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d CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />'I p Type print clearly in ink <br />- <br />PRESS HARD -YOU ARE MAKING COPIES everett <br />Public Works PERMIT NO.� <br />Everett, Washington <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: I �' I I t2 C H 16C) ( <br />HEREBY APPLIES FOR PERMISSION TO (Identify Quantities) <br />AT THE FOLLOWING LOCATION 11% e w r <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 120 DAYS <br />(May be extended upon written approval from Public Works) <br />ANEW PERMIT IS REQUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 2%8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Approved for Construction <br />Issuec (Bldg. Dept) / Date <br />Approved as Constructed WWI <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of E, arett 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 for and further agrees to comply <br />with all provisions of this permit. <br />i <br />Signature of Applican /D to of Application <br />Address <br />-vim— ')�?L.3 <br />City Zip <br />-� �-2� 7 c� y <br />Telephone Number Alternate <br />FEE <br />