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gIGN PERMIT APPLICATION <br /> .12 <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINC;TON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9506 19th Ave SE PARCEL#: 28051800401700 <br /> CITY Everett STATE WA ZIP 98208 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):The Joint <br /> CONTACT INFORMATION <br /> OWNER NAME:Conrad A. Topacio <br /> OWNER MAILING ADDRESS: STREET 1833 North 105th Suite 303 <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE:206-402-5567 OWNER EMAIL:Snlpreder@graiI.COm <br /> CONTRACTOR CONTACT NAME:Crossroad SIGN <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CROSSS*894M 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 63050 <br /> CONTRACTOR ADDRESS: STREET 16406 7th PL W <br /> CITY Lynnwood STATE WA ZIP 98037 <br /> CONTRACTOR PHONE:425-481-9411 CONTRACTOR EMAIL:ryan@C1OSSrOadSlgn.Corn <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-481-941 1 <br /> Ryan S h roy CONTACT EMAIL:ryan@Crossroadsign.Corn <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$1,100 ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: Install two low voltage LED signs to east and west facing facades on the building. <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 55" Height: 29" Square Feet: 11.07 <br /> Sign 2: Width: 55" Height: 29" Square Feet: 11.07 <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ❑✓Wall/Awning/Canopy-Qty:2 ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: ❑Non-Iluminated ❑✓Illuminated-Type(backlit cabinet,etc.): Internally/back lit *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 /> ✓ ✓� //27/ i( PERMIT# 52�05 - ()05 <br /> Owner/Autho ed Agent ignat Date (Revised 2/8/2021) <br />