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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT � <br /> everett � <br /> Type ar print clearly in ink <br /> PRESS HARD•YOU ARE MAKING COPIES <br /> Public Works PERMIT N0. <br /> Everett,Washington <br /> APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: <br /> y' i . <br /> HEREBY APPLIES FOR P 10 TO dentify nuanti s) <br /> � . <br /> FOR � � — <br /> � !, .: � 1 !. �„ <.�q:� .��.: <f�{/,' <br /> OFFICE ATTHE FOLLOWING LOCATION (S) <br /> USE <br /> ONLY � <br /> DETAILED,SC.".LED 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 /> A NE`N PERMIT IS REQUIRED IF WORK � �� 6 , V _ ' <br /> HAS Nf�T BEGUN WITHIN 60 DAYS �� Y� f �� � <br /> � � 1 (,j�� <br /> �� v <br /> THIS PERMIT TO BE POSTED ON JOB SITE. �1 <br /> � ��,. <br /> CALL FOR INSPECTION 259•8811 <br /> 24 HOURS BEFORE BEGINNING OPERATION ^ 1\ <br /> �1W <br /> - The undersigned owner hxreby agrees to hold and <br /> � � • save harmless the City of Everett from any and ali <br /> � claims for damae�es,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 /> PLANNING/SEPA APPROVAL with all provisions of this permit. <br /> I Signatu,e of Applicant/Date of Application <br /> Aadress <br /> City Z'P <br /> Approved for Cunstruction (PW) <br /> Issued (Bldg. Dept� <br /> Date Telephone Number Alternate <br /> Appraved as Constructed (PW) FEE <br />