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� <br /> CLEARING, GRUBBING, GRAC�ING, AND EXCAVATION PERMIT �� <br /> � <br /> � <br /> Typeorprintclaarlyinink ° eVf:.'I�E'.l '� <br /> PRESS HARD -YOU ARE MAKING COPIES <br /> ,, ' I <br /> Public Works <br /> Everett, Washington PERMIT N0. �'------ ' <br /> APPLICANT (Undersigned) AND FIRM REPRESENTED, IP ANY: � � "� '` ` � <br /> HEREBY APPLIES FOR PERM1IISSION TO (Identify Quantities) � - � <br /> �� <br /> FOR � <br /> OFFICE AT THE FOLLOWING LOCA710tJ lS) '�� �"�� `�'t-�� � � -` �" ' '� � � '�� �--���`�`'�"� " <br /> USE <br /> ONLY <br /> UETAILED, SCALED DRAWING OF WORh TO BE DON6, AT-i ACH 4 CO �--- � ._ _-__._ <br /> ATTACH LEGAL DESCRIPTIONS <br /> PERMIT IS VALID FOR 120 DAYS �-�-%'�� /�,, � � ����L` � , <br /> (May be extended upon written approval from Prblic Works) ���/' �'�� �'��� � '� <br /> Y,�' �"f � ' ' ' '`��` ' r�' � <br /> A NEW PERMIT IS REQUIRFD IF WORK - �C-�� -�'�: / � ' <br /> �HAS NOT BEGUN WITHIN 60 DAYS � � <br /> ...\� � '�I��(` _ i� <br /> . ; ' ii:'�'r�' _ —_ <br /> THIS PERMIT TO BE POSTED ON JOB S�TE.� �� �-_�---- ' "� <br /> CALL FOR INSPECTION 259�6811 <br /> 24'HOURS BEFORE BEGINNING OPERATION <br /> The undersi9ned owner hereby agrees m 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 /> grubbin9,grading,and/or excavation activities <br /> hereto applied for and further ayrees to comply <br /> PLANNING/SEPA APPROVAL with all provisions of this permit. <br /> � r � <br /> Signature of Applicant/Datc of Application <br /> i <br /> i: <br /> i_ :rl : ty — <br /> Adtlress <br /> r <br /> Appreved�forConstruction (PW) -� f ���Y Z�p <br /> � i•' <br /> �ssued (81dg. Dept) �� Daie Telephone Number Altema!n <br /> �� ���_ — <' ' <br /> `,:���-- <br /> �roved as ConsGu (PW) FEE <br />