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OGN PERMIT APPLICATIO* <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />WASHINGTON <br />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 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please), PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET PARCEL #: 069 <br />CITY It-ll�' [ ( ` STATE • % i ZIP V <br />SUITE/UNIT #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): + <br />CONTACT INFORMATION <br />OWNER NAME: ' _ — d �4' .S 11-/eATS <br />OWNER MAILING ADDRESS: STREET ;) 6; ) 0 <br />CITY r- Pc STATE STATE k�� ZIP -13 <br />OWNER PHONE: S — .3 S - 1% S L'0 <br />OWNER EMAIL:OX <br />CONTRACTOR CONTACT NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): .,- ` J— M <br />C z <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): < < <br />CONTRACTOR ADDRESS: STREETv�- <br />CITY h G- STATE/¢ . ZIP <br />CONTRACTOR PHONE: 3�i d ��7 Lo' �7 <br />CONTRACTOR EMAIL ,� s� ,V ,t/ S .•C'� <br />PRIMARY CONTACT: ❑ OWNER L?tONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />C�CC� <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />SIGN PERMIT INFORMATION <br />VALUATION OF WORK: $ ;5 <br />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: N ill �A)`J Ci4oitl T- i T! f"4 L� �igc� G 9/U/V Q e Q/CS a.v <br />W*CA e,9 S'T1PvAT%(W , a,+/ Satic,�f,� 6v.L <br />�iU S 7�l%i �u9 (�S S�T� FRouT- L� T� /r'� pX �',�c •� cLi�t�vue <br />e PATl CIAO L Li T /° L QX Fes« � ©� o o ti ilJ�� �� �,,� %� P <br />�A! STit7- ) <br />SIGN DIMENSIONS: <br />Sign 1: Width: ) - Height: s Square Feet: S <br />Sca-1' Sign 2: Width: - ; 5 Height. Square Feet: <br />At ,"Z_r/, Sign 3: Width: ��;� S�, Height: �� i Square Feet: <br />SIGN TYPE & QUANTITY: ❑YWall/Awning/Canopy - Qty: ❑Window- Qty-.❑Electronic Changing Message - Qty: <br />❑Projectin--g - Qty: ❑Freestanding- Qty: : - Type (monument, etc.) <br />SIGN LIGHTING: ❑Non-Iluminated l�lllluminated - 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 I am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />:d v <br />Owner/Authorized Agent Signature <br />City of Everett Official Use Only <br />PERMIT # <br />J u <br />(Revised 21812021) <br />