Mission E 9204 Donrey Outdoor Adv - Billboard
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` BUILDINQ PERMtT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Piease return tAls orlglnal and your buiiding plans to the Oeaartment oi 8uildtng and Safety)
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5 Sk Gbde /IC! A Zone "ect NO
6 pN„dl / Na af 8ulldinpa Sq FI IAere Oepih Frontaga
7 Set Back-Frant lL1S-1 IFt►S-2 Fiev Qenws Trac! MoOuie No
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8 OwtWlA '~nt 01101ftA►afR U18f1118DOr'0) 8usiness AOOress
9 rro ari , stace Phone
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12 Revrew Aequired Pian Checlc fY 1 Otner (YiN) SEPA Exempt (YI N) Oete
t5 Type WOrtc ~ BIdQ i MH C. New ~ ReOlaoe her
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DEPARTMENT APPRDVALS
This is not a Permit
Appilcatlon TYpe
{Stendard unless (Indicated approvals required ln elther •release' or •release wlth conditlons•
othenivJse lndicated) space prfor to permit iseuance 0 Fast Track Release
Early S1art aslease w/cond 1 Hofd Z
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Emrlronmentel Hesifh p Commerctal, C Resldential
~ W 1101 College Q New Construction, C Bldg elterationladditlon
~ Room 200 O Addltional structure,
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~ APPLICATION #
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CondittonslComments
❑ Ptannlng /Zoning• D Cammercial, L Cert of Exemption. C Frontage. ~
N 721 Jefterson C Setbaclcs. C1 lot w/d, Cl lot size, 0 uselzone. ~
Q CU, variance, zone change, shoreline, C fence,
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0 Engtrtsero• C Commercfat. C Residenttal, C3 Flood Plain,
N 811 Jetterson 0 drainage C new aocesslapproach. 'D tence,
, 0 road improvements , .
ConditlonslCommenta• ILeza ?r 4garpn
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N 811 Jefferson
ConditionslComments
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~ ❑ Plan Exsm ,
F1re Prev.
Conditlons/Comments
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Project Representatlve TelepAone
~ Apenciea Performing Speclallnapection
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1 Indkate above or attach condiNans releHve to ilnei es bulit epproval
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BUtLDINQ PERMIT APPLtCATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDEflSTAND
(Please return this ori;tinal and your buiiding plans to the Oepartment of Butidinp and Satety)
t own~er s Nwne pa~t) ~A retl trt+) aapwtmws uW only
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8 OwrterlAQe jit diNetertt tfqn Mt abws) Sua+neas Ade~ss
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12 FievtewRe4uired PIanCAedt (YIN) Oth!r (YdN) SEPA Eacemp1 (11;N) Oate
15 Type Work Bldp G MH C New - itwface r/01her~f
C Fire C Demo Z AddlAlter = Ma8 -r
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DEPARTMEidT APPROVALS ,
. , This `is not a Permit Apptication Type
(Standard untesa (Indicated approvals re-quired In either "release" or 'release with conditlons•
otherwise indlcated) spaoe prior to permit issuancs
0 Fast ~Track ,
Eerty start Re~ease
Release wlcond 1 Hold 2
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Environmentel Health Q Commerclal. p Residential
W 1101 Cotlege Q New Construction; L~ 81dg alterailon/addition ~
Room 200 `O Add(tional structure,
APPLICATION 0
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Conditlons/Commente `
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❑ Ptanning/Zoning: ❑ Commercial. Cert of ExemptioR, ~'J Frontage; i0 f I~(~ I
N. 721 JeffBrson 0 Setbacks, 0 tot w/d; fl lot size. ❑ use/zone.
❑ CU, variance, zone change, shorellne, O fence,
0 Other r
Condition Comments
C7U 13 /Lt, ! T"7-~-T:~p S' i TE ~~'t-f
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0 Engineers:. C Commerciel. -0 Residential, 0 Flopd Pialn,
N 811 Jetterson C , drainage L-1 new accesslappraach, Q fence.
, G road improvements
Con0ltlone I Comments :5.-~~~ T Ta ~Xr~~~Ch i~~ fn ~ t.~~~J'✓ ~i~ Ja~~
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N 811 Jetferson
Condltions/Comments
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Oonditlons/Comments '
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1 Indkete ebove or etteeh oondHlone relative to Ilnel as built epprovel
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2 Indkate eQove or ettach ressons for hold °
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