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E GN PERMIT APPLICATION <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 /> 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: STREETH 0 j k!k, iTV PARCEL#: 0313 ach (tl '40'70 <br /> CITY r\\.e0CI " STATE I 0S1tt� 1.0A ZIP CIPK <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: � <br /> TENANT/BUSINESS NAME(if non-residential): r- 1st z.A-eat Ro L K�:j x.l;ti 4"I Kar- <br /> i CONTACT INFORMATION <br /> OWNER NAME: (U.n(A V t >I t L ¶1 of.QPLf�1(x CS1 p <br /> OWNER MAILING ADDRESS: STREET 2t3 LID swirl 1 _ t,tel <br /> CITY �'�� lffj, STATE ilj Shtvx rlCiA, ZIP em'33 <br /> OWNER PHONE(3 ) f'fQ ct OWNER EMAIL: aAtriavtg lcrr attar 4 k�4,1I r Owl <br /> CONTRACTOR CONTACT NAME: tsA Ies -cii n ij S <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):MA R S H S i'taKc CITY OF EVERETT BUSINESS LICENSE#(RE UIRED): <br /> CONTRACTOR ADDRESS: STREET ;lilt Eve,.,. f- • <br /> CITY Flie 1 - STATE Waaii✓If.�)Ci i ZIP (I z <br /> CONTRACTOR PHONE:(42S) Zc 1 (03 t t CONTRACTOR EMAIL: io 1 ileS'qc)A'10 ,r ria <br /> PRIMARY CONTACT: ❑\OWNER )I CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: p,nt l C��, n CONTACT PHONE: (t4 ,) Z (�;SC1 0 I <br /> v t CONTACT EMAIL: tAnisjnc)9(\ P$Li'CW) <br /> r,,, SIGN RMIT INFORMATION <br /> VALUATION OF W K:$ lk SSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the pr uipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: 3(0 \44 � Z �� !�O�,�Z"}�x� <br /> 4" i of 1'i%► me, s b-tv us pc-A-ci <br /> yttyk faaf <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 4)7, p1,4 Height j Square Feet <br /> Sign 2: Width: Height Square Feet <br /> Sign 3: Width: Height Square Feet <br /> SIGN TYPE&QUANTITY: OWall/Awning/Canopy-Qty: t OWindow-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.)3 JettilaN 44eitt. <br /> SIGN LIGHTING: ❑Non-Iluminated 011luminated-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.I am the owner,or 1 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 /> IA <br /> PERMIT# <br /> -44,741t),VA • [ �1�'U1OQuirk 61S- izi SZ t o(o - 001 <br /> � �Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />