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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />� :''a��:it��. <br />Type or print cicarly in ink ' � <br />PRESS HARD - YOU ARE MAKING COPIES � � <br />I <br />. �t <br />/ <br />/ v <br />Public Works i ��, . ��_. <br />Everett, Washington PERMIT NO. <br />, <br />APPLICANT (Undersigned� AND FIRM REPRESENTED, IF ANY:� % ` � / " F �-" ` "� �� ����� // � <br />HEREBY APPLIES FOR PERMISSION TO Udentify Quantities) <br />FOR <br />OFFICE <br />USE <br />ONLY <br />AT THE FOLLUWING LOCATION (S) <br />DETAILED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 120 DAYS <br />(May 6e extended upon written approval from Public Works) <br />A NEW PEFMIT IS REQUIRED IF WORK <br />FIAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERM�T TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259�8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />Approved for Construction (PW) <br />Thr, undersi9ned owner hercby agrecs to hold and <br />save harmless the City of Everett from any and all <br />claims for dama9es, costs, expenses, or causes of <br />action that may arise because of the clearing, <br />grubbing, gradin9, and/or excavation activities <br />here[o applicd for and further agrees to camply <br />with all provisians of this perrnit. <br />Signaturc oi AppfcandDate of Application <br />Aatlress <br />City <br />!ssued (Bldg. Dept) <br />Date Telephone Number Alternatc <br />j//��Q (� -a`1-� <br />ytiprc�vec�onsvuc ed P'a'l) 1 F[E <br />