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1GN PERMIT APPLICATIOP <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.j''6:Z S /43r v4 - PARCEL#: ?, <br /> Cf r l' `r/ (��•/� STATE vtj,f9 Zil'Y /Gpa3 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): STAR R/ L-C'S (-7 e <br /> CONTACT INFORMATION <br /> OWNER NAME: ,S/1-//e��G�s <br /> OWNER MAILING ADDRESS: STREET <br /> City STATE ZIP <br /> OWNER PHONE: -OWNER EMAIL: <br /> CONTRACTOR CONTACT NAME: t 0i -c r../7 ��/ C sJl, r 25' C d' <br /> WA STATE CONTRACTOR LICENSE#(REQUIREDy:PO - T)SL:'3J/L(,CITY Of EVERETT BUSINESS LICENSE#(REQUIRED):S.Z $.2_ <br /> CONTRACTOR ADDRESS: STREET S�/s <br /> crn . /j.1/,/r,,x4 Scare fir;/ i 2S ?9G <br /> CONTRACTOR PHONE: f,Z,S--S%S-71//e. ,CONTRACTOR.EMAIL: /fir t 7"/"i S <br /> PRIMARY CONTACTWNER VCONTRACTOR ❑OTHER(Please.Specify) <br /> CONTACT NAME: CONTACT PHONE: 142S e. -C16/; <br /> B e ��^�S CONTACT EMAIL: /24,/Vic/ S ��j �jj C,e30-7 <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ a 5 (5.0 ASSOCIATED PERMIT#(if applicable); <br /> (Valuation shall include the prevailing fair market value of alt labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: / 1-5 <br /> 4 v o/. S j2n er // — / — N&ti Z-4/46 <br /> O/7 / S,3 7 <br /> SIGN DIMENSIONS: ,e• <br /> t'"� Sign 1: Width: O Height: b 5 `/ Square Feet: 2 7 <br /> „ .,cliker Sign 2: Width: I GI!y Height: 76 Square Feet: 3 Height: 3 , <br /> � �J/t - Square Feet:' / $ .2 2 <br /> /�jer7i�,r./Sign 3: Width: ,2+' / <br /> SIGN TYPE&QUANTITY: ❑Wall/Awning/Canopy-Qty: ❑Window-gqQty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty:ol, -Type(monument,etc.): <br /> SIGN LIGHTING: 'QNon-Iluminated isaffiuminated-Type(backiitcabinet,etc.)//T Se,Xtt,t/6ti / *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 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 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /�-�1 a�2i 2 k l I — 01� <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />