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imm OIGN PERMIT APPLICATIOS
<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 I(W)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET ' ( er0C)te.e.Y CLAr , PARCEL#:OOS 5 ).aoaao cA101
<br /> 0„ CITY Cr-Nr.e,f-ejdo STATE yV ZIP i,a,6'
<br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: "V��
<br /> TENANT/BUSINESS NAME(if non-residential): C,pd+'ZV1n Jr1‘ \ tWIT✓� OC 7 CA-)
<br /> p CONTACT INFORMATION
<br /> OWNER NAME: C„Dry\ h,J 1'i kk C'tc✓ O" (/), (M,ti Ca[fi TIJ
<br /> OWNER MAILING ADDRESS: sTREEti (¢Get .6-ye,+� yc gam,, W i J /
<br /> CITY EV -- STATE W � `ZIP � I?
<br /> OWNER PHONE: 41.a.5 "7 ) OWNER EMAIL: +-C, ,\\c.V\04 C SIAIZ) . 0�(
<br /> CONTRACTOR CONTACT NAME: N
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): C(- ac�,1.� by,.]pS4-TY OF EVERETT BUSINESS LICENSE#(REQUIRED)4014--Oa'Cr" 95
<br /> CONTRACTOR ADDRESS: STREET a.3 9 C.,2)'bM CJ Q
<br /> CITY rC`/R.,*/.4A-* STATE Po ZIP I
<br /> CONTRACTOR PHONE: 'tc15.VI/3 9 350 CONTRACTOR EMAIL:41c.-4•••- :O^An�(, 1belvirePc .�j,,lr+•t S, (pt-.,,
<br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) �J
<br /> CONTACT NAME: pp CONTACT PHONE: y2 g `-12 35o
<br /> CONTACT EMAIL:ho.yu,,`�✓� ;C , �p Q✓st,ri �S .CSbVV\
<br /> SIGN PERMIT INFORMATION
<br /> VALUATION OF WORK: $ 30 , da0 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 /> ems\-aA1 v./wv,��,�,.,� �,' ,. a t11Vvvx,v,je--ci IJ'3C I\ 5i5>4s
<br /> SIGN DIMENSIONS:
<br /> Sign 1: Width: 9 O`` Height: 6 Square Feet: SCD
<br /> Sign 2: Width: 11 " Height: a2 �a\` Square Feet: 3 • 77
<br /> Sign 3: Width: I ' Height: ( F Square Feet: a .
<br /> SIGN TYPE&QUANTITY: J, Wall/Awning/Canopy-Qty: of ❑Window-Qty: ❑Electronic Changing Message-Qty:
<br /> ❑Projecting-Qty: Freestanding-Qty: I -Type(monument,etc.): rMo►'\Uw.s l
<br /> SIGN LIGHTING: ❑Non-Iluminated JJlluminated-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:1 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 1 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#5220 M
<br /> 7
<br /> Owner/Authorized Agent Signat re Date (Revised 4/21/2022) /
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