2315 OKLAHOMA AVE 2016-10-21 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/23/2015 Permit#: PW1509-021 PROJECT ADDRESS: 2315 OKLAHOMA AVE DESCRIPTION OF WORK: NEW SINGLE FAMILY RESIDENCE CONTACT INFORMATION: OWNER: NAME: JACOBSEN HOMES INC ADDRESS: 1109 SPRINGBROOK RD LAKE STEVENS, WA, 98258 PHONE: 4253300444 EMAIL: APPLICANT: NAME: OWNER ADDRESS: PHONE: EMAIL: [AppEmail] CONTACT: ❑ Owner ❑ Applicant ❑ Other NAME: [ContactName] PHONE: [ContactPhone] EMAIL: [ContactEmail] COMMENTS FROM PUBLIC ORKS REVIEWER: PW Permit Required? YES ❑ NO LAND USE PROJECT#: Please provide explanation: W.O. M Associated Bldg./PW Permit#: C,15019—003 See back side for additional review elements to be completed by Public Works reviewer. REVISED 11/02/2015