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.` <br /> ; <br /> CLEARING, �RUBBING, GRADING, AND EXCAVA"t i0N PERMIT <br /> ('V('1'('.11 <br /> Type or print clenrly in ink <br /> PRESS HARD •YOU ARE MAKING COPIES <br /> � <br /> Public Works ---� <br /> Everett, Washington PERh^IT NO. <br /> APPLICANT(Undersigned) AND FIRM REPRESENTED,IF ANY: <br /> : /�' � '-( } - �' I i tiJ �' �.i1'��. J i.i. 11 '�n_� �, r..' ' — Ir� l <br /> HEREBY APPUES FOR PERMISSION TO Uuentify Quaniities) 4 �' �� � � i ' � � � ' <br /> _;4.. <br /> FOR � ,.� ; <br /> OFFICE AT THE FOLLOWING LOCATION (S) <br /> USE �� <br /> ONLY <br /> DETAILED, SCALED DRAWING OF WORK 70 BE DONE,AITACH 4 COPIES <br /> ATTACH LEGAL DES!:RIPTIONS <br /> PERMIT IS VALID FOR 120 DAYS <br /> (May be eztended upon written approval from Public Works) <br /> A NEW PERMIT IS RE�UIRED IF WORK <br /> HAS NOT BEGUN WITHIN 60 DAYS <br /> THIS PERMIT TO BE POSTED ON JOB SITE. <br /> CALI FOR INSPECTION 259�8811 <br /> 24 HOURS BEFORE BEGINNING OPERATION <br /> The undersigned owner hereby agrees to hold and <br /> save harmless the City of Everett from any end all <br /> claims for damages,costs,ezpenses,or causes of <br /> action that may erise because o5 the clearing, <br /> gruhbing,grading,and/or azcavation activities <br /> hereto epplied for and further agrees to comply <br /> PLANNING/SEPA APPROVAL with all provisinns ot this permit. <br /> , ! <br /> j � j I� � S /i,�. <br /> Signature � Applica�t/Date of Applicanan —� <br /> �1 � ��. .� r, S �'l> <br /> {itltlfei5 <br /> . L '-��—'r-��....1 � ,�� ---f�/ �I��^' �� <br /> Approved for Construcdon (PW) � <br /> CitY Zip <br /> -17�1 ,_,, . �� / ��� �� , ` <br /> Issucd (81dg. De�t) <br /> Date Telephone Nwnber Altemate <br /> Approved as Constructed (PW) FEE <br />