Upriver E 8822 Pasadena Park Church - Sign
a
.
(THIS I5 NOT A PEHMI1)
BUILOING PERMIT APPLICATION WOFtKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS C)F THE FORM YOD UNDERSTANU
C4MpLETE IN tNFC
(Please return lhis original dnd your buildiliq pIdns to Ihe Deyartment of Building dnd Salety)
SHADED AREAS AfiE FOA DEPANTMENTAI USE ~
ProImI Nurtitx'r
~ s Nume LAST FIfiST MI
s &i! p.- k QL~•v~ e~.• o~' ~ ~ o~.~ _ ~ _ _ _ _ ~
Prolact Address tSiroot fvama $ NuniGer)
5 ? R 2 2
1 ~ t~l~rws5 ~
Appl nt
aw a v-r9 ~ e w w.Q 9GoS 4A
~ _ ~ - - - -
Cgty Stale Ph(tne
,
Bu5ine88 Pfione
1 ►
C4nlravfor IAgant Adriress
City Stat< Zir,
1 ~
Contact - - - - ~ - ' L"nse Number MeyuiredN Business Phone ~
f I
Architect A Eng1n?e► Address
~City Stato Zip Phone
1 1
Conlatt ` - - - 8usiness Wiont,
1 1
Lendsr Address
Gty Slate Zip FNOne
! 1
Oesarlbe Wark Res Comm
51~~1 ' V
SubdrvisiontPlac Name/Sha►f PEat Numbet
PPNs po~r4A
Assessor Parcel Numppr Lo1 91odc PIOt NumDe►
D(PSoq 1- O 2 D 2
Aaztlnent Flle Numoera ~neo Ccmp Plan ConaM 7raa1
Nun+ber 01 Owelllng Unlts Number ot 8u11dinp t,at Siza (Sp Ft lAcre) Oepth Fronteae
Front Satbw4t Lett SdWfc iiight Setbaclc fie4r SetOadt
Ad01tMiW lnioftnallon Squaro FooteQe
W
. ~
~
H
Z
W
~
1- _
~
Q
- a
w
0
,CI~~~ - `Tyr
= Rlr~~ m ~ ~ ~ ~~3 ~ '
~
,
,
~a
DEPARTMENTAL REVIEW
~
Approved Cond Ap,proval Hold
Environmenlal Meallh Perrntt Nurnber ~
Q W 1101 Coilego
Roa►ri, 200 - ,
- ~a
y ~ Pianning/Zoning
N 721, JelferSon
~
- , ~
Engineers Permit Nurtlber
9- I
~ N 811 Jeflerson
Utfiifies
❑ N 811 Jelterson
•
i ~
Plan Revlew/Fire Prevenllon '
N 811 Je(ferson ~
~
- a
, p
a Ofher (SEPA/Crllical Meterial/etc
- ~
- , ~
~ Fa9t Track/Speclal fnspeolion intvrmetlon
- Y
Project Representative Phone
Address
1 certlfy that I hatie examined this appllcation and state Ihat the intormet►on contained in it and submitted ~
by me or rriy ayeiii t;, trun correcl. le9el. and binding,
~
C)wnLr `,ignatute f1~ta ~
~
~
~
~vt`.i
~
nottil ~
~
! ~ e
G
to
~
. 1975 ,
y
.o
~
4b~ ~
1990
; - - ~
~ -
~
♦
~ . _
♦ ~ 4~
G
ir f ♦ ~ -
~ Lj ` ~ ~ t ~ °`se "4`
. ~ ~ l~ardlc~►P ~ ~ • ~ - . , ,
, •
~
~ • ~l . ~ " ~ ~
~
~
'1 ~ { ~ ~ ~....-t° ~ ~ ~ Y' ~ ~ _ ♦ t ~ f
• r~ ~ ~ a''1' ~ j'
w v Ir ~ u r A t ry• i,
~ Z w 1
i ~ ~ ~ ~ ~~y • . a~----" t ~1 g ~
T'qb
~ ~1~ .`ts + ~ , • ~ ~ ~ a7 l~~ t ~ ~ ~ti.. f ~ ~
± ♦ ~ t a ~ , +y ~ IM~i►' " ~ ` •a~ J~' ~ ~ a ' R•~ ~ ~
~ ~ 'f ~ ~ ~i~,h,~ r~ yilky~ ~ • 'ml ~ ~ 1,J ` ~ '~Ro" y
' * r t , ~ ~ ~
*J~ * ~ ~ i ` r ~ ~
x
• y ~
,
•
. • 'rc ~ ~ • ~ ~
• , ~ ~
1 !e~ • ~ ~ ~ ~ ~ d < ~ ` ~ f ' •
•F `
_ ~ , l ~ • r,,
r
~ ~ f ~ ~ i~
r dt
;
~ ` ~
• ~ ~ ,y = ~ ~
~
Y
4 4 _ `a ~ ~ /F Y 0 J ~
~ ~ 'Ja..
i
~ l ~
♦
♦ ~ 1 %19
~ t
l- _ ~ ` • f
~ .
1. ' ` + ~ ' „ • '
I
r
a k
w
~ -
~
~
~
r.
tre ~ ` ~
~ ~ .
f