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Public Works <br />Everett, Washington <br />CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. '_ <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: <br />;�- ! 1 i ��, — -� <br />_ , ;' . _ <br />HEREBY APPLIES FOR PERMISSION TO (Identify Quantities) �"' <br />i" <br />FOR <br />OFFICE AT THE FOLLOWING LOCATION <br />USE <br />ONLY <br />DET:,I�EG, SCALED DRAWING OF WORI<TO BE DONE, ATTACH 4 COPIES <br />ATT.4CH LEGAL D[SCRIPTIONS <br />PERMIT IS VALID FOR 126 DAYS <br />(May be extended upon written approval from Public Works) <br />H N�W PERMIT IS REQUIRED !F WORK <br />HAS �OT BEGUN WITHIN 60 DAYS <br />TiiIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259-8677 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Approved for Construction (PW) <br />Issued (Bldg. Dept) Date <br />` u�/� -J —� <br />Approved as-6��enstreeFefl-{PJN� <br />n+�0/Gf� <br />_ . �_ ` ..� ;, <br />=-�0.�:,1 0` 7.0�;, ;u�3 c_��cLina or <br />1:��i..i71"1I-l:• %1"C.:i'.i Olt:.y: �G I.'=.._i],lrr?i::�. <br />L:l;�.i' �"L15 LX.�231li.f:. .'•�;G �_::.�".LLt10Rc.1. <br />cJe�zri�x�, crradir� or filli_rr� is <br />•'..IIOS• tii "t'lli;li''. '. :il.^.^,. �7� �rii.'',:�C4:1) <br />tn �. :_, . <br />The undersigned owner hereby agrees to hold and <br />save harmless the City 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, greding, and/or excavation activities <br />hereto applied for and further agrees to comply <br />� <br />with all provisions of this permit. . <br />� ,t.�.. � ...�`.. � <br />f; <br />Signature of Applicant/Date o1 Apolication � <br />. ,, <br />'�;% <br />Atltlress � - � ' ' <br />�s . — <br />City ' Zip <br />Telephone Number Alternate <br />FEE <br />