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CLEARING, GRUBBING;-GRADtNG, ANU'FXCAVi4TION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />Public Works <br />Everett, Wasl�ington <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY:� <br />HEREBY APPLIES FOR PERMISSION TO (ldentify Quantities) <br />" -. ! <br />FO R <br />OFFICE <br />USE <br />ONLY <br />AT THE FOLLOWING LOCATION <br />1 <br />PERMIT NO. <br />�T ��%i„ ) <br />�' <br />- �_ r .r: <br />' ` r; <br />� <br />�� ! � . . ,_1 .f�.. <br />DETAILED, SCALED DR/�WING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />� L � . <br />r7 (', ��+ i I . <br />.�..tM� _'...1'Vl_f .L�.�"��-�'�. ; <br />� �. ._' �� � ��,.�,,� <br />. t.�i.C. �=t..�,ti�_ . <br />�',� <-.J--t..� l� � [.....G.. :"�._.v;t"..f �,.. ' . <br />�_,,�� :' (` Y14�, l� : ��`-�L. � . <br />_ � li �, <br />�' �{ �i . _ �. . . <br />� <br />� :!� <br />PERMIT I5 VALID FOR 120 DAYS <br />(May be extended upon written apProval irom Public Works) <br />A NEW PERMIT IS REQUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO BE PCSTED ON JOB SITE. <br />CALL FOR INSPECTION 259-8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />� _ �u�,.;�' ,;r�� �_<,ir"t ,L,.�, <br />, ;.! <br />� <br />��.� l.,. i r � � �. <br />.'l�Y��, i.:,l,l�� i��" `. . ' . .�, <br />PLANNING/SEPA APPROVAL <br />P <br />Approved tor Constructwn <br />Issued (Bldg. Dept) Date <br />Approved as Constructed (PW) <br />�,Lw 4 -ti s-a° <br />everett <br />� The undersigned owner hereby agrees to hold and <br />save harmless the City o( 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 agrees to comply <br />with all provisions of this permit. <br />Signature oPApplicantlDate of Application <br />Address <br />Ciry , , � � � <br />Telephone Number Alternate <br />FtE <br />