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477PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 10/1/2015 <br /> Permit#: C1510-003 <br /> PROJECT ADDRESS: 2129 103RD ST SW A& B <br /> DESCRIPTION OF WORK: NEW DUPLEX <br /> CONTACT INFORMATION: <br /> OWNER: <br /> NAME: DYNASTY HOLDINGS LLC <br /> ADDRESS: PO 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 0 Applicant 0 Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] 4R <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC,WORKS REVIEWER: <br /> PW Permit Required? ®/YES 0 NO LAND USE PROJECT#: <br /> Please provide explanation: W.O.#: N�f1 <br /> G ijy w/ng- J explanation: / <br /> Associated Bldg./PW Permit#: Pa)l5i0—(UOS <br /> jetitiltk_ Za/S AVC/c--- <br /> See back side for additional review elements to be completed by Public Works reviewer. <br /> REVISED 11/02/2015 <br />