Laserfiche WebLink
INN JN PERMIT APPLICATION p9 c 3 <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 /> WASHINOTON 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-fit,pS CIO t��✓ � ! Ct ) �(V 2'(x.1 PARCEL#: -J I (:3"- !�(J <br /> CITY �V l-trC I STATE \,vA ZIP _1/8✓0 3 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME (if non-residential): 1XC 3 111115 () <br /> CONTACT INFORMATION <br /> OWNER NAME: LtCi linOSon ci(uti'I <br /> OWNER MAILING ADDRESS: STREET <br /> '' �1 tJv rs5 PNC <br /> CITY V l,I Ail A Yid STATE VS//' ZIP 01 803-3 <br /> OWNER PHONE: , OWNER EMAIL: v /t <br /> CONTRACTOR CONTACT NAME: %Cul(v >>� f1 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): W y r 1ZSL u32 S S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t57 1 C <br /> CONTRACTOR ADDRESS: STREET t)ii .)1 CI I'\A.& <br /> CITY ' �t e m In STATE (,^i far ZIP ' <br /> CONTRACTOR PHONE: i t.O L)LU CONTRACTOR EMAIL: Tbeil 11'1 b04 It(1') 1 <br /> PRIMARY CONTACT: [J OWNER ,C CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l3V 0) q,..4( ." 1,,5L <br /> U� I Vo`IcICo CONTACT EMAIL:'j;(iIyYlk,c\jC1ctll VIA I (cvm <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK: $ G t , C ) :w ASSOCIATED PERMIT#(if applicable): g?j' q Lj - Q0S <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 /> DESCRIPTION OF WORK: <br /> NEB sIt),1S rc-c-660 O ci.; tc . RIECEUVE <br /> JUN 3 0 2023 <br /> CITY OF EVERETT <br /> SIGN DIMENSIONS: Permit Services <br /> Sign 1: Width: 25) -5 11 Height: '-I,p" Square Feet: •15 st <br /> Sign 2: Width: UI - z')/1 Height: 'Z I Square Feet: 11 S 5F <br /> Sign 3: Width: ILI' �)' Height: 7 t Square Feet: I 5 Jt <br /> SIGN TYPE&QUANTITY: %Nall/Awning/Canopy-Qty` l) ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type (monument.etc.): <br /> SIGN LIGHTING: ❑Non-Iluminated Allluminated-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 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 /> PERMIT# U015P2-0/2-22 ^ 50— � CO(o <br /> Own r/Authorized Agent Signature Date (Revised 2/8/2021) <br />