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Public Works <br />Everett, Washington <br />CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Typa or print clearly in ink <br />PRESS HARD • YOU ARE MAKING COPIES <br />PERMIT NO. `- -'�''�^ <br />APPLICANT (Undersigned) AND FIRM REPRESEN fED, IF ANY: <br />�nr�r-c '��c �w�Sc.�J Po�.,n�.D �=�����'��tnti) r-wNS � i�C . <br />HEREBY APPLIES FOR PERMISSION TO (ldentify Quantities) R(�-�, {� j_ / l.l : i <br />everett <br />. i <br />DETAI LED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 120 DAYS <br />(Msy be extended upon written approval from Public Works) <br />A NEW PERMIT IS REUUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 2b9-8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />A�Q� �� � <br />�� �� � <br />�Q � <br />� e <br />PLANNING/SEPA APPROVAL <br />� 5Sa �� ��'c� <br />�/ IL <br />i.��,� -r-- :i� •�.I...,:��--�-� <br />'� Approved for Construction (Pl'�) <br />� Issued (Bldg. De Date <br />; � - f��c' <br />i � APproved as Constructed (�) <br />� <br />I v� c <br />r^ � The undersigned owner hercby aprees to hold and <br />1 ll J save harmless the City of Everett fram any ancl sll <br />V claims for dameges, costs, expenses, or causes of <br />action that mey arfse bacause of the clearing, <br />prubbing, gradin9. and/or ezcavation activitias <br />hereto applied for and funher agrees to comply <br />with all provisions of this permit. <br />� <br />� <br />`��,.,_, -�„��.:..,___� I i /s ����:: <br />Signeture Applicant/Date of Application ' <br />�l� �'� �i�y � � �L' <br />Address <br />L�ti���..���_:�` _./�� �7`1'-� :t.,. <br />Clty Zip i <br />-] -� �� �, � .� � _I� i .J 7, _ <br />Telephone Number Alternate <br />FEE <br />� <br />� <br />