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CL[ARING, GRUBBING, GRADING, AND EXCAV<aTION PERMIT ' <br /> ,�vereit <br /> Type or prin[clearly in ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> � ', <br /> Public Works � .__ <br /> Everett, Washington PERMIT N0. <br /> APPLICANT(Undersigned) AND FIRM REPRESENTED, IF ANY: <br /> HEREBY APPUES FOR PERMISSION TO Udentify Quantities) �L� l n �-��� �� — <br /> FOR � `7 '3 C� /�' 1�" ��2�[ — <br /> OFFICP ATTHE FOLLCWING LOCATION (S) ' "�� � <br /> USE <br /> ONLY <br /> DETAILED,SCALED DRAWING OF WORK TO BE DONE,ATTACH 4 COPIES <br /> ATTACH LEGAL DCSCRIPTIONS <br /> PERMIT IS VALID FOR 120 DAYS <br /> (May be ex[ended upon written approval from Public Works) � 3 sj — � G � � <br /> A NEW PERMIT IS REQUIRED IF\NORK . <br /> HAS NOT.BEGUN WITHIN 60 DAYS �L�n�%/ki ���'��""� ��� y�y <br /> jnlc� /�ii/y fj�uc:;iic�vs, �'i'✓✓'��- <br /> ' THIS PERMIT TO RE POSTED ON JOB SITE. L/d� //J S2i1�LG , <br /> � CALLFORINSPECTION259-8811 /`,�,,, 7�'� �� �/����� <br /> 24 HOURS BEFORE BEGINNING OPERATION ' ����•'�t �T �/_p � /� � e <br /> � ,bP'"' � / r"i°" � �C <br /> � ��as� 7�p7 Wow�` 3 <br /> d-�F' ,/�u��;N�) �" �� (� C7 V cl �- <br /> The uF.dersi�ntd uwner hereby agrees to hold ai�d , <br /> save harmless the Ciry of Ecerett from any and all <br /> claims Tor dama9es,costs,expenses,or causes of <br /> �/ � action that may arise because of!he clearing, <br /> '� � gruhhing,qreding,and/or excavation activities <br /> ,J_ � �' � hereto applied for and further agrees to complY <br /> PLANNING/SEPA APPROVAL �� witli ali provisions of this pern�it. <br /> Signature of ApplicantiDate of Application <br /> � _ <br /> ! '—r"_ <br /> Fltldfr55 <br /> i <br /> Approved for Construction (PW) ���Y Z�P <br /> Issued (Bldg. Dept) <br /> Date Telephone Number Alternate <br /> Approved as Constructed (PW) FEE <br />� <br />