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E IIFN PERMIT APPLICATION <br /> a 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 /> WASHINGTON 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 f '3 6 (p Hew ("I A t e. PARCEL#: Oo 1(3 i cep'5 ogq,00 <br /> W <br /> cry vl. H rL' STATE W A ZIP Cf I'J..2 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): ( -faycj f('S(e.,,_, <br /> CONTACT INFORMATION <br /> OWNER NAME: T©m (-4 ar r-c s o n <br /> OWNER MAILING ADDRESS: STREET ( 6 6(p +-k iw(t Ave- <br /> CITY <br /> ] V e re-f-f" STATE WA ZIP 9 g Z.e) 1 <br /> OWNER PHONE: 72.,0- 9 3(0- 502_I OWNER EMAIL: +On k h .Qrn yrnefiv yS�-ore , tom <br /> CONTRACTOR CONTACT NAME: , v`(dv <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):3(q h a..,ifag17 L7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l O$ / 8 <br /> CONTRACTOR ADDRESS: STREET 3Q 5 S+F P(fieV'e I`1 at( way Suck, U I/f.c err( /"� ue re STATE , by}l ZIP 9 UQty..aQ <br /> U <br /> CONTRACTOR PHONE: � 95 - O2 (� CONTRACTOR EMAIL:-1-kavi es gharctt'Y)0,_-eVetrP /ron- <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT- T/NAME: CONTACT PHONE: ZS — % (- O7-3(, <br /> f I/(Wee, (�.Gt 119 a 06\1 ✓o/'� CONTACT EMAIL: Live c. 6 .C, i Qh cu-oLIYtc�_evef'P , cO n <br /> SIGN PERMIT INFORMATION „} <br /> VALUATION OF WORK:$ f <br /> on�,QO ASSOCIATED PERMIT#(if applicable):(Valuation shall include the prevailing ir market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: <br /> r)s ( ` 34 il C i IICAVar S ( r) on & S iy) bray-ram-- <br /> od--hcheCd -f-o `f b v( 0 (n°� <br /> SIGN DIMENSIONS: <br /> // <br /> Sign 1: Width: ' � �pt a /(,( C Height: Square Feet:(p r-y 1 <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: Wall/Awning/Canopy-Qty: I :Window-Qty: DElectronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument etc.): <br /> SIGN LIGHTING: ton-lluminated ❑Illuminated-Type(backlit 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.lam the owner,or lam 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 298.200A WAC. <br /> City of Everett Official Use Only <br /> 1(3 t /2i PE IT# �^ `�• <br /> t f/ L) (_4l <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />