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OGN PERMIT APPLICATIOIS <br />EVERETT <br />WAHNIN[STnN <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plans to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.88101(E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET <br />PARCEL M <br />CITY <br />STATE ztP L D <br />SUITE/UNIT M ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): <br />CONTACT INFORMATION <br />OWNER NAME:`YX <br />OWNER MAILING ADDRESS: STREET <br />CITY <br />STATE ZIP <br />OWNER PHONE: L - _ v L► <br />OWNER EMAIL: <br />CONTRACTOR CONTACT NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />C1, Cli;11CITY <br />OF EVERETT BUSINESS LICENSE #(REQUIRED): Z U <br />CONTRACTOR ADDRESS: STREET <br />CITY L-11 Ylq <br />L10VA STATE ZIP 0 <br />CONTRACTOR PHONE: - 2 • - <br />CONTRACTOR EMAIL: o <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />214y <br />CONTACT PHONE: <br />CONTACT EMAIL: G ,� <br />SION PERMIT INFORMA ION <br />VALUATION OF WORK: $ 0 <br />ASSOCIATED PERMIT # if applicable): <br />(Valuation shall include the prevailing fair market value of a-0 Wor, materals, and equipment needed to complete the work, whether actually paid or not.) <br />DESCRIPTION OF WORK: <br />SIGN DIMENSIONS: <br />Sign 1: Width: 19 <br />Height: Square Feet: <br />Sign 2: Width: <br />Height: Square Feet: <br />Sign 3: Width: <br />Height: Square Feet: <br />SIGN TYPE & QUANTITY: Wall/Awning/Canopy - Qty: I Window- Qty: ❑Electronic Changing Message - Qty: <br />❑Projecting - Qty: ❑Freestanding- Qty: - Type (monument, etc.): <br />SIGN LIGHTING: Non-Iluminated ❑Illuminated - Type (baek►lt cabinet, etc,): 'requires a separate electrical permit <br />PLAN REVIEW REQUIREMENTS: Submit 2 hard copies of sign plans with permit application to Permit Intake Drop Box. <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the Information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # S Z l J <br />Date (Revised 21812021) / <br />�2— <br />