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art Or SIGN PERMIT APPLICATION
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--- -:-� T — • MAY 0 5 2004 APPLICATION P•BER: - /O
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, ""it .� aP..,-� ».�x i61F.� PROPERTI..ard ORMATION kY . zi :. F, ..,..44-
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SITE ADDRESS: , 0 5 . 3 D 51 . ASSESSOR'S TAX/PARCEL#: 0 ciQ` f - 7� 9 7
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TYPE OF PROJECT(Check all that apply): nPERMA T 'EMPORARY W ❑ALTERATION ❑REFACE n EXEMPT
n ELECTRICAL(To attach to existing 3-box) AL(New/altered circuit&j-box added)
(Separate permit is required)
NUMBER OF SIGNS APPLIED FOR WITH THIS APPLICATION:
PROJECT DESCRIPTION (Provide detailed description):
BUSINESS/TENANT NAME: L V I V ‘--k h— 1)ck A�! u 1 ✓) ) - c-,3-1AO l
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SIGN OWNER: NAME: DAYTIME PHONE:
.etyp G L— vc.S e 11.4-c7 cook)) 49 -5�
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: �/ EXPIRATION DATE:
(Required) t-- 0 -oa03 �� / /
CONTRACTOR: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): '\a EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
I -- - ( )
-
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(Copy required) / /
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS(SWEET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( ) -
FAX NUMBER:
CONTACT FOR THIS PROJECT: ( )
o PROPERTY OWNER n APPLICANT ❑ CONTRACTOR E-MAIL ADDRESS:
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TYPE/PURPOSE OF EVENT: OeC: r( n Cis 1 �'^ P.-- ) D (AL Yl( n (i S I CI r"--
DATE
DATE OF INSTALLATION: ,51_ 1/0 Lf DATE OF REMOVAL:
TEMPORARY SIGN TYPE: BANNER ❑ INFLATABLE i, PORTABLE ❑ SEARCH LIGHTS/BEACON
NUMBER OF EACH TYPE:
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.s .. :: s'` K =. � ROy CT DETA=L'8 ;_ z ' 44 -- F
/'I�ROPOS ! NUMBER OF WALL SIGNS: PROPOSED NU OF FREE STANDING GNS:
TOTAL ESTIMA ! "• COST: $ NUMB OF TENANTS/BUSINESS SPACES ON PROPERTY:
• •MANENT FREE STANDING: ❑MONONT O OTHER 0 PEDESTAL ❑O 0 TENANT DIRECTORY
NU :ER OF EACH TYPE:
PERMANE BUILDING MOUNTED:0 AWNING O CABINET ❑ CANOPY ❑ CENTER IDENTIFICATION (CID) ❑ CHANNEL ERS
NUMBER OF CH TYPE:
0 MARQUEE o OTHER o PROJECTING ❑TENANT DIRECTORY
NUMBER OF EACH TYP'•
.f t .+t � f.•..a,+ s— yDETA_ ILED,SIGN INFORMATION
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FREE STANDING SIGN SIGN A A(SQ.FT.) ILLUMINATED?: REFACE? PART OF CID TOTAL SIGN BASE
TYPE WIDTH X HEIG X#OF FACES NO/INT/EXT YES/ SIGN? HEIGHT(FT) HEIGHT(FT)
A
B
C
STREET FRONTAGE(Fr):
BUILDING MOUNTED ILLUMINATE . SIGN AREA(SQ.FT.) BUILDING EXPOSED BUILDING
SIGN TYPE NO/INTERNA ERNAL WIDTH X HEIGHT X#OF FACES ELEVATION(N,S,E,W) FACE(SQ.FT.)
A
B j�'
:, ,,,,,,, ---- ----
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i��:DISCLAI•MER/S•IGNATURE BLOCK , :;:•-•::;:.,.'•;,:a::.:--:;A,72.--;;z;;,`...'
Krt I certify under pen Ity of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authoriz b owner of the above premises to perform the work for which the permit applicat'on is made
NAME/TITLE: DATE: /
SIG {{ TURF
NAME(Print) V-0� �,� e i iD
PRINT
FOR OFFICE USE ONLY:
ZONING DESIGNATION: COMP PLAN DESIGNATION: I
BUILDING MOUNTED SIGN FREE STANDING SIGN
AREA PERMITTED: AREA PERMITTED:
I
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:
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