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V65 <br /> SIGN 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 /> WASHINGTGN CONTACT INFORMATION: (P)425-257-8810 1(E)PerinitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,3 14 R ET PARCEL#: <br /> CITY [5 STATE AP'5fg-401 <br /> SUITE/UNIT M ADDITIONAL LOCATION INFORMATION:TENANT/BUSINESS NAME(if non-residential): I �l' l( t,— <br /> P <br /> CONTACT INFORMATION <br /> um <br /> OWNER NAME: lb <br /> OWNER MAILING ADDRESS: STREET ' / - <br /> CITY V STATE <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR CONTACT NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): UU��r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1-i ZS L1 CONTRACTOR EMAIL: allilwl 1, b1� <br /> PRIMARY CONTACT: ❑OWNER TRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 1 CONTACT PHONE: L <br /> CONTACT EMAIL: ,^z <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ C 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 /> SAS W1 Z <br /> i <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: Height: Square Feet: <br /> Sign 2: Width: Height: 5 Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY:' all Mounted-Qty: L []Awning-Qty: []Canopy-Qty: ❑Window-Qty: <br /> ❑Electronic Changing Message-Qty: El Projecting-Qty: El Freestanding-Qty: -Type(monument,etc.): <br /> SIGN LIGHTING: on-Illuminated El 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> IL 17 PERMIT# <br /> Ow r/Authorized Agent Signature Date (Revised 111812022) <br />