL FEES AIA.F PAID.
&eetf
f r 7tint Narme IDate F el�a d E t
rFMFDNLAWFUL"TOTME IY,rOCCUPY AWILDING OR'9TR CHIRE1NIH,irsF'CNALIfIPJ:ST"FeC"nON1FiASBFl=.uNhatiADLANDL4F'}"I1(]VALO AC..Rt'171FIC "M [6F
OCCUPANCY 6IASB ~SIJORANTED LIK109°IIS°I 10i MCI lr,,,
Q]NLIlC�]E OAPP . LTCA,I T ASSESSOR OTI.