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4677PUBLIC WORKS <br /> REVIEW WORKSHEET P 1Sro -vat <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/1/2015 <br /> Permit#: C1510-002 <br /> PROJECT ADDRESS: 2119 103RD ST SW A& B <br /> DESCRIPTION OF WORK: NEW DUPLEX <br /> CONTACT INFORMATION: <br /> OWNER: <br /> NAME: DYYNASTY HOLDINGS LLC <br /> ADDRESS: P O BOX 716 <br /> EVERETT, WA, 98206 <br /> PHONE: <br /> EMAIL: <br /> APPLICANT: <br /> NAME: [AppName] <br /> ADDRESS: [AppAdd] <br /> [AppCi], [AppSt], [AppZip] <br /> PHONE: [AppPhone] <br /> EMAIL: [AppEmail] <br /> CONTACT: Owner ❑ Applicant 0 Other <br /> NAME: [ContactName] �� �� <br /> PHONE: [ContactPhone] (J -_yaa— 1ag <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC y✓ORKS REVIEWER: <br /> PW Permit Required? EdYES D NO LAND USE PROJECT#: N� <br /> Please provide explanation: W.O.#: <br /> S (k y-r-k CA);/i+) bor'L6( Associated Bldg./PW Permit#: /90/570 006 <br /> ja.)6-6,Ak <br /> s <br /> See back side for additional review elements to be completed by Public Works reviewer. <br /> REVISED 11/02/2015 <br />