Laserfiche WebLink
a <br />CLE<�RING, GRUBBING, GRAJING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />. PRESS HARD • YOU ARE MAKING COPIES <br />Public Works =t ' <br />Everett, Washington PERMIT NO. '�'- % <br />APPLICANT IUndersigned) AND FIRN REPRESENTED, IF ANY: ���%`��� L:�l�i I F; <br />everett <br />� <br />� <br />'� <br />IHEREBY APPUES FOR PERMISSION TO (ldentify Quantities) � Y �`���"' � � r�� �� T!J ��XI S I I"l ��. ' i l : <br />FOR <br />OFFICE ATTHEFOLLOWINGLOCATION <br />USE . . <br />ONLY _ <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATl'ACH 4 COPIES <br />ATTACH LEGAL DESCHIPTIONS <br />PERMIT IS VALID FOR 120 DAYS <br />(May be extended upon written approval from Pu61ic 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 259-6871 <br />24 HOURS BEFORE BEGINN!NG OPERATION <br />PLANNING/SEPA APPROVAL <br />, <br />Approved foi Construction IPWI <br />Issued (8 g. Dept) Dat <br />A rvedasContucte PW) ^ ��/ � <br />::,. �-.�: �� .�� <br />• ti- � <br />The undereigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and ell <br />claims for damages, costs, expenses, or causes of <br />action that may ari<e because of the clearing, <br />grubbing, grading, and/or excavation activities <br />hereto applied for and further agrees to comply <br />with all prov,isions of this permit. <br />:� <br />� �� .i����* c, <br />; j %'i�r, ,��%:: �? . / � � .• <br />Signaturo o( Applicant/Date of Application <br />i <br />; �l�i ;':;�.:IL1�Eti !:ii�L��.1�;11'!�, <br />Aatlress <br />����:i.�:�rr, �.�nsni,;.;rai� _+sz;,� <br />City ��P <br />.� .'_ . .. ... 1�,�� '�:�'�.-.. _.. <br />Telephone Number Alternate <br />FEE <br />