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E GN PERMIT APPLICATION <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 14 0 Sit y ei ,r. Sut4G T.02, PARCEL#�M D 5 l g o 0401100 <br /> cm( e vi/r rSTATTE�Q�y1MN��n ZIP 1 g�I <br /> Plp SUITE/UNIT#: [03 ADDITIONAL LOCATION INFORMATION: f6 W' W u1VGW GoricrIktv06olrl <br /> TENANT/BUSINESS NAME(if non-residential):S#41,, FoiV D AA C, • <br /> CONTACT IN ORMATION <br /> OWNER NAME: Ka14,er,lne I}il\w'& c <br /> OWNER MAILING ADDRESS: STREET 1-}1.1,. Cmhp\t Pk)& A/ <br /> CITY &V UI A4( ] STATE 1�/V i ZIP m0 C <br /> OWNER PHONE: OWNER EMAIL:5 ,red/ 103(.0 tma.rbvn. <br /> CONTRACTOR CONTACT NAME: ID,,,,,,-Ex AkQl <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):60K $37j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 (03 <br /> CONTRACTOR ADDRESS: STREET a150/ (L 0 Eby Alf <br /> CITY (VXeX1' STATE tAJi J tov ZIP 9 XZo 1 <br /> CONTRACTOR PHONE: ¢a - i,- q3 , CONTRACTOR EMAl ayy4, yet, j ws.c© %i V <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C4- 5) is c.. (A350 <br /> curia CONTACT EMAIL: dim, (twat alt s1iks.cowe <br /> G SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ 5, 2,611 • t 9 ASSOCIATED PERMIT#(if applicable): <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 /> T(A)b PrgitA‘, 114 I siyrAs ( no- ele viViy) cave vl 4 +0 <br /> +wo 1t(,&k\ v , 0 44w, by I41 <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: -3 W .vr•ltt Height: �j a tt.5 Square Feet: 5 . l/ <br /> e\ -t2 <br /> Sign 2: Width: 3�,. 5 '/ Height: 52. S tI Square Feet: c. , �6 ( . t <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: Wall/Awning/Canopy-Qty: a ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> CI Projecting-Qty: 0 Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: Non-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.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> e j 0/14:11 <br /> ! - PERMIT# 2301 r () OS <br /> w. /Ailtho -Z Abut ignatur Date (Revised 2/8/2021) <br /> I12.— <br />