Loading...
Sprague E 15405 Country Boys - Sign ("!"HIS IS NQT A PERMIT) BUILQING RERlUI1T APPI,ECAT10N WORKSHEET PLEASE PRihlT AND CUMPLETE C11VL11 THQSE PAPcTS QF THE FORM YOU UNf]ERSTAND CQRI+4FLETE IN IhIK (Please return thrs vrlginal and your bWiltfY-p9 plans Io the Deparirnent af Bulld+ng and Safety) SHADED AREAS ARE FOR 01ERA(ITRIEMTAL USE P~~~~ ~~mber ~ - 0w►ter'9 Narne LAST nnr c ei~,-" 4.7 ~ 3 1 M.. ~ P~roZe~! Addr~3.s {Street Name & Number` ~ -I 1 Vc- APO'iiCar11 Nftlrt3~3 c C~E tate Z~~+ ~'hqpe ~ - ~c~~►l~ l ~ r~. ~ ~-!S~`~... A+~sm~p~.~ P~iOna ConlradurlAgent A~~~It+!ss Gtly 51ate Zip Phme i ~ Contad Litnnw ntunabnrI t;~~~Ulrptl11 I)u5if1t1SnPhAna ~ f 1 /1[E~'3it~Cl/~int3B► ...r l1~ldr~s ciky SlatH ?►r r , CohTaat ~ - Husiness f'tror,c I ~ Lender AuitJrOss C1ly Phana f M Td ~ subr,hdalmr Ptat NaMrShon Fnat Hurnaer ~ ~ A3sewap`ftoel Number k.o! 8lzcic Piat Number 1 AaAlfwft FlJe Numbers ZaR,~ Ccma Ptar► cvftls Tr"r ~~mq Mttitberaf 0*8JIMp Wtii13 Num6er Ot 8uRdFrigs Lat SMze ($R Ft iAcre) C1ePih FrOrtlage . s Ff0et Sedhatk i.ali Se0bac1t A(+OtFt q4-IlUcn Rm SelbaCk RIlN 1Nldln Additkma! fntormWbon Square FooWge ~ . ` 4 , ► . ~ ~ . ; ' ~ - ° ~ ~ . ~ 0 iL ~ j j -•iw'aF 4 -t.~ ~ z ~ya Y ~r Z ~ r i . • + ~ ~ ♦ T~ ~ ~ A" i m NUR1~f Ot ~r(lOfll$ ~ Mr • ` ~ 1 ~ ~ l. T6~h D~a#e l3roup Tyua ~ t'~~ • ' '7 } . - ~ ~ I ~I - , • - - ~ _ _ ~ . _ _a _ _ ~ ~ ~ t { ! - i- - - -4 ~ . ~ - ~ - _ - - ~ ~cs-j ~ ~ . _ a ~ , ` ~ - ~ - ~ - . ~ ~ ~ _ ~ ~ • ~ ~ ~ ~ ~ ~ - - - - h W - - I- ~t--- j - _ . 1, _ ~ , - - ~ - ~ ! i ~ - - , _ , a i . ' ` I ' ~ l 4 , 1 r ~ we u - ~ - - , _ . . - - ; - , : , ~ ~ ~ ; 1 } , ` DEPARTMENTAL REVIEW c ~ ~ I APPrrn+ed Cond Hold , Approval Envlronmsntat Mealth Appllcatlon M ; ❑ W 1101 College' ' Room 200 ~ , 'r I i ~ Planning/Zoning N 721 Jefterson , _ - ~ ~ - , t Engineers ~ N 811 Jefferson ~ Utlltlles ❑ N, 811 Jefferson , - - ~ ~ 'Plen RevlewlFlre Prevenlion N 811 Jeffefson Other (SEPA/Critlcel Meterisl/ete ) ❑ ❑ Fset Track/Speclal Inepectlon Intormatlon P, ro)ect Represenlative ~ ~ P,hone Addresa i certify that I have examined thls plicatlon and etate that the Infarmatlon contained in it and submitted by me or my agent to compile aald pllcatlon la true and correct ~ 7~V ~ Stgnature - - /Z .Oate ~