02-104312FOA'N; 'M
IGN PERMIT APPLICATION
• PPUCATION BER: -
4 3 I **The following is required information — Please print (in ink) or type** 115'W
ButuD�N�`
SITE ADDRESS: j'2' SW
ASSESSOR'S TAX/PARCEL #
(1.2-1 03-9 - q 7
TYPE OF PROJECT (Check all that apply): r:PERMANENT XTEMPORARY ❑NEW ❑ALTERATION [;REFACE [)EXEMPT
) ELECTRICAL (To attach to existing J -box) ELECTRICAL (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:
011
SIGN OWNER: NAME: —
GN /a N7/ ,,j A.
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
b.Z33 23kO S+ /VF- 7�?c oYrv�i' W A adz 2
CCTY OF FEDERAL WAY BU NES LICENSE NUM R:
(Required)
CONTRACTOR:
APPLICANT:
DAYTIME PHONE:
(IS -3)
EXPIRATION DATE:
NAME:
/-
DAYTIME PHONE:
EVENING PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
3202 A 3)-d */-e 5. m00% yr t AjA groO
CTTY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
q - Y9 - l 0(07/6
FAX NUMBER:
-00- IRL -- --
(XC3 ) S -9--33 5
CONTRACTOR'S REGISTRATION NUMBER:
(Copy required) VeFj) 5ea Cj--(=1
EXPIRATION DATE:
DaZ / l / / 0
gr
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
6X33 t,3 ed S -I Nb i4 Cor,. VJA
CONTACT FOR THIS PROJECT:
❑ PROPERTY OWNER O APPLICANT ❑ CONTRACTOR
TYPE/PURPOSE OF EVENT: T �O/� /' y S'l6A) ,
DATE OF INSTALLATION: / d (7 u Z
DAYTIME PHONE:
(9X3) 9-9'�-1 -7STY
EVENING PHONE:
FAX NUMBER:
E-MAIL ADDRESS:
ote ll cog9 g0a.o (. c
DATE OF REMOVAL: / / 4 7 h '2--
TEMPORARY SIGN TYPE: X BANNER ❑ INFLATABLE ❑ PORTABLE ❑ SEARCH LIGHTS/BEACON
NUMBER OF EACH TYPE: /
aeae�Ecr
PERMANENT FREE STANDIN45Q ❑ MONUMENT ❑ OTHER ❑ PEDESTAL ❑ WE ❑ TENANT DIRECTORY
NUMBER OF EACH TYPE:
PERMANENT BUILDING MOUNTED: WNING ❑ CABINET ❑ CANOPY ❑ CENTER IDENTIFICATION �D)EolANNEL LETTERS
NUMBER OF EACH TYPE:
o MARQ E ❑ OTHER ❑ PROJECTING ❑ TENANT RECTORY
NUMBER OF EACH TYPE: I/
FREE STANDING SIGN
TYPE
SIGN AREA (SQ. FT.)
WIDTH X HEIGHT X # OF FACES
ILLUMINATED?:
",NO/INT/EXT
F EFACE? I
YES/NO
PART OF CID
SIGN?
TOTAL SIGN
HEIGHT FT
BASE
HEIGHT FT
/
REGISTRATION NUMBER:
REGISTRATION NUMBER:
REGISTRATION NUMBER:
B
REGISTRATION NUMBER: "
REGISTRATION NUMBER:
rB
C
D
E
STREET FRONTAGE (FT):
BUILDING MOUNTED
SIGN TYPE
ILLUMINATED?SIGN
NO INTERNAL EXTERNA �
AREA (SQ. FT.)
WIDTH X HEIGHT X # OF FACES
BUILDING
LEVATION N S E W
EXPOSED BUILDING
FACE (SQ. FT.
A
STRUCTURAL APPROVER INITIALS:
/
REGISTRATION NUMBER:
REGISTRATION NUMBER:
REGISTRATION NUMBER:
B
REGISTRATION NUMBER: "
REGISTRATION NUMBER:
C
D
E
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: e� ����� - DATE:
SIGNATURE
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// 1 7 n
NAME (Print) 1�36yuW/V/Oy .Ic�LL
PRINT
Fop nFFTCF I ICF nN1 V•
ZONING DESIGNATION:
COMP PLAN DESIGNATION: `
BUILDING MOUNTED SIGN ,
AREA PERMITTED:
AREA PROPOSED:
LARGEST BUILDING FACADE:
NUMBER OF SIGNS ALLOWED:
FREE STANDING SIGN`
AREA PERMITTED:
AREA PROPOSED:
STREET FRONTAGE:
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