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Imo <br /> im •IGN PERMIT APPLICATI. <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 1 100 Pacific Ave PARCEL#: <br /> CITY Everett STATE WA zip 98201 <br /> SUITE/UNIT#: 300 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): Proliance Surgeons Everett Bone & Joint <br /> CONTACT INFORMATION <br /> OWNER NAME: PACIFIC AVENUE ASSOCIATES <br /> OWNER MAILING ADDRESS: STREET 1100 PACIFIC AVE#300 <br /> CITY EVERETT STATE WA 98201 <br /> ZIP <br /> OWNER PHONE: 425.636.4210 OWNER EMAIL: K.RUSSELL@PROLIANCESURGEONS.COM <br /> CONTRACTOR CONTACT NAME:MELISSA SHRYOCK <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):ARTCOSC1 64D6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET108 S BRANDON ST <br /> CITY SEATTLE STATE WA ZIP 98108 <br /> CONTRACTOR PHONE:206.661.2052 CONTRACTOR EMAIL:SALES@ARTCOSIGNS.COM <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206.661.2052 <br /> MELISSA SHRYOCK CONTACT EMAIL:SALES@ARTCOSIGNS.COM <br /> 1 SIGN ERMIT INFORMATION <br /> VALUATION OF WORK: $ 7.3 1, S G C' (?.Z411-- +5 " ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all la or,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: <br /> NEW ENTRY SIGNS <br /> 2 - REPLACMENTS OF EXISITING SIGNS USING FOUNDATIONS AND POWER <br /> 1- NEW BLADE SIGN NON-ILLUMINATED WALL MOUNT TO ENTRANCE <br /> ,, ,,;,.-, 7(/0 riot it 10Weci <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: 53 3/4" Height: 53 3/4" Square Feet: 78 <br /> Sign 2: Width: 51 3/8" Height: 26 1/4" Square Feet: 18 <br /> Sign 3: Width: 36" Height: 36" Square Feet: 18 <br /> SIGN TYPE&QUANTITY: ❑✓Wall/Awning/Canopy-Qty: 1 ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑✓Freestanding-Qty:2 -Type (monument,etc.): MONUMENT <br /> SIGN LIGHTING: ❑Non-iluminated ❑✓Illuminated-Type(backlit cabinet,etc.): EXISITING *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 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 Everett Official Use Only <br /> 5iAi ci 6.9.2022 PERMIT# <br /> Owner/Authorized Agent(Signature Date (Revised 4/21/2022) <br /> I <br />