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SIGN 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 /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> WASHINGTON <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 3229 Pine St PARCEL#: 00439075301500 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: Left side Of building <br /> TENANT/BUSINESS NAME(if non-residential): Evergreen Safety Council <br /> CONTACT INFORMATION <br /> OWNER NAME: CCI Property LLC <br /> OWNER MAILING ADDRESS: STREET 88 S Hudson St <br /> CITY Seattle STATE WA ZIP 98134 <br /> OWNER PHONE: 206-624-6263 OWNER EMAIL: charles(a)pande-cameron.com <br /> CONTRACTOR CONTACT NAME: Evergreen Sign Company <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):EVERGSC854CO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): j 6 55 8 <br /> CONTRACTOR ADDRESS: STREET 1513 Central Ave S Suite 1 <br /> CITY Kent STATE WA ZIP 98032 <br /> CONTRACTOR PHONE: 253-852-1354 CONTRACTOR EMAIL: danielleh@evergreensign.com <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Danielle Holt CONTACT PHONE: 253-852-1354 <br /> CONTACT EMAIL: danielleh@evergreensign.COm <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK: $ 1,480 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: Installation of sign that was removed from a location in Kirkland and mechanically <br /> fastened to the building with bolts <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 179.9375" Height: 36.25" Square Feet: 45.3 <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: LiWall/Awning/Canopy-Qty: 1 ❑Window-Qty: ❑Electronic Changing Message-Qty:_ <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: QNon-Iluminated ❑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.I am the owner,or/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 /> PERMIT# <br /> T�� et- 3/9/2022 5 2- ; o , ' <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> >/— <br />