|
I
<br /> . CLEARING,GRUBBING, GRADING, AND EXCAVATION PERMIT (,` `I.�,Ct
<br /> � Type or print clearly in ink
<br /> PRESS HARD•YOU ARE MAKING COPIES
<br /> Public Works pERMIT NO. �' �
<br /> Everett,Washington � ,'3��� , .,,
<br /> � �tr -' �i
<br /> APPLICANT(Undersigned)AND FIRM REPRE�:NTED,IF ANY: ���
<br /> HEflEBY APPLIES FOR PERMISSION TO (ldentity Quantities). ` � � r
<br /> i
<br /> . �^ � CL�/ � t lf l{J f t T / -
<br /> OfFICE AT THE fOLLOWING LOCATION(S) �
<br /> t!!E
<br /> ONLY
<br /> DETAILED,SCALED DRAWING OF WORK TO BE DONE,ATTACH 4 COPIES
<br /> ATTACH LEGAL DESCRIPTIONS
<br /> �, � � �. 'i , �.. .
<br /> r�� � �
<br /> PERMIT IS VA��D FOR 120 DAYS - c` `�J �r ` (,i �
<br /> iC` Gr ;
<br /> (May be eztended upon writren approval fram Public Works) 1 I ,
<br /> .. ..7M�c, v✓.w_jCI ic.1 ` ,ic, .{ ., . , �
<br /> \
<br /> q NEW PERMIT IS REQUIRED IF WORK ' 1 \ U N� . ,
<br /> HASNOTBEGUNWITHIN60DAYS „ �. �,a� y��+[ Su.��-� "-�i��c�J .
<br /> � c w.a��n �::1 i� �e ;v, o.,. ,
<br /> THIS PERMIT TO BE POSTED ON JOB SITE. 1 � ( ( f. �,� j .��.�
<br /> ,- � .�7i'1� A�+O Jf'flt��r�L
<br /> CALL FOR INSPECTION 259�6811 ,.:i ,l —S;� y�� ��f�
<br /> 24 HOURS BEFORE BEGINNING OPERATION
<br /> �
<br /> , � _ ��l:,,�1 � � t ',,� � � �
<br /> j ;' "_ > ' r
<br /> ����i :i � , .,-�-, �� ' ; -�
<br /> The undersigned owner hereby agrees to hald and
<br /> �f� ��� save harmless ihe Ciry of Everett from eny and all
<br /> 4/ claims for damages,costs,expenses,or causes of
<br /> � Gwo'+?/%�Z� action that maY arise bxcause of the clearing.
<br /> � grubbing,grading,andlor excavation activities
<br /> hereto apP�ied for and further agrees to comply
<br /> with all provisions of this permii.
<br /> PLANNING/SEPA AP�ROVAL
<br /> Signature of Applicant/Date of Application
<br /> AOdress
<br /> K i %.
<br /> . - s .-���.��� i ',�;�.'._ ._ ._�,� . —.,-, . �� Zip
<br /> .�-r:. ... City .
<br /> , Approved for Consiruction (PW) '• � �
<br /> Date
<br /> Telephone Number Alternate
<br /> Issued (
<br /> ' " / s��
<br /> FEE
<br /> ', A roved as Co structe IP -�
<br />
|