04-102311 ( N PERMIT APPLICATION
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CITY OF - APPLICATION NU1�Ef2 - _ `'� - ,7t
Federal Way 'A;._�
**The following is required information-Please print(in ink)or type**
4 s'v,l'1
■ PROPERTY INFORMATION .
SITE ADDRESS: 2-4 0-67 9 • 9 l ST/ .F4.f ASSESSOR'S TAX/PARCEL#: OCT ZI 04 - q 00
. ■ PROJECT INFORMATION
TYPE OF PROJECT(Check all that apply): ❑PERMANENT ❑TEMPORARY ❑NEW ❑ALTERATION ❑REFACE ❑EX'EMPT
0 ELECTRICAL(To attach to existing J-box) o ELECTRICAL(New/altered circuit&j-box added)
(Separate permit is required)
NUMBER OF SIGNS APPLIED FOR WITH THIS APPLICATION: ���///JJ14 1
PROJECT DESCRIPTION (Provide detailed description): /f\4CC rN T-iksr-40 v pvJ}t--)(
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BUSINESS/TENANT NAME: " ' W,
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■ PEOPLE INFORMATION
SIGN OWNER: NAME: DAYTIME PHONE:
TCUikiA t, 5 ViA/ /g-(0-1- lad.' (4zr) 74-1 -0b17
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
1Z'4tk R: 4Z �- u -QCs-204
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE:
(Required) -- -- 0 / /
CONTRACTOR: NAME: DAYTIME PHONE:
P-1Ccs Ord Cif& . /111-Fe-A/111-770:11,.5/GYN (42S) 74-1 - gf°77
MAILING ADDRESS(STREET ADDRESS;CTIY,STATE,ZIP): EVENING PHONE:
121414- 1+ Q y'fq it 1 'L iT; (i9-q13720¢ ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
NTe.S(, et-74-Q c -- -- ( ) -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(Copy required) / /
APPLICANT: NAME:
DAYTIME C ., LA--1 (t6 )PHONE:67qt
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
3(2- S 4c, . 7 d/d¢ ( ) -
FAX NUMBER:
CONTACT FOR THIS PROJECT: ( )
o PROPERTY OWNER APPLICANT ❑ CONTRACTOR E-MAIL ADDRESS:
' ■ **TEMPORARY SIGN APPLICATIONS ONLY**
TYPE/PURPOSE OF EVENT:
DATE OF INSTALLATION: DATE OF REMOVAL:
TEMPORARY SIGN TYPE: o BANNER o INFLATABLE o PORTABLE ❑ SEARCH LIGHTS/BEACON
NUMBER OF EACH TYPE:
- . ' ■ PROJECT DETAILS
PROPOSED NUMBER OF WALL SIGNS: I PROPOSED NUMBER OF FREE STANDING SIGNS: 1
TOTAL ESTIMATED PROJECT COST: $ 2. Sao-c-f- 1NUMBER OF TENANTS/BUSINESS SPACES ON PROPERTY:
r TYPE OF SIGN(S) (Check all that app'
PERMANENT FREE STANDING: o MONUMENT ❑ OTHER ❑ PEDESTAL ❑ POLE ❑TENANT DIRECTORY
NUMBER OF EACH TYPE:
PERMANENT BUILDING MOUNTED:❑AWNING ❑CABINET o CANOPY ❑ CENTER IDENTIFICATION (CID)7X-CHANNEL LETTERS
NUMBER OF EACH TYPE:
o MARQUEE o OTHER ❑ PROJECTING ❑ TENANT DIRECTORY
NUMBER OF EACH TYPE:
• 'DETAILED SIGN INFORMATION
FREE STANDING SIGN SIGN AREA(SQ.FT.) ILLUMINATED?: REFACE? PART OF CID TOTAL SIGN BASE
TYPE WIDTH X HEIGHT X#OF FACES NO/INT/EXT YES/NO SIGN? HEIGHT(FT) HEIGHT(FT)
A
B
C
STREET FRONTAGE(FT):
BUILDING MOUNTED ILLUMINATED? SIGN AREA(SQ.FT.) BUILDING EXPOSED BUILDING
SIGN TYPE NO/INTERNAL CTERNA WIDTH X HEIGHT X#OF FACES ELEVATION(N,S,E,W) FACE(SQ.FT.)
C
D
E
■. DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made
��
NAME/TITLE: DATE: TAA-0/014'
SIGN URE
D / �f
NAME(Print)
PRINT
FOR OFFICE USE ONLY:
ZONING DESIGNATION: COMP PLAN DESIGNATION:
BUILDING MOUNTED SIGN FREE STANDING SIGN
AREA PERMITTED: AREA PERMITTED:
AREA PROPOSED: AREA PROPOSED:
LARGEST BUILDING FACADE: STREET FRONTAGE:
NUMBER OF SIGNS ALLOWED: NUMBER OF SIGNS ALLOWED:
LAND USE APPROVER INITIALS: DATE:
STRUCTURAL APPROVER INITIALS: DATE: co /6._(:) 6'
REGISTRATION NUMBER: REGISTRATION NUMBER:
REGISTRATION NUMBER: REGISTRATION NUMBER:
REGISTRATION NUMBER: REGISTRATION NUMBER:
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4115•FAX 253-661-4129