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PUBLIC WORKS j <br /> E� REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 12/1/2015 <br /> Permit#: B1512-001 <br /> PROJECT ADDRESS: 2525 W CASINO RD BLDG 7,A/B <br /> DESCRIPTION OF WORK: TI TO ADD BREAKROOM-CLEARWATER SERVICES In w �tw <br /> CONTACT INFORMATION: <br /> OWNER: <br /> NAME: INTEGRATED REALITY �✓ L �'(J <br /> I <br /> ADDRESS: 1015 THIRD AVE#900 <br /> SEATTLE,WA, 98104 <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 ❑ Other <br /> NAME: [ContactName] <br /> PHONE: [ContactPhone] <br /> EMAIL: [ContactEmail] <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: <br /> PW Permit Required? ❑ YES N\NO LAND USE PROJECT#: <br /> Please provide explanation: W.O. #: <br /> Associated Bldg./PW Permit#: <br /> mo C�Q�ge`Z�o �Si a/c <br /> See back side for additional review elements to be completed by Public Works reviewer. <br /> REVISED 11/0212015 <br />