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Sprague E 7918 Tom Rousseau - Sign (I I'1!S IS N 0 t ,4 P ER^•I'! 11 ) 6UlLQfNG PERMf'T A.PFL.IG1lTION WORKSHEE1" PLEASE PRfNT AND C01/1PLETE UNLY TNGSr PARTS C',F T HE FORM 'r UU UNDFrSTAND COWI.ETE IN INK (Piease return this originat and your bLi!dirg tc tite Uzparlrr-nt of 8;:iiJing ac,d Safety) SHADEC) AREAS ARE FOR UEPARTMEN-fAL USE ~ ~}r~}NCi NUrrL~AI . t1N~~r•. q'~„r.y LAST Fl~~f %~l 77)V ,eovs s 16.441 s~c•j3 r nd I i~,,n .sc; N:.- tZ Numhyr - - - - - - - - - - - - - - - - 7916 v0As r- s~R4 6-OC ~ 5Av--r4locrdc, &..W 17921 Z- Appli;;ant I r1d:.~r~;g - - • - - - - --i _ C'tY Stats ~ Zip 11ticr:e ( ) - - . { Busw.-ss Ph:me - - - . ~ 1 1 I [Uritia Irr Aq-,1.! ~ Adk7r -35 /f/D~"~~~►~E S T' ~/~'ait/ ~G6i~1~P~C/~ .S' Z i D~' I~1.~4~F..Q L~~ _ - L' ti'a; e Zi p Phone ssPo,r,~vE ~ r,c~A 992 Z ~ . - [ . - ~ 1 i:nr:•~ I'IUr•~►~Q• fF?N~`~Jlres:!) f 5iainrxs Nhone .4. 4! ~ So~► ~ ~~f3 - r ~ 9'~" Ar: hil9ct/ Enfllne9r ' Adrf; -;5 Ci-ty 31a~e 1 -Z~p f~honE - 1 ) Contact - - - ,T_~~--- `li~~~r•P..SS °r~nr~H ~P.t~C~BI A::t~' - ~ - - - - -1--------- C,tY i State Lip _ Ph:7ne - _ ~ ' . • _ ~ Rcn. ~ Ccatm. . ~ , . 4 x' iubdlrisHx,r Wal harnelShort Pmaf Number - . . itommm PK00) NVfhbK (.01 81oGk PIat NslmbAf . Ptrtlrtent Fito Numbrti , Zone I ComG Plan CaMm 1'ract ; .~,,r .1 ~e' M M C7t G ~^-s- NwrW a owe+iing unica r+umber of euiia►nQ, i,a slzs tsq. FtJ Acr•> oWn 1 Frontape _ ~ ~ ~ ff,rt sv+bar~c ~.rr ssreadc Aron► Selloack w.ur soYa.ac a1w wiatn AadjtlCnO lMOrmitian Squar* Foo+.2rpe . . 2 O F= Q . S . ~ O . ~ ;fl,*. . . . Z , . ~ ~ x ' . , , .z~ _ . Q ..i . ~ ~ Y . . ~ ~ , . . 4 . ~ . • ' ~ . . . . . • m Mlfrltilf 01 138Q1U0fTY1 Bull+flns Tw•hrtlcion ~ lktv Group ~ 1'Yp* ' ~ ~ ~ . F ~w~i. eM~, ~Aillwril~~ ti. ~ i i`l~~~r .r.~. ~~wwllOl• • - • W.. .~n. < . ~..i tiw ~~sa~1~ r . . i anr~ • ~ r1 r~ r DEPARTMENTAL REVIEW . Cond. , Approved Approval Hold Environmental Health Application N ❑ W. 1101 College Room 200 Planning/2oninfl ❑ N. 721 Jefferson rc~ Engineers ❑ N. 811 Jefferson v . Utilities ❑ N. 811 Jefferson Plen Revlew/Flrs Prsventlon ❑ N. 811 Jefferson Other (SEPA/Crltlcal Materlal/etc.) ❑ ❑ Faat Treck/Special Inspsctlon Informetlon ' ProJect Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to compile said application io true and correct. , . / ~ Signature L Date ~ - Show on Slte Ptan: Additional Information: , Lot Dimens(ons Landscap(ng . Exi:ting Structures Drainage Plan Proposed Improvements Hydrants Structure Setbacka Yopography Easements Lighting SepHc System Slgnage . + _ ~ . , , i . . . 4c : . . . . . Water lines Shorelines Sewer Lines Nighwater Mark ; fences, Wells Drivewayts► Le5e'`tr7ov , Right of Way Wldth(s) Names of Fronting Street ~ ~ . Flanking Street . T i , . , Legal Deacriptlan / 1 ~ ~ I ♦ ~~e It? -7._._,Z~ / ; . , . , . . . : . . ~ . _ : EW E..4s1' :mn' •4&!? E92 UE. . ~ _ . . • - . . . 1 . _ . . . - f . , . . 1 ~ . . . ~ . i ooo". . _ ~ - / ~tj • - . . . . . . ~ . i i~ - _ . - ~ . - ~ • - -•-----a j'" ~ ~ r - • - ~ + - r ~ i r • • ; - ± • . ~ i ~ ~ , ~ , . , . . • , , ~ • . ~ _ , . _ / ~ . 1-- l----t 1 i- , ~ , . ~ , f , ~ : , ~ ~ . . ; ~ . / . , ! } t Scale: ~"~O-O Date: Z - 28- SG . Revisions, Attachments: . . . 4 - ~ pl.tJ r'~ C - 7_c-~-% P L! E W 3-0~- J~ 3'.Or_. / ~ ' . . 12'-o.. ~ ; ! r-~--\ ~ D A r---~~,-~ 3• D v ~ ~r JL ~ ~ . ~ . . . / / ~r , ' . - . / . , _ . ~ ^ • ~ . ~ ~ , • ~ , . . ; . . . . . ' ~ , . ' l , . 1 . 1~o1ls s~sa 3'X 3'X Dti~~ . NORTNWEST SIGN CO1VIPANY SOUTN12107PlAYEAORtvE SPOWINC.KASHCrvGTON 99223 15071 448•1195 SCAIE: ~ OM APPROVED 41'. ORAWN 6Y ~ OwTf: 2 ! ~cl- S5- REVISED Sp,~A G v~ ~ P~PoPCtSED s IGN aT ,,~Q s r 7518 . , DRAwiNG NUM6Eq l86// . ~ -