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CLEARlNG, GRU(ioING, GRADIf�IG, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD • YOU ARE M.AKING COPIES <br />Public Works <br />tverett, Washin �' �n <br />r1PPLICANT IUndersigned) AND F':.M REPRESENTED, IF ANY: <br />PERMI'f NO.� 17�1 3�0 <br />HEREBY APPLIES FOR PEFlMISSION T� Ildentity �uar.tities) ._SiSA ^�L��,L�d!_� � /S1�Ef� <br />FOR <br />OFFICE AT THE FOI_LOWING LOCATION (S) <br />USE <br />ONLY <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VAL�D FOR 720 DAYS <br />!May bz extended upon �vritmn apProval from Puhlic Works) <br />A MEW PERMIT IS REQUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PEf Mll' TO BE FOSTED ON JOB SITE. <br />CALL FOF +NSPECTION 259�8811 <br />24 FIOURS 6EFORE REGIiVNING O°ERATION <br />PLANNINGiSFPA APPROVAL <br />Appra�ed for Cunstruction (i'W) <br />l;sued (Bldg. Dept) Date <br />The undersigned owner F.ereby agrees to hold and <br />save harmlzss ihe Ciry of Everett fiom any and all <br />claims for damages, costs, expenses, or causes of <br />action that may arise because of the clearing, <br />grubbing, yradin9, and/or exca4ation activitics <br />hereto applied tor and turther agrees to comply <br />with a�l provisions of this permit. <br />1 / <br />J�Cl1�'2�� � GOA r� <br />Si9na[ure of Applicant/Date of Application <br />� D ,8�-,����5 <br />Atldres5 <br />�%� ci/�c � ��:2 7 d <br />City Zip <br />�5-`'1 /6 s _ 337- 7/� <br />TelephoneNumber Alterna�e <br />l�pproved aa Construeted (PWI FEE <br />