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•GN 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)PermitServices@everettwa.gov (VV)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 11419 19th Ave SE PARCEL#: 01105500000200 <br /> CITY Everett STATE WA ZIP 98208 <br /> SUITE/UNIT#: A-105 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):KUMON <br /> CONTACT INFORMATION <br /> OWNER NAME:Targa Real Estate Services, Tommy Petramalo <br /> OWNER MAILING ADDRESS: STREET 720 S 348th St#2 <br /> CITY Federal Way STATE WA ZIP 98003 <br /> OWNER PHONE:253-632-6621 OWNER EMAIL:tommy©targarealestate.com <br /> CONTRACTOR CONTACT NAME:CROSSROAD SIGN <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CROSSS*894M1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62014 <br /> CONTRACTOR ADDRESS: STREET 16406 7th PL W <br /> ciTr Lynnwood STATE WA ZIP 98037 <br /> CONTRACTOR PHONE:425-481-9411 CONTRACTOR EMAIL:ryan@crossroadsign.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-481-9411 <br /> Rya n S h roy CONTACT EMAIL:ryan©crossroadsign.com <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$4375 ASSOCIATED PERMIT#(if applicable):Electric permit applied for online <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 /> Installation of lit channel letter on raceway sign and blade sign above tenant's front <br /> door. <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 154" Height: 36" Square Feet: 38.5 <br /> Sign 2: Width: 36" Height: 15" Square Feet: 3.75 <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ❑✓Wall/Awning/Canopy-Qty:1 [iiWindow-Qty: ❑Electronic Changing Message-Qty: <br /> ✓❑Projecting-Qty: 1 ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: ❑✓Non-Iluminated ❑✓Illuminated-Type(backlit cabinet,etc.): Internal LED(1 wall sign) *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 WAC. <br /> City of Everett Official Use Only <br /> Ryan Shroy roV Digitally signed by Ryan Shroy <br /> R <br /> Y : 022.09.02 15:24:07 8/1 8 PERMIT# <br /> 0 70 S 0 q <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />