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in AFIGN PERMITI APPLICATI <br /> CITYIIII <br /> wir OF <br /> EVE R E T TEVERETT 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 88101(E)everette ps <br /> (Blue or Black Ink Only Please), @everattwa.gov I(W)everettwa.gov/permits <br /> 1 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET <br /> ■ , Ire A� " P, , . , .-405--6ll00 <br /> cm E.- Ve(r^e" STATE IA) ZIP • <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): l: f at-CK. Lai) _ c4 f tr <br /> CONTACT INFORMATION <br /> OWNER NAME: ' 5 dl. 120 f c . GL I e )CC 0\ <br /> OWNER MAILING ADDRESS: s omEr 1 S 0 f t e f c t <br /> cm, _ t.J P STATE �i� <br /> OWNER PHONE: '2-o r5f� .. 2-f �"j y ZIPP $ i <br /> 6, OWNER EMAIL: j(kiA-ncir N1SGIbe( OVIc�Gt 1ealCfCi &9Meci i1 <br /> CONTRACTOR CONTACT NAME:h Gt(t ` <br /> A STATE CONTRACTOR LICENSE#(REQUIRED):o '/gA a k,i/7 LACITY OF EVERETr BUSINESS LICENSE#(REQUIRED): Q <br /> CONTRACTOR ADDRESS: em' ,305 F Eve(elf <br /> . ,f Na(t Wa V/1c 197i�7 <br /> sm s <br /> STATE idd 4 ZIP 9( Q <br /> CONTRACTOR PHONE: L- 2-5.- Q 51 , 02,36 6 CONTRACTOR EMAIL:+1Aq Ube, ( ) S (5 I ave,r)c\et/K it;con-) <br /> PRIMARY CONTACT: ❑OWNER %CON RACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ilia I jee,, DO(A a il, ap h ot( vo" lilliptaimielmerivrAcT Emu.:i A c\i,e6& 1 i narzu-mk_t,veArifr,co„In <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ erl'aol t V V 'ASSOCIATED PERMIT# <br /> f <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,w applicable): <br /> DESCRIPTION OF WORK: hether actually paid or not.) <br /> n 54-p I CPS f. 0 a t he -' 0 n L.. bV-c1 c- e 1--- <br /> SIGN DIMENSIONS: Li <br /> " l 2.. ri <br /> ) <br /> Sign 1: Width: Height: G-'Y 6 F- <br /> Square Feet: <br /> Sign 2: Width: Height <br /> Square Feet: <br /> Sign 3: Width: Height <br /> IGN TYPE&QUANTITY; K+ / Square Feet <br /> wning/Canopy-Qty: / :Window-Qty: :Electronic Changing Message-Qty: • <br /> ❑Projecting-Qty: :Freestanding-Qty: <br /> -Type(monrrmen;etc.): <br /> IGN LIGHTING: f on-Iluminated :Illuminated-Type tbacknIcabinet etc.): <br /> t -*requires a separate electrical permit <br /> LAN REVIEW REQUIREMENTS:Submit 2 hard copies of sign plans with permit application to Permit Intake Drop Box. <br /> 7KNOWLEDGEMENT 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 /> vent 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 /> Nang Official before being authorized under any circumstance.lam the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> d I corn*with the State Contractors Law 18.27 RCWand 29&200A WAC. <br /> ---ThCity of Everett Official Use Only <br /> .--' /7- (f( Z O/Z-Z I PERMIT(# 220 ' <br /> 00(?), <br /> 1 <br /> Rer/Authorized Agent Signature Data (Revised 2/8/2021) t <br /> /Z <br />