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SPRAGUE E 6711 DONRY OUTDOOR ADV. BILLBOARD (THIS IS NOT A PERMIT) BUILDING PERMIT APPLICATION WORKSHEET ; PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND COMPLETE IN INK {Pisase return this original and your b(jilding plans to the Department of Buiiding and Safety) SHADED AREAS ARE FOR DEPAR7MENTAL USE ProJfx:t Nurnbpr Ownpr'S Namg LAST FIRST MI J P►oJect Address (5tfeet Name R Numher) - ~ Z,p ~ Ap,phcant • ' Mdross I City . (i L StatP~ Zip . Phone f ~ Business Phone f ) Contr;yctpr ! Agenl Address ' CIty j State I~ Zip Phone ~ ~ i. 1 ( ,c~ Contact License Number (qgquired) J~ Business Phone _ _ ArChltettlEn9ineer Addrr~s ~ . C;tY Sfate F'hone / L' ~ ~ Contact Businfts Phone ~ ' ~ ~ ~ 1 r~ 1 - ~ ' • / ~ ~ / ' ' ; 1 } ~ iLencler Address City Slate Z,p '-phone . r ~ C~cn'i Woric ; Fke. Comm. ; ; 8ubdfvislon/ Plai Name! SAOrt Piai N umbor I.swaor Paroel umber Lot glock Plal Numbei FrrtMwst File Nurnbers ~ Zane ~ Comp. Plan Gensua Tract 1 ~ Nvmberot Owsllinp Unit!l Number of BulldinQs Lat Size (Sq. Ft.lAcre) Depth Frontaps ProM Botbrdt Left 5etback R19ht Setback Fiear Setback AddltWnat Inlormatfon Square Foota9e W ~ ~ H . Z W ~ F- Q Q a w . o Bulidinp Twhnbtaa ~Nle Group TrPe ~~v - ~C~'"194G , ~ ~ ' ~ ~ _ ~ ~ - - ~ . ~ ' . - . ~ . , ~ I , I ~ " ~ ' - 4 I . • ~ ~ ~ + ~ t~ . , . ~ ~ t w, ~ ; ~ ' ~ ~ ~ 'a ~ ~ ~ ~ ~ 1 , ~ ~ ~ - , ; . ~ ~ ~ , i , ~ ~ f ` 1 ~ ~ ~ ~ ~ . ~ ~ , ~ ~ ~ ; _ - ' ' ~ ~ ~ ~ , . _ . ` I ► ~ ' ' ~ . ~ _ . ~ ~ , ~ , ~ , ? ~ ~ ~ . ` ~ ~ ~ ~ t , ' ~ ' ` ' , ' , F ~ ~ , ~ . . ! . ~ , ~ , , ` ~ . ~IS M _ J . ' ~ 'G ' 4 ' 1 ~ t ~ ~ ` ~ . ~ _ ~ I . t ~ ~ . v ; ~ ~ ~ ^ fi . _ . . - p t `~i ~ . C 1 ~ , Y A t ° , . ~ , ~ , , , , , ~ti , ~ . - ~ ' ° ~ I ,p • " , . ~ . ~ ~ ' ~ ~ l ' ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ , 7 ' ~ ~ , . ' i 'r ' i~ ' ~ ` , { , i ~ . , - - ~ " ~ 1 ~ e--•°"a • _ - " _ _ ~ ° n~ ' ~ ~ ~ ' ~ ~ ~ ~ , ~ ~ ~ ~ ~ ~ ~ ° ' ' ~ i ~ ~ ~ ~ i ~ ~ I. ~ ~ ~ . ~ ~4~~1~ j ~ ~ • , , ~ ~ ° ~ , + " " a a ~ • ~ ~'ti } ~ ~ , - , ~ ~ ` ~,~~~i~-~ . + ~ , ~ ~ , 1~1~'11~. ~ ' - ~ ~ ~ ~ , ~ - ~ ~,~r . '~1 ~ . , y . . ~ w,,`~ . T . ~ - ~ , _ . ~ 1 , , ~ ~ .4~~_ .~i r . 1 ` ~ ~ ~ ~-~°~„"_"P . , 1 , - ° ; I ~r,. ` . ~ + _ - ! . . ~ . j ~ 4 ~ 4 1~ F~ - ' . ~ a ~ ~ Y~ ~ ` ~ ~ ~ j s ~ ~ T . ~ ~ ,1 0 , A' . - . , ~ '''1 ~ . "~i ~ ~ ' w 1, e ~ " ~ ~ ~~L'6.~'~ ~ s t ~ h ~ j ~ , ' e . '4 _ ~ ~ - ~ ~ ~ ~ y_ ~ ~ ~ , , } ~ , ~ ~ ~ w p - j ~ . , ~ ~ ~ ~ a ~ 1 ~ r ~ ~ , ~ ~ . ~ ~ "A ~ ~ f . $ , ~ . ~ ~ ~ ~ ~ ~ , ~ ~ ~ _ ~ i ~ - ~ - ~ _ ~ ~ ' r ~ ~ i ~ ~ - - ~ ~ ~ ~ . • ~ " ~ 0 1 - ~ ° _ - 4 - 1 4 1 ~ ~ ~ , ~ ~ ~ ' ~ ~ , ~ ~ ' ~ , ~ ~ ~ ~ ~ . ~ ~ , - ~ - ; ~ t ~ 5~ ; ; ~1 - ~ : ~ ~ ~ - ~ ~ ~ _ a ~ ~ ~ ~ ° . ~ ~ ~ ' , ° - ~'a ~ ~ ~ ~ ~ ~ _ ` ~ ~ ~t ~ ~ ~ ~ ~~1 ~ ~ - ~ - ' ~ 4 , , . ~ ! ~_~~a~ ~ ! 'i + 1 ~ . . . , ` r _ r i' ~ -r - . " . ' ~ ! . . ~ ~ - - k ~ I ` I « ( 1 ` . e , ~ - ~ ~ ~ ~ ~ ~ ~ j ~ ~ ~ a _ ~ - ~ ~ ~ • j ~ II ~ 1 . _ - ~ ~ ~ " ~ , , I ~ , , 1 _ ~ , - , ~ ~ 4 , i ~ ; ~ _ _ ' _ 4 ~ s . ~ ! 1} ~ i ~ ~ 13 w 3 4 v.~'r°0 "'i~:.~'i D [_A ('K 7 9 0 17 40 4 R I E'GI::L_, / 3 1 /7 5" TA X 1.) N I'" D F Z F'~' E:' T; M I" 1'~t 0 V f::: D 1.) M PR` D V E F) T C.i 111'11!- r~ 1 iwi f" . 'i' C11' f`t L. F~ C~~~ E: ~'r ~i S r`1 L_ kJ ~.~R f'1 I~k 1~A~...UL F~ 1=ti I::, t`~ i... L ~ 1::- v fi L. LM C:: v F11... l.9 l:: Y 17~ E; x c ~ 9 : s 14 0 0 4~ .00 140000 14 (1) C} 0 06 x ~ 6-1 . 92 14 r:o °i} 0 0, 14000 0 1 400CIG 4 .9 :1 14 <<000 ~00 j 4 n~~C.) C, 1 -10 0 0 13 .2 r) 4 3 W 3 0 FT 0 1. )'W i I ~ 0 T-`~ S E I / 4 S CJ F Fi R ~ . 1 13534-90wa3 1 A I_ F O N 1.}U A N E . N Tr!~ ~i~Ir+.['.r. I. Is,T. K a NJ ~ W r-i 9 9:1 0' i7 0 t'l r.:r 7 8 i._ r~ ~ r~~ ~ i... c: ~:i . re: i_: r-" 1', ~ ; LJ r r'l Lt . II1 U ~~q a:~~ 1) . I'r~, ~ ~ ~ COD 140000 14 r., r,, -0 rti 1824 4 ~ 7~S . v Y! ..'f 9 12. ~ . 64 14(30r~~J 4~~Gt~~7 ~ f)~ . N! ~ r.~~~ ~7C) . ~)0 , r}r~ ~2 6 4 !J . F I Fti F' kJ . WE: F Li 4.1 N I`' D . T A X EX CO T:, E1{ R ,3 T L) r-'7 R F l-f . !-J IN) UNi "L? - I r [X ~'X CO1? F ``1~4 El . V, 9 22 3 . 05 • 264 B 5 FtiIf:=GEL., R D 13 '25 43 WA230F1~ OF SWI/4 D 06 2 017 SEA14 s a F 13 ~:3 4 - ~r ;33 6 7 4 i f-~ ~:'i'~`f-~ ~~°rl~C~ ~'~V~:: a"~t}d;~"1~~?~_, Mw1'. RErt ET' F:MS DDRMS PTHS' F#SMT C;ONI,S' COND Fr' Fk0 DW GI) WW [",R DD SE F''AT INT A T R SF' R Dh Cf' T GAR SMF' 11 SE= UNT S L.. C1 'F' ,S` I ~ L. A1=1 k:: t) ~ I~~ L•~ S . I) AT ~e S,.P1:-'1CE i A FF' 0 S ~ 40181 12/3 1 /75 BLo I) i VA L. Ir'L. D 2 Vf-`sL f3 l... 11 3 VAL , IONE HE::PiT ROOF S'II}f- 50 14 i I i i I i J , . ~ DEPAATMENTAL REVIEW Approved Cond. Approval Hold Envlronmental Hsalth permit Number ❑ W. 1101 College Room 200 r Plann(ng/Zoning ❑ N. 721 Jefferson , ~,C~J - ~ • , Permit Number Englneers ❑ N. 811 Jefferson Utilltlea ❑ N. 811 Jefferson Plen Review/Fire Prevenilon ❑ N. 811 Jefferson Other(SEPA/Crltical Material/etc.) ❑ . . ~ Fast Trsck/Speclal Inspectlon Intormat(on Project Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent is true, correct, legal, and binding. Owner's Signature Date