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CLEARING, GHUBBING, GRADING, AND EXCAVATI�,a PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />Public Works <br />Everett, Washington <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, !F ANY: <br />HEREBY APPLIES FOR PERMISSION TO (ldentify �uantities) <br />PERMIT NO. <br />FOR <br />OFFICE ATTHE FOLLOWING 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 VALID FOR 120 DAYS <br />(May be extended upon written approval from Public Works) <br />A NEW PERMIT IS RE�UIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPErTION 259-6811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Approved for Construction (PW) <br />Issued (Bldg. Dept) Date <br />� N.- r r"i;i •.�.. <br />The undersigned owner hereby agrees to hold and <br />savc harmless the Ci[y of Everett trom any and all <br />claims for damages, costs, expensas, 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 agrees [o comply <br />with all provisions of this permit. <br />Signature of Applicant/Date of Application <br />ress <br />ry <br />Zip <br />Teicphone Number Alternate <br />Approved as Constructed (PW) FEE <br />—I <br />I <br />`J <br />