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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />Public Works <br />:'verelt. <br />I <br />o� <br />Everett, Washington PERMIT N0. � <br />, -, ' / � <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: � ' ` � i �-<-' � � �' � . � + <br />HEREBY APPLIES FOR PERMISSION TO (Identify Quantities) � <br />FOR <br />OFFICE ATTHE FOLLOWING LOCATION (S) ' f'� % <br />USE ' <br />ONLY <br />DETAILED, SCALED DRAWI�IG OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL QESCRIPTIONS <br />PERMIT IS VALID FOR 720 OAYS <br />(May be extended upon writ[en approval from Public Works) <br />A NEW 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 25J�8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Appr�ved for Canstruction <br />Issued (Bldg. Dept) Date <br />�� <br />The undersigned owner hereby agrees to hold and <br />save harmless the C�iy 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 />grubbing, grading, and/or excavation activities <br />hereto applied for and further agrces to comply <br />with all provisions of this permit. <br />ISignature of Applicant/Date of Application <br />r;atlress <br />City <br />Zip <br />Telephone Number A!ternate <br />Approved as Constructed (PW) FFE <br />