Pines S 16 Donrey Outdoor Advertising - Billboard Structure
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BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNOERSTAND
(Ptease return thia origlnal and your bullding plans to the Department of Buliding end Safety)
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9 7jp Clty State Phone
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12 Fa►rew ReqWreO Plan Ch6ok (YlN) Othet tYiNy SEPA EremDt (Y!N) Ome ~
15 TyDe Wo►k [3 61dg t` MN Z New = Replase I .j~OfAe►
^ Flre C Demo - Add+Alter ~ Move
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Contact pormn Phane If dlHerent Ihan above
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- DEPARTMENT APPROVALS
This is not a Permjt
Appiicatlon Type
(Standard unfess (fndtcateQ approvals required in either °release' or 'refease with conditions'
otharwise Indltated) spaoe prlor to permlt issuance )
] Fast Track ] Esrly Start Release
Retease w/cand 1 Hold 2
Emrironmental Heallh C Commercial, 0 Residential
W. 1101 Colle9e Q New Construction, L-1 Bldg alterationladditlon
Room 200 ❑ Addltionel structure,
APPLICATION N
CandittonslComments
] Plenninp/Zoning• 0 Commercial, 0 Cert oi Exemptipn. 0 Frantage,
N 721 Jefferaon D Setbacks. O lot wld, a lot site. O use/zone,
O CU, variance, zone change. shoreline, G fence,
Q Othet
Conditione 1 Comments ~G¢ T'C QLA07 D~-~ A~D►'tGl-t~~ .
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~ Englneem: C Commercial. r-I Residential, L Fiood Plaln,
N 811 JeNerson 0 drainage C new access/approsch, C? fence, ~
0 road improvements
CortditionslCommeMs
Utlllties:
N 811 Jefferaon ,
Condnions/Comments
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D Pien Exam
Fire Prev.
Condition9/Comments
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ProJect Rep►esentative Telephone
Agencies Performing Special inspection
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1 Indkate above or ettach condttions rolstivs to flnal ss bullt approvel
Z indkats above or ettsM reasons for hold
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Owner ac A,ddxess 2220
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L,ocation Class Traffic
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