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- ' <br /> CLEARING, GRU��ING, GRADING, AND EXCAVATION rERMIT <br /> everett <br /> Type or print clearl•;in ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> Public Works _ � <br /> Everett, Washington PERMIT NO. --` <br /> APPLICANT(Undersigned) AND FIRM REPFiESENTED, IF ANY: � �` ���% �'� " �' i -y ' ���irr:it <br /> � ! - �vL�� . i'n.-e irt.-, l�lq �I.;i".. ': [' .: 1 l � . . <br /> HEREBYAPPLIESFORPERMISSIONTOUdentifv 'luantities) ���" ' ' ' ' r' ;''i�: �i , :' � <br /> FOk <br /> OFFICE AT THE FOLLOWING LOCATION (S) <br /> USE <br /> ONLY <br /> QETAILED,SCALED DRAWING OF WORK TO BE DONE,ATTACH 4 COPIES <br /> ATTACH LEGALDESCRIPTIUNS �'�" ' ' ` <br /> i` i:verett U" <br /> „o��ncil . <br /> PERMIT IS VALID FOR 120 DAYS {:�:'�c�2 6 aCYF <br /> (May be extended upon written approval from Public Works) '.�.i. �1?OOO C.'.� <br /> �, �1 12Q:10 �. <br /> A NEW PERMIT IS REQUIRED IF WORK �; ���� <br /> HAS NOT 3EGUN WITHIN 60 DAYS ,`;r�iii /�,�f7�"> �', ��1I�:��. ��� <br /> . � �'qi�� f,'1n; ,,�!/���- �,/' <br /> THIS PERMIT TO BE POSTED ON JOB SITE. <br /> CALL FOR INSPECTION 259-8811 <br /> 24HOURSBEFOREBEGINNING OPERATION <br /> . � :i.,''�: � . <br /> j��� <br /> �� n�� � <br /> � ; Thr,undersigned owner hereby a9rees 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 [hat may �rise 6ecause of the clearing, <br /> grubbing,grading,and/or excavation activities <br /> hereto applied for and fu�ther agrees to comply <br /> PLANNING/SEPA APPROVAL with �II provisions of this permit. <br /> Signature oi Applicant/Date of Application . <br /> Aadress <br /> ; .:_ - _��. . . � . <br /> � �� .. City Lp . <br /> Approved tor Construction (PW) <br /> 'Date Telephone Number Alternatr. <br /> Issuc�p�) / -- — � . <br /> , ��3-�/ <br /> � Approved as onsvucted (PW) FEE <br />