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�. 'N PERMIT APPLICATION ) <br /> CITY OF EVERETT PERMIT SERVICES MAY 2 6 2023 <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 3200 Cedafy, t 290 Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I(W)eve relt .�ovl(pArm(tsV4R E T <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION rerrn1 Grvices <br /> PROJECT SITE ADDRESS: STREET(p ,2 jJ W PARCEL#: Oo`_-gq 7l)} Q} I U l <br /> CITY '�\/r'I/7 I STATE ��;�,� ZIP <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): I + <br /> CONTACT INFORMATION <br /> OWNER NAME: j�•V I n Snot U ( U r;11 i <br /> OWNER MAILING ADDRESS: STREET •Q• oX <br /> CITY tnf+ STATE ;tli ZIP <br /> OWNER PHONE: ;l OWNER EMAIL: 0 <br /> CONTRACTOR CONTACT NAME: 1 j U t ((n M L t V <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): �'32'�O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 t7 310 <br /> CONTRACTOR ADDRESS: STREET "j,1I U (� �Tv�� )S <br /> CITY M1 V V fl 7 1 STATE UV(') zip "')g 47 3 <br /> CONTRACTOR PHONE: ;bb g2,tj 2 CONTRACTOR EMAIL: iD dif-n�U�GIfYIC�) °)��1Tt <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (?,(r 0) `1 L1 I �LS� <br /> CONTACT EMAIL: bA mhp f1tV1 @ �1Y1G1 i j !pm <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK: $ ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of an labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: <br /> New POIC Si on <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: I ! `' Height: Square Feel <br /> Sign 2: Width: Height: Square Feel: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY: ❑WalllAwninglCanopy-Qty: ❑Window-Qty: ❑Electronic Changing Message-Q_ty\ <br /> ❑Projecting-Qty: VFreestanding-Qty: ` -Type(monument,etc.): T D}c ,) <br /> SIGN LIGHTING: ❑Non-Iluminated Ailluminated-Type(backid 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 /> Ownb/Authorized Agent Signature Date (Revised 21812021) <br />