4101 RUCKER AVE CHEVRON 2023-10-25

SIGN PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1 (E)PermitServices@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4101 Rucker Ave PARCEL#: 00582101500300 CITY Everett STATE WA zip 98203 SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): Rucker Chevron CONTACT INFORMATION OWNER NAME: RH M Centre LLC OWNER MAILING ADDRESS: STREET 4101 Rucker Ave CITY Everett STATE WA zip 98203 OWNER PHONE: 425-917-2109 OWNER EMAIL: steven@insigniasign.com CONTRACTOR CONTACT NAME: Insignia Sign WA STATE CONTRACTOR LICENSE#(REQUIRED): INSIGSR813QA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 325 Burnett Ave N CITY Renton STATE WA ZIP 98057 CONTRACTOR PHONE: 425-917-2109 CONTRACTOR EMAIL: steven@insigniasign.com PRIMARY CONTACT: § OWNER § CONTRACTOR § OTHER(Please Specify)_____________________ CONTACT NAME: CONTACT PHONE: 425-917-2109 Steven Thomson @ Insignia Sign CONTACT EMAIL: steven@insigniasign.com SIGN PERMIT INFORMATION VALUATION OF WORK: $ 5,000.00 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) DESCRIPTION OF WORK: - Replace existing freestanding sign gas price faces with LED gas price faces (REFACE ONLY) SIGN DIMENSIONS: Sign 1: Width: 67" Height: 152" Square Feet: 70.68 REFACE ONLY Sign 2: Width: Height: Square Feet: Sign 3: Width: Height: Square Feet: SIGN TYPE&QUANTITY: § Wall Mounted-Qty:____ § Awning-Qty:_____ § Canopy-Qty:____ § Window-Qty:_____ § Electronic Changing Message-Qty:_� § Projecting-Qty:_____ § Freestanding-Qty:_l__-Type(monument,etc.):------ ____________ SIGN LIGHTING: § Non-Illuminated § Illuminated Type(backlit cabinet,etc.): *requires a separate electrical permit PLAN REVIEW REQUIREMENTS: Submit 2 hard copies of sign plans with permit application to Permit Intake Drop Box. 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Steyp�YL 06/20/22 Owner/Authorized Agent Signature Date (Revised 11/8/2022)