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c� � <br /> , ' CLEARIPJG, GRUBBING, GRADING, AND EXCAVATION PERMIT V 1 `J l <br /> Type or print clearly in ink �' � <br /> PRESS HARD-YOU ARE MAKING COPIES i <br /> , I <br /> Public Wurks pERMIT N0. � � <br /> Everett, Washington -�E� <br /> .'�"- <br /> APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: °S • I <br /> 7110 'TI-1 ��'j-- ,✓C' - �2� ' <br /> - /, R � N T- 77 no /��nCK A7� — <br /> HEREBY APPLIES FOR PERMISSION TO (ldentify nuantities) �SL�.--�— ��C`�n����4 I <br /> FO R <br /> OFFICE ATTHE FOLLOWING L�CATION (S)—. <br /> USE <br /> ONLY <br /> DETAILED, SCALED DRAWING OF WORK TO BE DONE,ATTACH h^.OPIES <br /> ATTACH LEGHL�ESCRIPTIONS <br /> �� ��S <br /> PERMIT IS VALID FOR 120 DAYS {, vi � � ` <br /> /` P� � ,m ���' N� <br /> (May be extended upon written approval from Puhlic Works) � <br /> A NEW PERMIT IS REQUIRED IF WORK N�a S G�,./r�""�lJ � <br /> HAS NOT BEGUN WITHIN 60 DAY5 �a��/� e %�,rSS <br /> l�_v„�yr�r / 3 <br /> THIS PERMIT TO 9E POSTED ON JOB SITE. (N � JG, � <br /> ! <br /> �r� <br /> h � <br /> a-� ,� eSs` <br /> CALL FOR INSPECTION 259�8811 � � �/ <br /> 24 HOURS BEFORE BEGINNING OPERATIOPd � ,,,,n e� �o� <br /> �o� �/d�S °� �Q/�, u ���r/`a J <br /> � P �� <br /> � <br /> I ,�\ The undersigned owner here y agrces to hold and <br /> L i/�� save harmless the City of Everett from any and all <br /> � claimi tor dam�yes,costs,expenses,or causes of <br /> action that maY arise because of the clearing, <br /> grubbing,gradin9,andbr excavation nctivities <br /> hereto applie�l for and further agrees to comply <br /> witli all provisions nf this permit. <br /> PLANNING/SEPA APPROVAL <br /> Si9nature of Applicant/Date of ApGlication <br /> Aadress <br /> Zip <br /> — Ci�Y <br /> v <br /> F,pproved for Construction (PW) <br /> Date Telephone Number <br /> Allernatr. <br /> Issued (Bldg. Dept) <br /> FEE <br /> Approved as Constructed (PW) <br />