Laserfiche WebLink
-� 3��7le' Ga�-e -r�„s <br /> . . T�z M ,D �n� t� - <br /> PUBL/L N/O/�K5 <br /> Address Application <br /> Ouildmg Type: Wa�er Trealmenl Facility __ __� �X New ❑Venfy ❑Preliminary(future) <br /> Please mmpletc numbered itrms(1 - I)and submrt by e�mnJ ro: mhole�@Ci eerrett wo.us Co11415-157-8813 foi atFcr opt�ons <br /> 1. Relationship to owner: 'cl o"tr�cio� � Date:,s�� zinz � <br /> 2. (a) Your name and mailing address: (b) Ph,one: (c) e-mail: <br /> --- --- - ----- --- --. ---------- - � --------- - - - _._.., <br /> Alan Hall ' i(425)355-2826 � �alanh�glacieremiro.com � <br /> �Glaaer Environmental � <br /> 4416 Russell RU.Stc A Muk�Reo.WA ---- �---- <br /> 3. Date needed (please allow up to w4 eeks for assig�ment or verification): i3rsnz <br /> - - ---- - �-- ___ _ __ _ _-' _ <br /> 4. Primary address application: unsurc <br /> 5_Supporting information and current use of primary address (licenses, marketing, etc.►_ _, <br /> �On a woodeC lol listed under 2 Darccl a's: 2804100100200 8 2BOOa0300300500 <br /> '- -------..-.--.._..----_"------�------�-- -----�----..--'----------• _ . . <br /> r-- -- ---- — --�O Yes / No ❑ <br /> 6. Site plan attached (recommended to expedite request): �see eizoa�ozz _ <br /> i 7. (a) Owner name and mailing address_ (b) Phone: (c) e-mail: <br /> --- -- ..----' �-- ---------------- ----. <br /> � The Boemg Company '�� ���»25)269-7B66 I <br /> �3003 W Casmo Rd ---` � <br /> 'Gverett.WA ! � ��� <br /> I _ . � <br /> p,a f�: FOF OfFICc USE ONL Y L oa�✓o.: <br /> Current Parcel Address: <br /> , Suggested Parcel Address: <br /> iOwner written approval to revise parcel address received: � Yes / No � <br /> � Owner written approval for city proposed address reteived_ __ _ _ _ O_Yes / No ❑ <br /> COE Master Address: <br /> Go Sync GIS Map Address: <br /> Micro(iche: <br /> Utility E�illing: <br /> I <br /> I <br /> Permit Scrvices: <br /> Pield address vcrified with photo: ❑ Yes / No O <br /> npplicaLon(ormovailablco�li��edth(Ip.//www,everetlwaorR/Get_PDFasp.7pdf�D=54dR UpAatcd '/?3/?01_' <br /> �3 <br />