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4E77. PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/29/2015 <br /> Permit#: B1510-043 <br /> PROJECT ADDRESS: 11632 EVERGREEN WAY <br /> DESCRIPTION OF WORK: TI-HAPPY SPA <br /> CONTACT INFORMATION: <br /> OWNER: <br /> NAME: EVERGREEN RETAIL LLC <br /> ADDRESS: 1215 SENECA STREET#100 <br /> SEATTLE,WA, 98101 <br /> PHONE: <br /> EMAIL: <br /> APPLICANT: <br /> NAME: [AppName] <br /> ADDRESS: [AppAdd] <br /> [AppCi], [AppSt], [AppZip] <br /> PHONE: [AppPhone] <br /> EMAIL: [AppEmail] <br /> CONTACT: 0 Owner 0 Applicant 0 Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: <br /> PW Permit Required? ❑ YES ,NO LAND USE PROJECT#: <br /> Please provide explanation: W.O. #: <br /> JI/U <br /> S/4-, 1'J©/''i- Associated Bldg./PW Permit#: <br /> Se2 ' i s/S dev. 4e, co.CCS, <br /> See back side for additional review elements to be completed by Public Works reviewer. <br /> REVISED 11/02/2015 <br /> d <br />