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Sullivan N 1104 Chevron - Sign ~ (THIS IS NOT A PERMIT) 6UILDING PERMIT APPLtCATION WORKSHEET PLEASE PRINT AND COMPLETE ONI.Y THOSE PARTS OF THE FORM YOD UNDERSTAND COMPIETE 1N iNK (Please return this original and your bullding plans to the Oepartment of 8uilding and Safety) SHAOED AREAS AfiE FOR DEPARTMENTAL USE ■ . ~ PMM mttn lor ~ ~ Owner s Ne/ne LAST FIRST MI NumDet~ ~p zc~ 10 ~ 41 .,r(I J.. ~ aaa►es~ &/;v Avplicanl I~~ L ~ 0~ d ~ ~ P OGZ" CI~ 1-,[ Stata ~ Zip Jor PhOne L&Y' Businow Phone . ooncwa,AgeM ndd.ess ~Q 11 Aktil v4- Vx~ ~ Ci" Sfate / Zip Ph+one w Jvy 1 4f tact Llcenae Number (Required) / Bueirtesi Fflo~ ~ ~V !..OF3 f..a6 Mhitect 1 Enpineer ~rom Clty Slate zip Phone { ) Gbntaat Butinm Fhom 1 1 umder Ada►ess - ~ - , • oty State ZiD F Phom . I ) rw ~ 1 ~ r +`.r Qw'~t~~v~-~` ~ ~r-` .,~~«J ~'~~^i t~'~-~~,~1 S~ :¢3~~ ~ ti r .~,~.r -r,t~i+v OAN tort Filat ~ ' ~ .c' ,~~y~M`~^ .a,0.~,0'- ♦ r 7 i 1~~`s - ~ 4~" `~d ~ ~t~ ~ ~N~~~='~'~-4.~.w'b~}~ ~ ' 2~' - ^'it'~~ ~~~i~r ~ }►~'?~~~~i'~°.+i ~ ~ ` ~ ~•~y~'+ ~ t+~',1~ ~r~' t/`.~. ~-.,o~ l~ v Z44' ~ s tr.1 J - e s. AOSBSSwP8►~8! lyumbe~t _ ,~~^~,.~~„~i t ~~t,bg ~ y~ _ ~s ~ M ~ r f " ~ _ ~ s ~ ` C4.~.,p~w..A t... ~u ~3F ~✓~J w .y l ~,p~. -Y" ~ ~ ur.a..~ ~D~:b~'A`~r + c / Z ~ 10 ~stiH{{~ cW1P.PM~~ cwdDTmd 'D? ,Cr~i~~*~1ar 4 • ~ [3:~ U w. ♦ pf 2'w : q C.., i ~ a ~ .ayA 1 ~ ° "~,:n.s ~?u~~ :i 5 .ti ~ ~ n c ~ - s y~w:t E ,i;;. . j..~_-,e~;aG•ri _ e~ - ~ ~a NWnl~etOt Owelttnp lh+lt8 - ~'~be►tf~ BwiQt~ ~ ~i'`~ _ ~ ~ i6Q~~•/A0n9)~, ^ ' , ~ Oeptlf.~~,.e~~►.,.~~ . Ftant~ • ~y~"~ 1~`'t~, ~ . • t ' i ~ • M.~~.-L~ r 'a! ~ a~' t,. # ~'~~It~IF~~~"~ J p v' _ "st? ~b~~F~~~;~il~~~'~~ s9__ * • . Front 8eiba* ; r • ~att 8e~t " ' r,~ Rf01~t SM~t~~„ ~ ~ ' i~eer~~~fc•.,"` ' ~ T ¢ Rf 11V Widlhr=~ ' . ~ t,X'I•'4s. S'¢~~f~'~ t ~ K~ r-7~iy ~a- ~ ~ ` • ~ ~/^~+i~~cR ~kkmW tntato, lm '`1t t^=f ~ 3!~'t ~ w~" l I ~,t ~-v/" kc~J.'1~_~ ~ qk~Y • qOV~~R 'li~R`f'-~' ~ cb ~`yEY~~~'' ~ ' ? b:. ♦ J y.1' 1,'y .JS~j~.f.s r.s r ~ v G 'c' 7~ • J y.s v yl♦ ~i ~ ' A w ,1~.-~~.?~ ~ d J ,~,.p .e ~ o - - • a~ ~ ` ~ ~ ^ 'J. - ~ ~ d! 41. ~ 4 ~ ~ ♦ t ~ C l ..5~}p - ~ ~ ~ • ..~1~ ~ ~.~T'~, Z < r ~ y ~ . ~ e. a..~/✓' ~ ~ • 4 ~ C t,y f ~P•~'~~.'~~P ° t ~ J t ~~.r iJ~ ~ Q J af r '0 s ~ o'~-t ~ J ~i d ~ . " " i- t ~ ~ t ~ ..y'~- y ~ _ - ~ ' a ~ ° ~ "4 yQp- ~ , • ~ ~ r ~i~5 ~ ; ~ ~ ~ E c. ''Y,';fi ~f ~T ~ ~ a C ~ t _ 1 } ^ ' ~T ` ~ • ~ ~ fii tc r ~ „d~ •-r r'.~~+; ~ Q _..t~~ • e = ~ ~ ~ , P" ♦ ~ ~ ' ' ~i ~i ' j RM r, ~ y ° • o ~ • J.:~ ((y~T~ 3'~ 4J4. F'~ ♦ ! : ~ ~tt-• • < ~ ' ~ k t O f~ if • 'Y • N~,.•c Z ~ i ~b+ ~ f. C .a .e fi►„~ •L ' C,Js ir~~ ~ r ' ~r ~ : r. ~ ^ ~ i4 ~ ,~.,z _ - y ^ ~ _ • „s • ~ ~ ~ Q ^ c ► ~ ` ~'t'1P~a ~d r_ ~ r ^ - 1 ► = * ~ c p~ ~~i. 1 s ls~ vw ' ~ ~ ~ l s s ~"~7' s^' - p.. ~y~ "Y4~t~~ oYiW yi~ T~ ° YWY as' ~ ^~y• • ~'a`' ~ R.. ~ ~ ~ ~~~i ~i1MY~ ~ ~►ir •7►~ ~ + ~ m ~ t 'Y',y~M: ~ .Qt~+'+o ` r _ ~lia YS ' y.~~~7~ ~ ~ ^ ~"st. ~ Q 5~~~~~~ ~~+a J -~42• °~:4~'+~~ ■ 1 ~ • DEPAATMENTAL REVlEW Cond ' Approved Approval Hold . 1 Environmental Hesllh Applicatton 0 ❑ W 1101 COltepe Room 200 PlannlrrglZontng ❑ N. 721 JeNerson i ~ • I I ~ - t , Englneers 9 ~ 1 S- ❑ N 811 Jetferson ta -A& - uuu«s8 • - ❑ ~ N. 811 Jefferon _ • , Plen Revlew/Fire Prerention ❑ N 811 Jefferson - - Othe► (SEPA/CN!leel 11Aatarlal/eta.) ❑ ❑ 'Feat Tradc/Speelel Inepeetton InlormeUon ProJeM Representattve Phone Address _ 1 c.ertity that 1 have examined Ihis applicatlon and state that the intormattan contained in it and submitted by me or my apent to compfle said applicatlon la true end correct Signature Oate i 1 ~ . 3 S i r, 1 ~ t1 y b - ~ A ' 1 t' ~ 7 2 f~ . lz ! . , ~ r t ' ♦ t ~f ~ , ~ • s~. ► ~----.~5 3 ~ ° ~ ~ _ ' ~ • ~ ~ ~ ~ - i J ~ s IP F , ~ 0A~- _ - , S vi ~ ~ ~ . 1 ' ~ . . • t " ' ' c ~ (It