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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />everett <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />Public Works � PERMIT NO. '�� <br />Everett, Washington � <br />; . � .. <br />APPLICANT (Undersigned) AND FIR�JI REPRESENTED, IF ANY: ����� 4��-' ' ,��+L� ' ' <br />. '_ ._ � _ J., i!/. /.�,,,,+rc '� <br />HEREBY APPLIES FOR PERMISSION TO (Identify Quantities) —' �?% <br />`� , <br />+ A� THE FOLLOWING LOCATION (S) <br />s�i:E !; , <br />. Y'' <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH IEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 12C DAYS <br />(May be extended upon written approval from Public Works) <br />A NEW PERMIT IS REQUIHED 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 BEFORE BEGINNING OPERATION <br />PLANNINGlSEPA APPROVAL <br />�r= .1 /"'i' %-_-_ / �i, i <br />Approved fo� Coustruction (PW) � � - � <br />'r "' - <br />�'�.iZM�T Da� <br />�; kf !'i1'���Tl��i�'�- <br />i: . <br />N�i iT,CL�'�"= <br />�; rt, ti,:l�IT�1 l0e\)� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages, costs, expenses, or causes of <br />action that may arise because of the clearing, <br />grubbing, grading, and/or excavation activities <br />hereto appiied for and further agrees to comply <br />with all provisions of this permit. <br />/ �- <br />i'' i i • <br />Signature of Applicant(Date of Appl�cation <br />;i ! <br />!/ /'/ ^/'-( !}v. <br />AUAress ' <br />�- � ,��,.T-� ; (., r� ''� .: F , <br />City Z�P <br />Issued (BI . Dept) ' , , � � �� �� Teiephone Number Altemate <br />_ �: � .> `d"/ <br />q as Cons ruct� � � - �� FEE <br />