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MIN <br /> II IAI N 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: STREET 9 01,f_ At oc,pri (,./0 �I PARCEL#: <br /> CITY e"-' `I E ve STATE I _t a_ ZIP J432 <br /> SUITEIUNIT#: ADDITIONAL LOCATION INFORMATION: �'1V // <br /> TENANT/BUSINESS NAME(if non-residential): Q( go II A. <br /> CONTACT INFORMATION <br /> OWNER NAME: �-- , 4 t JI A <br /> OWNER MAILING ADDRESS: STREET q2LT �,-v`jV% //^v?'ev bo l/ <br /> CITY �,�r O,ni✓.b STATE ZIP yi9 <br /> OWNER PHONE: 4 —..... <br /> 33 g o 10400 OWNER EMAIL: <br /> CONTRACTOR CONTACT NAME: etc,,7 Sz.g4LS <br /> WA STATE CONTRACTOR UCENSE#(REQUIRED).. ^ ' J_/a CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): '72� <br /> 1 <br /> CONTRACTOR ADDRESS: STREET 'jA lel <br /> COY ✓�'» o / STATE (L ZIP 9A O S 4 <br /> CONTRACTOR PHONE: — - '7 CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: D OWNER VCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 3 —VO <br /> `Tam 'Park__ CONTACT EMAIL: c i c_ q ,f a <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ 400 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: <br /> FnAa iI is S1 )1 <br /> (>1 —Ole IA)a l( <br /> ---? "Ilff7 Jaye- SIB a (breci <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 76 f Height: ?cif Square Feet: _7r0 <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: WaII/Awning/Canopy-Qty: DWlndow-Qty: ❑Electronic Changing Message-Qty: <br /> 0 Projecting- R) : OFreestanding-Qty: -Type(monument,etc.).' <br /> SIGN LIGHTING: ❑Non-iluminated ! Iluminated-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 I 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 /> 31. ........-1------ -- <br /> PERMIT Mt. <br /> Owner gent Signature Date 00401 <br /> (Revised 2/8/2021) <br /> 1 <br /> /Z <br />