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CLEARING, GRUBBING, GRADING, AND EXCAVATION PERMIT <br />Type or print clearly in ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />Publir, Works <br />Everett, Washington PERMIT NO. <br />APPLICANT (Undersigned) AND FIRM REPRESENTED, IF ANY: I I <br />HEREBY APPLIES FOR PERSiISS10N TO (Identify Quantities) <br />L. <br />FOR <br />OFFICE AT THE FOLLOWING LOCATION IS) <br />USE <br />ONLY _ <br />I ED SCALER DRAWING OF WORK TO BE DONE, ATTACH 4 COPIES <br />L <br />t <br />DETA L <br />ATTACH LE iAL DESCRIPTIONS OR, rl)'L <br />aP1L.T� \ <br />PERf11T 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 80 DAYS <br />THIS PERMIT TO HE POSTED ON JOB SITE. <br />CALL FOR INSPECTION 259 8811 <br />24 HOURS BEFORE BEGINNING OPERATION <br />PLANNINGISEPA APPROVAL <br />i <br />Approtled for Constr cf) n (PW) <br />Issued (B 0 + Date <br />i <br />v <br />pproved as Constructed (PWI <br />M � AJ r=' 3 Fi �, Cn f1 <br />i <br />vit <br />fill <br />---fit= f-5 A/lll�% <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett 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 />i� <br />Signature of Applicaht/Date of Application <br />rA- <br />City Zip <br />i <br />V a <br />Telephone Number Alternate <br />FEE <br />