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Public Works <br />Everett Washington <br />� <br />CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />7ype c.' print clearly in ink <br />PRESS HARD -� iJU ARE MAKING COPIES <br />PERMIT N0. <br />APPLICANT (Undersic�ned) AND FIRM REPRESENTED, IF ANY: � � �` � � ` ' '' � `" <br />..� � / � — �- / �,- � /�` [% ,-' `i!iiGil � vJ.�f� �; ; _� " <br />_ I% <br />: ._ ' ^- i' i f�/1!' ".. r':;: ,, .– <br />HEREBY APPLIES FOR PERMISSION TO (ldentify nuantities) <br />FO R <br />OFFICE <br />USE <br />ONLY <br />ATTHE FOLLOWING LOCATION (S) ���« �' ���r�������J � �//, <br />'i_i ;,r'���/ti ' <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 720 DAYS <br />(May be extended upon written approval from Public Wo�ks) <br />A NEW PERMIT IS REQUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO B[ POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259•8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANUING/SEPA APPROVAL <br />, -. . -:--� ;� / ; � / `n <br />Approved-for Construction �PW) � <br />ssued (Bldg. <br />Approved as Constructed (PW) <br />Date <br />;> .�:J <br />,_ <br />�� Tj���, �� <br />� <br />�<Z;v�>�r <br />� cJG'i�A'7/�//�'i,t/ <br />, �;;�,cnPc �"T�' G,e'�?����1.'G <br />1'J'rC.S�-;Uc".-G7 '/7� <br />� <br />The undersigned owner here6y agrees to hold and <br />save harmless the City of Everett from any and all <br />clxims for damages, cos[s, expenses, or causes of <br />actian that may arise because of the clearing, <br />grubbing, grading, and/or excavation activities <br />hereto applied for and further agrees to comply <br />with all provis�ns of this permit. <br />i <br />�� i`�, � U � �' /+' �/ �'i /", �''; <br />ture of Applicant/Date of Appiica'tion � <br />�; <br />�% i�!'�. % •� '_�i?L <br />AdUress <br />IC !'. �r/./(, -c / [J::- ; �,�" : _ <br />cicv Z'P <br />-i �/_ _'<i'. ' __+�. -. ., _.. J" <br />Telephone Num6er � Alternate <br />FEE <br />