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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD • YOU ARE MAKIP�G COPIES <br />Public Works <br />Everett, Washington <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO (Identify �uantities) <br />FOR <br />OF►�ICE AT THE FOLLOWING LOCATION (S) <br />U:�E <br />ONLY <br />PERMIT N0. <br />DETAILE�. 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�REQUIRED IF WORK <br />HAS NOT BEGUN�WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259�8811 <br />24 HOURS BEFGRE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Approved for Construction (PW) <br />Issued (Bldg. Dept) Date <br />The undersi9ned owner herehy agrees to ho�d and <br />save harmless the City of Everett from any and all <br />claims for dama9es, cosu, expenses, or causes of <br />action that maY arise because of the clearing, <br />grubbing, grading, and/or excavation activities <br />here[o applied for and further agrees to comply <br />with all provisions of this permit. <br />Signature of Applicant/Date of Apptication <br />Aadress <br />City <br />Telephone <br />Approved as Constructed (PWI FEE <br />Zip <br />Alternale <br />�� <br />