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PUBLIC WORKS <br />d Address Application <br />Building Type: ; S} R _ _ XNew QVerify ❑Preliminary (future) <br />Please complete numbered items- 7)ondsubmd by e-mail to: mholey@aeverettwo. us Cali 415.1S7.8813 for other options. <br />1. Relationship to owner: OWhef' Date: +- Zq-13 <br />2. (a) Your name and mailing address: (b) Phone: (c) e-mail: <br />42S•337• ' o6D comersfaylekomeS <br />TP. <br />Lampiinerl C7rn �P u-S <br />3. Date needed (please allow up to 4 weeks for assignment or verification): <br />4. Primary address application: <br />5. Supporting information and current use of primary address (licenses, marketing, etc.): <br />origin( addres-s °F dc(t40'd kouse : 1130 `low s-t- sw <br />C'E nevu W3 ) -Parcel 4k 28041300203000 (551I -00(, <br />6. Site plan attached (recommended to expedite request): XYes / No ❑ <br />7. (a) Owner name and <br />, mailing address: (b) Phone: (c) e-mail: <br />Cornerstone- It Mr-5 42-5.33$— jPPCornt(5'1brte-k0i'Wr5.k5 <br />POD 144-24 sse� <br />Mi I1 Creek R E-U& <br />Dale: FOR OFFICE USE ONL Y Log No.: <br />Current Parcel Address: <br />Suggested Parcel Address: <br />Owner written approval to revise parcel address received: ❑ Yr_s / No FJ <br />Owner written approval for city proposed address received: <br />COE Master Address: <br />Go Sync GIS Map Address: <br />Microfiche: <br />Utility Bdlini;: <br />Permit Services: <br />Field address verified with photo: <br />C0�� <br />Sent IT <br />h,r,liration lo«n avedabla onl,ne at http://www.everettwa.org;Get P0F.asox?odf1D=5448 <br />❑ Yes / No ❑ <br />n Yes / No ❑ <br />Upe -. i :'ii1 <br />103 <br />