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0 0 <br /> PUBLIC WOK5 Address Application <br /> Building Type: E]New Revise { ;Preliminary(future) <br /> Please complete numbered items(1-7)and submit by e-mail to: mholey@ci.everettwo.org Call 425-257-8813 for other options. <br /> 1. Your name: Date: 2 y.)c_t <br /> 2. (a) Mailing address: (b) Phone (c) e-mail: <br /> 11*1 L,-Po�- s i\�n— ,15�t <br /> 56,TTt_� �_4A q&IzZ <br /> 3. Date needed (please allow up to 4 weeks for assignment or verification): <br /> 4. Address submited for review: <br /> 5. Current or proposed use of address submitted for review: <br /> see B t qo�;- O3,� <br /> 6. Site plan attached (recommended to expedite request): C Yes/ No 0 <br /> 7. (a) owner name and mailing address: (b) Phone: (c) e-mail: <br /> T6- <br /> Date., <br /> 6-Matz. FOR OFFICE USE ONL Y Log No. <br /> Current Parcel Address: <br /> Suggested Parcel Address: <br /> Owner written approval to revise parcel address received: ® Yes/ No El <br /> Owner written approval for city proposed address received: 0 Yes/ No C1 <br /> COE Master Address: <br /> Go Sync GIS Map Address: <br /> Microfiche: <br /> Utility Pilling: <br /> Permit Services: <br /> Field address verified with photo: 0 Yes/ No 0 <br /> Application form available online at http://www.everettwa.org/Get PDF.aspx?pdflD=5448 <br />