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Public Works <br />Everett, Washington <br />CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARF MAKING COPIES <br />D <br />PERMIT NO$ yZ 3 <br />APPLICANT Nndersigned) AND FIRM REPRESENTED, IF ANY: ���`��! U"VI.S <br />E=verett <br />HEREBYAPPLIESFORPERMISSIONTOUdentify�uantities) ";�``�'''`�f. .. ;'i`•,lii. �Ji( L.�TL'lSI��� �(0 E?:ISTI�IG „(:I'iEl.Ai <br />FOR <br />OFFICE AT THE FOLLOWING LOCATION (S�—I �I�O /YIUi[i��7r:� <br />USE <br />ONLY <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMi % IS VALID FOR 120 DAYS <br />(May be extended up�� 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 BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />I.CL�IIc� �4fi��� //�/7� <br />Approved r Construction (PW� <br />Issued (Bldg. Dept) Date <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett irom any and all <br />claims for damages, costs, expenses, or causes of <br />action tliat may arise because of the ciearing, <br />grubbing, grading, and/or excavation activities <br />hereto applied tor and further agrees to comply <br />with all provisions of this permit. <br /><;-. � <f�� • / � '� <br />Sipnature�of Applicant/Date of Application <br />l�iiU (iUKiLTEO f1�ULEVA;'L <br />Adtlress <br />EV[fi:iTT, NASIIIHGTO:"1 .t;,2u3 <br />City Zip <br />�H� _J::-LC�U �.1� . i.,-J'+�:� <br />Telephone Number Alternatc <br />Approved as Constructed (PW) PEE <br />=AllTll{� .S�iPP.Lz10�1 COP�1 <br />