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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br /> � Type or print clearly in ink <br /> PRESS HARD -YOU ARE MAKING COPIES <br /> Public Works pERMIT NO. — <br /> Everett,Washington <br /> APPLICANT(Undersigned) AND FIRt�A REPRESENTED,IF ANY: <br /> HEREBY APPLIES FOR PERMISSIOh TO (Identify Quantities) <br /> FOR <br /> OFFICE AT THE FOLLOWING LOCATION (S) <br /> USE <br /> ONLY <br /> DETAILED,SCALED DRAWING OF WORK TO 8E DONE,ATTACH 4 COPIES <br /> ATTACH LEGAL DESCRIPTIONS <br /> PERMIT IS VALID FOR 120 DAYS <br /> � (May be extended upon written approval irom Pubiic Works) <br /> il <br /> A NEW PERMIT IS REQUIRED IF WORK <br /> HAS NOT BEGUN WITHIN 60 DAYS <br /> I THIS PERMIT TO BE POSTED ON JOB SITE. <br /> � CALL FOR INSPECTION 259-8811 <br /> � 24 HOURS BEFORE BEGINNING OPERATION <br /> I <br /> �� The undersigned owner hereby agrees to hold and <br /> save harmless ihe Ciry of Everett from any and all <br /> claims for damages,costs,expenses,or causes of <br /> action that may arise because of the clearing, <br /> grubbing,grading,and/or excavation activities <br /> hereto applied tor and further agrees to comply <br /> pLANNING/SEPA APPROVAL with all provisions of this permit. <br /> i <br /> � licant/Date of Application <br /> I Signature of App <br /> il <br /> Aadress <br /> City ZiP <br /> ', Approved for Construction (PW) <br /> ' � lephone Number Alternate <br /> Issucd (Bldg. Dept) - � Date <br /> :� � � p�" ,/ �/� lfC� <br /> -���� /- /�� �rt/� /� �i`�/` ..S/ <br /> '��' FEE <br /> ��/Approved as Co tructed ( W) <br />