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Ii iN PERMIT APPLICATION ()I oc-3 <br /> ve; <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 130Q f C✓Ir)(t'C�l V\((A) PARCEL#: it I 2 0 35 <br /> CITY \v f Vl•ft STATE VA ZIP g}20 <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> �. ., • I I <br /> CONTACT INFORMATION <br /> OWNER NAME: 1CG JvOYMIC v'e <br /> OWNER MAILING ADDRESS: STREET 1 g'•'IC5 h)C. G Gt A\JC <br /> CITY 'Lt Oil An STATE WR' ZIP { <br /> OWNER PHONE: } OWNER EMAIL: Y1 ) /1 <br /> CONTRACTOR CONTACT NAME: Nil e• :'v a•); <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): O rs\161ZSL$32 3S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t51 r^Y <br /> CONTRACTOR ADDRESS: STREET ,rr(,t t.4 6 l ('I S• <br /> CITY MA• Y e n(kl STATE W Pr `)r L / <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: J Ottl 0`1 0tj Cl aCt1Ai ) <br /> • <br /> PRIMARY CONTACT: LI OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: pj i p) 61y)- gioSio <br /> (�, <br /> UI "0YACCI CONTACT EMAIL: )LAIYncxy(1(t�1 '<�:11 t P WY) <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ - t.), GV ;, ASSOCIATED PERMIT#(if applicable):(Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actu id Ec E v E, <br /> DESCRIPTION OF WORK: D <br /> tJC W S1& 'iS YC ci ni of rxis-hni can}ICI JUN 3 0 2023 <br /> J <br /> CITY OF EVERETT <br /> Permit Services <br /> SIGN DIMENSIONS:Sign 1: Width: Et ILI +�,)L 1 ' Height: I r r Square Feet: " 5F <br /> Sign 2: Width: >j'- 8. Height: ( ' W Square Feet: 1:;'y SF <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ((Wall/Awning/Canopy-Qty: LI Window-Qty: ❑Electronic Changing Message-Qty: <br /> Uloizti i) <br /> ❑Projecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: ❑Non-Iluminated Xyluminated-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# <br /> ot31190 ii 3C0) -00 to <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />