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EVERETT <br />SIGOPERMIT APPLICATION i <br />CITY OF EVERETT PERMIT SERVICES <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 .3 k 2.5 AAcDomil Avt PARCEL #: 0 <br />0 y 3 0I 6-7�I 3 001 <br />CrrY J re,STATE WA ZIP 18 2 0 <br />SUITE/UNIT #: 10 ( ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): CO L 1 <br />CONTACT INFORMATION <br />OWNERNAME: .31Zs Me-D6ogp t Avenae Pr4 er-tY L -C <br />OWNER MAILING ADDRESS: 1 603 VYY ea N r - <br />A <br />CITY 9e_li4&VV� STATE VJA ZIP. 40k8ODj <br />OWNER PHONE: t-i Z5 Cl k ( -64ctj 1OWNEREMAIL: Seth , o c- z1ov, 4krll � wppl ,coin <br />CONTRACTOR CONTACT NAME: r AS T S T .& J S <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): CL PAST S�3 23 <br />ITY OF EVERETT BUSINESS LICENSE #(REQUIRED):{SD <br />CONTRACTOR ADDRESS: STREET 7-8-0 2 Co (b ), A V e <br />CITY �Vj°,l`�-�^r STATE WA ZIP <br />CONTRACTOR PHONE Li _251 413 8— a 3 S <br />CONTRACTOR EMAIL: 9-7C�_ <br />k oZ T �r sts t ns : C O <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ZOTHER (Please Specify)�5 ales Re <br />CONTACT NAME: 11 �, <br />,IV hG etl t'��� i <br />CONTACT PHONE: yzs L.�'3 Si - I -3,5o er, -. III <br />CONTACT EMAIL: ,'+CM+Z <br />SIGN PERMIT INFORMATION <br />VALUATION OF WORK: $ ( 7% <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 />1 <br />DESCRIPTION OF WORK: "Rebfand l o� for Compotny, s 2 d i me t sj' o not l - l i ltlm i i�a4t4 5'ic ns. <br />("n <br />f� J„ 13otnrlp� JJ <br />SIGN DIMENSIONS: <br />Sign 1: Width: Cj Height: —7 Square Feet: b <br />L <br />Sign 2: Width: 495, 1 Height: Square Feet: b a Ll <br />Sign 3: Width: � �� Height: W Square Feet: ( . <br />SIGN TYPE & QUANTITY: Wall/Awning/Canopy - Qty:-;5-- ❑Window- Qty: ❑Electronic Changing Message - Qty: <br />❑Projecting - Qty: ❑Freestanding- Qty: - Type (monument, etc.): <br />SIGN LIGHTING: kNon-Iluminated ❑Illuminated -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 1 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 />City of Everett Official Use Only <br />7nB <br />-©a( <br />Owner/Authorized Agent Signature Vat. (Revised 21812021) <br />V7__ <br />