16TH E 1111 Valley Alliance Church - Sign �-la
BUOLD PERMIT APPi.IC�1f�ON WOA HEE
PLEASE PRINT AND COMPLEYE ONLY THOSE PARI"S OF THE FORM YOIi UND�RSTAND
(Please return this original and your building plans to the Oepartment of Buitciing and Safety)
1 Ovrner's htame (last) (t�rst) (m) pepartment Use Only g
U A L�� ���--174 NC Z.. C° l� t� Comm
2 Pro}ect Addreaa (not Malling Addresa► or Road Name Space Zip
ll 1) ���f
3 CftylCommunity State SubdivisionlPlat Name
j�-��N�~' Z.L��
4 Assessar Paroel No. Lot Block
+r OEPARTMENT USE ONLY ,t
`f ais�� 3 ��a�� 7
5 Sic Code Zone Act.11 Zone Pro�ect No.
6 Dwell S No. oi Buildines Sq. Ft./Acre Depth Frontage
7 Set Back-Front (l)S-1 (R)S-2 Rear (bnsus 7ract Module No. Initials
16 Architect Firm Name Street Address
S'� M
Z�p City State Phone
Contact Pereon Phone If d(fferent t�an ahove
Contractar Firm Name Sireet Address
�jl�M�
Zip qty State Phone
p�� License No. Phone if difterent than above
8 Owner/Agent (if difterent than M1 abovey Business Address
g Z�p City State Phone
t 1
LL,
/2 Review ReqWred Plan CReck (Y/N) Other (Y/N) SEPA Exempt (YlN) D�te
15 Type Work O Bldg MH O New Q Replace �Q Other
O Fire D Demo d Add/Alter O Move
14 Describe Work
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10 Applicant Na Street Address
%�C,��-i.,�" C' L" 13 7/ 1> 3 o-1
11 Zip City State Pho�e
�i �j K R N t �J�- r�- 2 7 0 3
Lender Street Address
Zlp City State Phone
1
Contact Person Phone if dilferent than above
1
Additionat Information
DEPARTMENT APPROVALS
This is not a Permit
Applic2tion Type
tStandard unless (Indicated approvals required in either "release" or "release with conditions"
otharwise indicated) space prior to permit issuance.)
C] Fast Track Retease
C] Eariy S1art r9lease wlcond 1 Hold 2
C Envi�onme�tnl Health Commercial; rJ Residential
W. 1101 College New Construction; i7 Bldg alterationladdition
Room 200 Additional structure;
APPLICATION
ConditionslComments:
Q Planning/Zoning: Comme�cial; O Cert. of Exemption; O Frontage;
N. 721 Jefferson O Selbacks; Q tot wld; lot size; O useizone;
CU, variance, zone change; shoreline; O fence;
O Uther
Conditions/Comments:
O Flood Plain; y
Engineers: C] Commercial; CI Residential;
N. 811 Jeffersun drainage L7 new access/approach; O fence;
v
O road improvements
Conditions/Comments:
Utilities:
N. 811 Jefferson
ConditionslComments:
Other.
Plan Exam
Fire Prev.
Condit�onslComments:
Project RepresQntative Telephone
U
a Agencies Performing Special Inspection:
1.
Y O
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1 IncSi�bte �siavc or attach condittons reletive to lOnal a� bullt approval
2 in�l�s�» above or atta�h reasons br hold
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