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PUBLIC WORKS <br />E" REVIEW WORKSHEET <br />(ATTACH 1 SITE PLAN FOR REVIEW) <br />PROJECT ADDRESS: <br />DESCRIPTION OF WORK: <br />CONTACT INFORMATION: <br />OWNER: <br />NAME: <br />ADDRESS <br />PHONE: <br />EMAIL: <br />APPLICANT: <br />NAME: <br />ADDRESS: <br />PHONE: <br />6101 ASSOCIATED BLVD <br />STORAGE MEZZANINE -ELECTRIC MIRROR <br />Date: 11/16/2015 <br />Permit #: B1511-020 <br />UNDERWOOD GAF2TLAND EVERETT LL <br />/vi- °% ✓ ice <br />4210 132ND AVE NE <br />BELLEVUE, WA, 98005-1115 <br />1 <br />ELECTRIC MIRROR <br />�g6 62 <br />EMAIL: <br />[AppEmail] <br />CONTACT: <br />❑ Owner ❑ Applicant ❑ Other. <br />NAME: <br />MONTAGUE NEIL <br />PHONE: <br />4254193547 <br />EMAIL: <br />NEILM@NWHS.COM <br />COMMENTS FROM PUBLIC WORKS REVIEWER: <br />PW Permit Required? ❑ YES ❑ NO <br />Please provide explanation: <br />LAND USE PROJECT #: <br />W.O. #: <br />Associated Bldg./PW Permit #: <br />See back side for additional review elements to be completed by Public Works reviewer. <br />REVISED 1110212015 <br />