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' � CLEARING,GRUBBING,GRADING,AND EXCAVATION PERMIT <br /> Type or print ciearly in ink l'-\�l':I�'t� <br /> PRESS HARD•YOU ARE MAKING COPIES <br /> Public Works --' <br /> Everett,Washington PERMIT N0. �' �_� 7'� <br /> ( � . ' <br /> APPLICANT(Undersigned�AND FIRM REPRESENTED,�F ANY: �F������� �-� - I..�- `� , �" <br /> HEREBY APPLIES FOR PERMISSION TO(ldentify Quaniities) � � � � ' ' -` <br /> :} <br /> 1 �' �'^, <br /> OFfICE ATTHEFOLIAWINGLOCAt10NlSl-� � � � '� u�� �r * - �. <br /> 111� �. <br /> ONLV <br /> DETAILED,SCALED DRAWING OF WORK TO BE DONE,ATTACH�3 COPIES <br /> ATTACH LEGAL DESCRIPTIONS <br /> Ir I <br /> PERMIT IS VALID FOR 120 DAYS I�I .� t �� I I '� , �- '�� �`-- � � ' - <br /> fMay 6e extended upon written approval from Public Works) � i �,,� �_, �1 y ,� � ,-.� , �;� � <br /> ; � <br /> ANEWPERMITISRE�WREDIFWORK ����`�-��^���' ��� '� <br /> HAS NOT BEGUN WITHIN 60 DAYS <br /> THIS PERMIT TO BE POST[D ON JOB SITE. <br /> CALL FOR INSPECTION 259-8811 <br /> 24 HOURS BEFORE BEGINNING OPERATION <br /> � • i ;c.i ��� : ./ � l . <br /> 1'r';i? �n. I ��q L y � � ; � �.J L:• '!, CI �1 •.... / � . . . <br /> �-�.�.� �/� .�,�.:.-� ' : <br /> L//� � � 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 cauces of <br /> action that may arise because of the clearing, <br /> grubbing,grading,and/or excavation activities <br /> hereto applied for and further agrees to comply <br /> PLANNING/SEPA APPROVAL with all provisions of this permit. <br /> ' ' — . <br /> Signature of Applicant/Date of Application <br /> ��.; �����..� . <br /> Aatlress <br /> � , . -.-.-- � . . . . , . <br /> Approved for Concvistion (PWI City � Z�P <br /> Issued(BI . Dept) Date Telephone Number Altzrnate <br /> > /,� .�:�.�.� � z/zy��/ <br /> APpr�ved as Constructed�IP �- FEE <br />