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PUBL/L: WOl�KS <br /> Address Application <br /> - (]New [�/erify [jPreliminary(future) <br /> 6uilding TYp�� , Ex��; +i^ -S 1- (: _ <br /> PleasecompletenumGereditems(7-7)midsubmitbye-mailro: mhaleyCilci.everett�va.us Ca11425-157-8813forotheroptions. <br /> 1. Relationship to owner: F1r� c�a- Date: ���'l0-I;; <br /> 2. (a)Your name and mailing address: (b) Phone: (c) e-mail: <br /> Gra;� Koah '�25-v7v•h�l� i <br /> �:•ii� G�•rr�� 11�,: �ILJ Gr<<i� l<a�hhomeiUno(,��'� <br /> Sdzrnviaoc�. �.'�i^ ���'��� <br /> 3. Date needed (please allow up to 4 weeks for assignment or verification): <br /> 4. Primaryaddressapplication: 360� En�l /1✓e �vere.;;- ;'d� <br /> 5. Supporting information and current use of pnm ry address (licenses, marketing, etc.): � <br /> C�-E (�_LOf�.f �j�l'J!N 360lo Earl I�vc � �96P1c2 1'� (JOl'I'�:�� J6�J . <br /> O�Her rcGorr�S '"7it��✓ �I��J$ <br /> 6. Site plan attached (recommended to expedite request): -� Yes/ No �i <br /> 7. (a) Owner name and mailing address: (b) Phone: (c) e-ma��• G �Qn` �,e��1� - L� <br /> �en �1=•1-�� �' G fnY%l;�>. Mnt}(n �ZS-30&'4253 k <br /> 3�06 EG+'I RvE �' <br /> GverGt(- wll 262�1 <br /> a�=re: <br /> FOR O�F£C�US_r• nid[.;' :,-g mo,: <br /> Cu�-rent Parcel Address: <br /> Su�gested Parcel Address: <br /> ❑ `res �lo n <br /> O�.�mer v�ritten approvai tn r�vise parcr_I address �ecci�'ed: � <br /> O��mer��aritt.�n ,�nnre�dalior�:ilyrr��n�sedaddres, (iC21Y:d: ❑ Yes; I`to U <br /> COI: ihlnsicr ;:�'J;�.�ss: <br /> ro s;,nc �is rnap �ddress: <br /> il�licrofiiche: <br /> UiilityBilli�' 3��C �� �hJ L�„n�„_ � '�b�. 'ZJfb� '4"� <br /> .-. -�� <br /> �l�o �b �Url �''� <br /> Perini� Scavic���: <br /> 1 ield adriress veriFied viith ptioto: ❑ Yes/ No ❑ <br /> ;'.�cpl'uStion (orr.� ;���'I;�I;k�onlineuLhttp'I/tvw�v.eyeretlwa.orR/Ge[ PDf.asps�lpdfl�=5d43 Upd_l:� '�'-'�?'�1; <br />