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; ,, <br />Putlic 1Norks <br />Everett, �Nashington <br />APPLICANT <br />CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />AND FIRM R[PRESENTED, IF ANY: <br />PERMIT NO. '�� f_"� ' —_ <br />everett <br />/ ' � � <br />� .. ,�.� � . � ., �,, i. , �1 �. , � . ; �. <br />HEREBY APPLIES FOR PERMISSION TO (ldentify Quantities) , . <br />DETAILED, SCALED DRAWING OF WORK TO BE DOYE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALIJ FOR 120 DAYS <br />(May be extended upon written approval from Public Works) <br />A NEW PEAMIT �S REQUIRED IF WORK <br />HAS NOT BEGUiJ WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTIOIJ 259-8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPRO��AL <br />�'_'r _ � _ _'. .' /., .. � .., <br />_ , ;�., ; <br />Approved for Construction (PGV} � <br />� Issued (Bldp. Dept) Date <br />! - ����� .� /3-�� <br />� pproved as Constr�cted (PW) <br />�, <br />The und:rsigned owner hereby agrees to hoid and <br />save harmi,ss tha City of Everett from any and ali <br />claims for �!ameges, costs, expei�ses, or causes of <br />ac:ion that may arise because of the clearing, <br />grubbing, grading. and/or excavation activities <br />hereto applied for and further agrees to comp�y <br />with all prqvisions of this permit. <br />i <br />� / �" .' .i <br />� � �/��%� �� ;f''/:� .-. <br />� : � j ,C.��% /� f.t - . ; _.� <br />Signat6fe of pplicant/Date of Application � <br />/' ( <br />�- ri.���✓ .� i� <br />Aadress <br />.. <br />` _ i �� <br />� ;�"✓ i n_0 !1 1 <br />City ' Z�P <br />, <br />���� . i -i- � <br />Telephone Number Alternate <br />FEE <br />