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IIGN PERMIT APPLICATIOIP <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVE R E T T 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)everetteps@everettwa.gov 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 6300 101 e,netfl C,,c#AI. PARCEL#: $ iaaOaS015o <br /> ern' 6.y.(yPA'c STATE \ei P7 ZIP elaacts <br /> SUITE/UNIT#: O b0 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): ;tey --Vwh 'Tc,1-‘v�6I�l�S <br /> CONTACT INFORMATION <br /> OWNER NAME: Ma y<-o [Ark vva1,05 es <br /> OWNER MAILING ADDRESS: STREET (03OZ7 Q�'fj.¢✓try C�-{ejA1� 3\I03 <br /> CITY (.QJ✓p. " ' STATE V,_ r"IT ZIP Cjg <br /> OWNER PHONE: t"t) 5 99 55'5 r, OWNER EMAIL: Qt yJ I i .c0 \ ck <br /> CONTRACTOR CONTACT NAME: cQ.545'110)I4S " <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): F14ST"4 31.J I` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C(JW 3 C <br /> CONTRACTOR ADDRESS: STREET oi00: Queika Ave <br /> CITY E,VCAAI.e,4-L. STATE \t,l ZIP c18a01 <br /> CONTRACTOR PHONE: gel 5 43 3 935a CONTRACTOR EMAIL: L17/ Pco-qs C ,.,S ,(-610-1.--.. <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L/a 5, -Hat 4/35 Q <br /> CONTACT EMAIL: ,ts)etiRei"(�-1i S .Cov+-• <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ 3 ' 5 `J .(o dZ ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair n{arket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: i V�Sra,tl,�` •�t• <br /> wcr+I+yM p <br /> 11 g 1 ' -Ex6e.lf; to s .;1:0p s Fe-d-tvi►% D4. <br /> hiI-- n 5t�iaAte• h-.�� <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: I s q •101 Height: 3-W .(_tiv Square Feet: Z <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: BWall/Awning/Canopy-Qty: 1 El Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: OFreestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING:nNon-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.lam 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# l 1 <br /> Owner/Authorized Agent Signat e D e (Revised 2M/2021) <br /> z <br />