7114 BEVERLY LN 2017-01-13 - Laserfiche WebLink

PUBLIC WORKS REVIEW WORKSHEET (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/2/2015 PROJECT ADDRESS: DESCRIPTION OF WORK: CONTACT INFORMATION: OWNER: NAME: ADDRESS PHONE EMAIL: APPLICANT: NAME: ADDRESS PHONE: EMAI L: CONTACT: NAME: PHONE: EMAIL: 7114 BEVERLY LN SITE WORK FOR NEW SFR POHLAND TODD & HOLLY 314 HEATHER ROAD EVERETT, WA, 98203 4253459003 POHLAND TODD & HOLLY 314 HEATHER ROAD EVERETT, WA, 98203 4253459003 [AppEmail] ❑ Owner ❑ Applicant ❑ Other POHLAND TODD & HOLLY 4253459003 COMMENTS FROM PUBLIC WORKS REVIEWER: PW Permit Required? ❑ YES ❑ NO Please provide explanation: Permit #: PW1512-007 LAND USE PROJECT #: ��d� � Q� "� W.O.#: �� . � � � -C�o�� Associated Bldg./PW Permit #: C � � -' � See back side for additional review elements to be completed by Public Works reviewer. REVISED 11/02/2015