Sprague E 12709 NW Outdoor Adv - Poster Panel ..r ,
(THIS lS NOT A PERMIT)
BUILDING PERMIT APPLICATIOlV W4RKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN !NK
(Please return this original and your buitding plans to the Oepartment oi Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE '
Project Numper
Owner s Name IAST HRST MI
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Project ACareas (Street Name 8 NumDer) ~ ZIP
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Applicant Ado►ess
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City State ~ZiO Phone
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" 8usiness Phone
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c«>>ractor iAqent Aadress
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Gty State Zip Phone
14 Contact Litense Number (Requir ~ 8usiness Phone
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Arcnitect! Enfl&neer Addre55
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City ~ 51ate ZiD Phone
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Coniact Bus+ne5s Phone
Lenc]pr AdUreSs
Gty State ZIp Pnone
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Gesc►ibe Woric Res. Comm.
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Subdiriaion/PlatNameJShort Plat Number . . .
Asaessor Paroel Number lot Block Plat NumDer
1-5-15 ~2-.~ ~ZU
Pertinent Fite Numbers Zone Gomp, plan Census Trect
NumDer 0f Dwellinq UnIts Number o1 Bulldinqa Lot Slze (Sq. Ft.lAcxe) Depth Frontape
Front SetbaCk Lett Setback RiQht Setback fiear Setbac;k
Addit►onal Informalion Square Footape _
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Building Technician Oate ar°'up ~ . . '7YDt
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DEPARTMENTAL REVIEW
Cond. Approved Approval Hold
Environmental Health Permit Number
❑ W. 1101 College
Room 200
PlanninglZoning
~ N. 721 Jefferson
Permit Number
Engineers
~ N.811 Jefferson ~E2 ti,-c~eA 51 -Ie ~ uST ~g
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Utilities
❑ N. 811 Jefferson
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Plan Review/Flre Prevention J
N. 811 Jetferson plwi;? E0 s2 )(,u
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Other (SEPA/Critical Material/etC.)
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~ FaSt 7rack/Special Inspection Intormetion
Project Representative Phone
AQdress
I Certity that 1 have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature Oate - -
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