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00 P118LIC WORKS <br />L Address Application- <br />Building Type: (�jGnt�{iUucd L)FIZ <br />1-j) aCq- 00�' <br />Uvenry Urrmnnuiuiy v­, <br />Please complete numbered Items N - 7) and submit by e-mail to: mholey@d.everett.wo.us Call 425.257-8813 for other options. <br />1. Relationship to owner: O[ )L— Date: 8-7— I Z <br />2. (a) Your name and mailing address: (b) Phone: (c) e-mail: <br />Ca'eg pt„b.,s <br />HlS-347-&g5,(a `yor-Se y,C' ci.e.s Ca looc �g.m• <br />IIQ, CI T1 Sr t� tw, r /� <br />t-V•.•�tr w.V 4$2o:3 <br />3. Date needed (please allow up to 4 weeks for assignment or verification): J\t R,,,,4 I4;S1,46- <br />4. Primary address application: <br />S. Supporting Information and current use of primary address (licenses, marketing, etc.): <br />2 cF UL.�A W0: '1012- 00 1 -� Ex:sty W-r btz. %Nvt k P%rc e-\ V 1 a <br />7arcl p 6clI) I-,wev- R;�jG bHr s new c,,A4rs <br />Ky`X 6lTIl pf.. 56 W'%'h Ipa CA /Rrh i71. 5,6 <br />6. Site plan attached (recommended to expedite request): ❑ Yes / No ❑ <br />7. (a) owner name and mailing address: (b) Phone: (c) e-mail: <br />C-5\tcl C kAJ'c-vS Y15=3g7-4,g36 p. <br />I(° &97h sc SG <br />6v'dK UjPr 46zs':3 <br />Date: FOR OFFICE USE ONL Y Log No.: <br />Current Parcel Address: _ <br />Suggested Parcel Address: 123 - s,p yth PI S t; EvelVL{ `� 03 <br />Owner written approval to revise parcel address received: U Yes / No ❑ <br />Owner written approval for city proposed address received: ❑ Yes / No ❑ <br />COE Master Address: <br />Go Sync GIS Map Address: <br />Microfiche: <br />Utility Billing: <br />Permit Services: <br />Field address verified with photo: <br />❑ Yes / No ❑ <br />Appbtationtnrmovadahleonlinrathttp://www.everL,ttwa.o.glGet PDF.aspxtpdf1D=5448 Updated 212312012 <br />