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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Public Works <br />Everett, Washington <br />APPLICANT (Undersigned) AND FIRM <br />Type or print clearly in ink <br />PRESS HARD • YOU ARE MAKING COPIES <br />n <br />PERMIT NO. <br />9 <br />IF ANY:lQ.L— <br />HEREBY APPLIES FOR PERMISSION TO (Identify Quantities) <br />FOR t r _ -rh n4o <br />OFFICE AT THE FOLLOWING LOCATION (S) <br />USE <br />ONLY <br />DETAI LED, SCALED DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />ATTACH LEGAL DESCRIPTIONS <br />PERMIT IS VALID FOR 120 DAYS <br />(May be extended upon written approval from Public Works) <br />A NEW PERMIT IS REQUIRED IF WORK <br />HAS NOT BEGUN WITHIN 60 DAYS <br />THIS PERMIT TO BE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259-8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNING/SEPA APPROVAL <br />(-..F '� /7 //Vir) - <br />Approved for struction IPW) <br />Issued (Bldg. Dept) Date <br />q proved as Constr ed W) <br />('CNslvatcTlofn CCpy <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Ever�tt from any and all <br />claims for damages, costs, expenses, or causes 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 />with all provisions of this permit. <br />SiSu�l,rTlrr of Appli?Trit/Date of Application <br />i <br />Address <br />C" I/Q half n 22/ <br />City Zip <br />2 Sg—//D�7 <br />To ephone Number Alternate <br />EE <br />