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• • <br /> SIGN PERMIT APPLICATION <br /> E Vf R E T T 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 /> WASHINGTON CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(IN)everettwa.gov/p"ermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 12906 Bothelt_Everett Hwy PARCEL#:28053000406200 <br /> cm Everett STATE WA cm 98208 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):I n &Out Pho <br /> CONTACT INFORMATION <br /> OWNER NAME:Fred Meyer Associate-Sheila Isbell <br /> OWNER MAILING ADDRESS: STREET PO Box 42121 <br /> city Portland STATE OR zip 97242 <br /> OWNER PHONE:5035398156 OWNER EMAIL:Sisb011@1045inc.com <br /> CONTRACTOR CONTACT NAME:-TR.-Nguyen 'C -c `- y.('' <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CCSTRONPL8t2J3 city OF EVERETT BUSINESS LICENSE#(REQ <br /> CONTRACTOR ADDRESS: sTSEET2601 NE 12TH S1 ' '`" L <br /> cnv RENTON STATE WA zip 98056 <br /> CONTRACTOR PHONE:206-61 8-6543 CONTRACTOR EMAIL:LITSIGN@YAHOO.COM <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-618-6543 <br /> TR. Nguyen CONTACT EMAIL: LITSIGN@YAHOO.COM <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$5,000 ASSOCIATED PERMIT#(if applicable): '2 i Din)— (01 <br /> (Valuation shall Include the prevailing fair market value of at labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: Install one complete set channel letters (storefront sign - nonilluminated) <br /> SIGN DIMENSIONS: <br /> Sign 1: Width:12`-7" Height: 25" Square Feet:27sf <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ❑✓Wall/Awning/Canopy-Qty:1 ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: CINon-lluminated ❑illuminated-Type(backiltcabinet,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.tam the owner,or tam 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 /> 12 n._ <br /> r PERMIT# 0/13o <br /> Owner/Authorized Agent Signature ate (Revised 2/8/2021) <br />