SPRAGUE E 7103 Sign - West Valley Mazda . y 1
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETF, ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safely)
• 1 Owner's Name (last) (first) (m) peWment lJse pnI y
Wes t Vallev 1`lazda PM• ~ Comm
2 ProJect r (not Mailinp Addresa) or Road Name Space Zip
E. .~~Sprague Avenue 99206
3 Gty/Community State SubdivisionlPlat Name
Spokane WA
4 as.sessor Percel No. Lot Block
3 3 1 Q~ ~'1Q ~ ,t * * DEPARTMENT USE ONI.Y * + rr
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5 Sic Code ne Act. N Zone Project No.
33 - s511 D~!-f2_J-
6 p,,,el I # I No. of Buildfngs Sq. Ft.lAcre Depih Frontage
7 Set Badc-Front (L)S-1 (R)S-2 Fiear ORnsua Trect Module No. Initlals
* 16 Architect Firm Name Street Address *
Zf p Gty State Pfione
f )
Gontact Peroon Phone if different then above
• 0 /
Contractor Flrm Name Street Addrsss
Tri-State Sign Co., Tnc. N. 619 Napa
Zip Clty State Phone
99202 Spokane WA ( 509) 535-7724
Contact Person License No. Phone If different than above aOrlyn Vieesaa TRISTS*257Q6 8 Owner/Agent (if different than M1 above) Business Address
g ZIp City State Phone
( ) ~
12 Revfew Required Plan Check (Y!N) Other (Y1N) J SEPA Exempt (YIN) Date ,
,
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15 Type Work Cl Bldg CI MH 0 New C Replace • Othe~ ~
CJ Fire ❑ Demo C7 AddfAHer O Move SignaP-e
14 Describe Work
Tnstall 4'x1$' and 4'x8' ~ii~nlav on Dine ner sketch
10 Applicant Name Street Address
11 Zip City State Phone
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* * ,
Lender Street Address
Zlp City State Phone
Contact Person Phone i1 different than above
( )
Add i t i ona I I n format ( on
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DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either "release" or "release with conditions"
otherwise indicated) space prior to permit issuancd.) ~
~ Fast Track
Eariy Start Release
Release w/cond 1 Hold 2
~ J Envlronmental Health [I Commercial; ; 1 Residential -
W. 1101 College Cl New Construction; F) Bldg alteration/addition
Room 200 P. Additional structure;
APPLICATION #
Cond(tions/Comments: -
❑ Planning/Zoning:~ U `Commerciat; 0 Cert. of Exemptfon; 0 Frontage; , ~~3 7
N. 721 Jefferson O Setbacks; O lot wld; O lot size; O use/zone; rU
❑ CU, variance, zone change; shoreline; O fence;
❑ Other
ConditionslComments: .
El Englnesrs: 0 Commercial; 0 Residential; ❑ Flood Plain;
N. 811 Jefferson O drainage Q new accesslapproach; O fence; t
0 road improvements
Conditions/Comments:
0 Utilittes:
N. 811 Jefferson
ConditionsJComments:
Q Othor: L~
❑ Pian Exem
Fire Prev.
Conditions/Comments: ,
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Project Representative Telephone
U
o, Agenc{es Performing Special inspection:
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3.1 Indicate above or attach conditlons relative to i{nal es built approvai
2 Iricllcate ebove or attach reasons for hold
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