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Sprague E 17002 23 Signs on Site (THIS tS N4T A PERMIT) 6UlLL7iNG PEfIMIT i4PRLICATtON WORKSHEET RLE/kSE PRINT AND ~OMPLETE C}NLY Tt-iOSE PARTS OF THE FC]RM YOU UNDERSTAND CQMPLETE I N 1NK (Please return thts arigrnal and your buildind plans to Ihe Deparlment of Bui►ding and Safety) SHi#DEd AHEAS ARE F(]R OEPARTfi11ENTAL USE ~rn~ec~ Nurnoe~ ~ C1wer s INarrte LAST FIRST MI 1~V 6!5~ 4-774~6 Rr0)9Gt Addtes9 (SRtetltName $ blumher) Zi~ ~ ;wz 4~ !~d owAk4- /~LtIL 5"'or/f&~ Apptccant A+.klress J~P,L ee• 2.ZT~, 1, ~/Z~ 5;#~'14 F_ Ciiy SIa1L ZIp Pfiians ~,J`~~~.}~~ 5 ff ~►~-~,g,:~,-° aus,nms P,on ' ~anlfa~laf 114~~1 AQQres5 ukx l.'3if je 60 .~JYC-,~ City Zic- _z~f~ Pttgne i~ grf I GdhtaCl LiGenIIQ NUrnber (PteqUired l 41iSiRmpt1011B . e ) ~rl ~ r41Gitit1?G1 J EngTft~ Adtl rt:,,5 HO/Y~ _ . C40 y 5tSTB ZFrf P4+ernN Cor~taet 8usaet&s Phonp { ) Lender Adr1r ess oty SteRe ZiG Phone r ~ ~ft mit Fio Oamm eAJ !5 ~ -r'r- A - ~ subMvWO++rPLKr+lernefsnnrt Riac wumrm _ ...r r . . , AOas'arFera~! Nwnihm' y ~ f.ot _ FJlock f98t, Number ~ ~ ~ D 4- Pwtirien! F1le Humbom Plan Geroua Tract _ Nwnbera DwelirrrgUnits Number ot Buftdinpa cua sW ($q. F.IRcre) ~ r Dapa, - Fronrqa - FraM Setba9ic laeEt SeUmedk . ~ "ht Selbacfc €kar SetGaude - ~ „ ~ re~, - ti • - „ ~ ••F_ t~ ~ . -J,- _ ~ - 4 w AdditlarellnEormatiori - ; 54uare FooWga ~ n e' - ~ ..r 1. ♦ 'M1 ~ ~~~~31~~~~~ ~ ~ l[.~ ~ ~ (~..~LC.~'Lt R~` • 1 ~ ~ w z LLI ~ ~ ~ ~ a e ~ M1 o - - . Buttain~7'ecnnlc~n ~e JYP'e . ~ ~7 J - ~ . . ~ r QEPARTMENTAL REV1E1A1 Ct+nti Approved Appreval 1°°l~fd Enwrronmentei Heallh Permri Ivurnber ~ V►1 1101 Cofle4e Roorn 2{}Q ~ PIsnrtingl2Qnrng N 721 Jef terson ~ Lq a-C r ~ ~ 7 Perrnit Number Engir~eer~ ~ N 811 Jefferson Ufllitles ~ N 811 .letferson Plan Reviewl Firs Prevention ~ M 811 Jeffersnn Other (SEPAICrlltcsi Materleiletc ~ ~ Fast TracklSpecial {nspeclion Intvrmatlun Pro1ecl Represenlatwe Phone Address I certtfy Iha! I have amined this applicat}on and tat thal ihe intormation contained in i1 and submitted by me 4r my a nt I true, rreci, le nd bIn01 g Owner`s StgRature Date names o1 + a Frontang Street - Flankin Stre - ~ _ g et - ' 1 ~ LelalOescription ~ ' • - - - _ ~ - - f ~ 2 UF ~ E1F ~ I LyG ,v X4 s -I, RP ~xG 30. F'r tY Ex ' e, - , J ~ 1 ~ _ . . _ v6eA w A - - - ~ - - - . _ _ . ~ ~ ' I ~ / CY ~ ~ r~ Or 5 ~ - ~ > ~ _ • ~ - - - - - ~ - ~ - ~ a , ~ CI~G ~ , ~ scate - ~ Date- Revisions Atlachments