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IGN 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET p 5d( ot,LRCEL#: <br /> }F T Ave_�v e o v5/?Kfo(ao/av <br /> CflY v'c.A/ STATE VIA ZIP R QON <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME: I mryl ac, f#4 kL C_ancf-p/ia,1 Perris -- 4 c* <br /> OWNER MAILING ADDRESS: STREET Gf 3 Co if 04. Aye <br /> G <br /> CITY % STATE rJlat ZIP1-adt <br /> OWNER PHONE: e5 3 taj 7D tq OWNER EMAIL: JtSSi t oter I G — O !ph <br /> CONTRACTOR CONTACT NAME: c1S41-lg�S �✓,t�p/ J <br /> WA STATE CONTRACTOR LICENSE . ] f 3,*_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):SCA G7� <br /> CONTRACTOR ADDRESS: STREET/94Q d '�(� "Apt.. <br /> . 1-r '^ <br /> CITY f� J�j1/�fs6'�j' STATE •VI+ ZIP / zile I <br /> CONTRACTOR PHONE: 1-IA (43%' q3/, CONTRACTOR EMAIL: (F�►- '""t"r�•c. , be4���YYY�6- 1 C. <br /> PRIMARY CONTACT: El OWNER )CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q a s y $g Ci3s 0 ^,�n l- ra,,._ <br /> V'lou,yv�,�• Q, �QX^�c•.� CONTACT EMAIL:1%4LArr`^:'^n� . bX,y�4YC�''T,43TcieS w•ll <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ �145 .-3O ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value o I labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: �� /I 7.) <br /> J ,-. SYu 'u tO 6vlet` 4 <br /> SIGN DIMENSIONS:Sign 1: Width: '30 Height: C e ., Square Feet: act . 1(0 <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ❑Wall/Awning/Canopy-Qty: ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: Freestanding-Qty: ! -Type(monument,etc) <br /> SIGN LIGHTINGNon-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::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 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 <br /> Everett Official Use Only(� ,,) L2A PERMIT# S O (W <br /> wner/Authorized Agen nature Date (Revised 2/8/2021) <br />