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u apIGN PERMIT APPLICATIc. <br /> IMF EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 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@evereltwa.gov i(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: srnt_Er , r _ +°�Y? /`T a( Wa PARCEL#: 6'O = ( ,90 13 QQ 307 <br /> CITY eva .. :e—t-E--- O <br /> �� �` 11 STATE ZIP9312.0A <br /> SUITE/UNIT#: 0 ADDITIONAL LOCATION INFORMATION: <br /> TENANTIBUSIN NAME ' non-residential): 7\4 y l t~ /"t a Y }-- <br /> ��t <br /> CONTACT INFORMATION <br /> OWNER NAME: <br /> 414,5 Lc f'li ram. . OJ «.r 9 <br /> OWNER MAILING ADDRESS: STREET ` q p5 5 .-^ Via re-ft 1 a l l a / 3 GI j tt, f 0 <br /> 3 <br /> l if <br /> CITY -e\'e L1 STATE 4 Ci 3 z`.`'LJ <br /> � J 3t� ZIP `� t <br /> OWNER PHONE: 2O(p ..-L i L- '�55, 2_ IOWNER.EMAIL: y LA.5( bCj oJ) Gj' , ., (�qma I ,corn <br /> CONTRACTOR CONTACT NAME: J J c1 �'} <br /> `te�i;I��A�n..t <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED) f )0- r r[ <br /> (,,,J 11 C� f �,.! CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q 573 <br /> CONTRACTOR ADDRESS: sTREET 06 3 E Ever Hai(a i( Way <br /> CITY %ve <br /> STATE 111 j A ZIP 9 20g <br /> CONTRACTOR PHONE: L( 25..- 9 5 l- 0 2 !CONTRACTOR EMAIL:"#i PA/ee PczJ- 15 ,a.ya met-e Ve lam.', CV r r, <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ' i CONTACT PHONE: 9 �5,.c/5I.- 02.3(0 <br /> t Y t o V e e, Do kil0-n 9 a{3hG(I von, CONTACT EMAIL:Th a u ee.fit)." 15 n ararylck_..e kj.„„'1 t t ?}t'r1 <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ S 1 ?'(5 r 00 !ASSOCIATED PERMIT#(if applicable): /(Valuation shall include the prevailing fair market value o all labor,materials,and r paid o C I rat t / p i-ayt�,��� <br /> DESCRIPTION OF WORK: equipment needed to complete the work,whether actually paid or not.) J <br /> n5*c ( ( 1 c to j 1,4oun}ed Los° cLhc( c he 0ire1 1-eL1rs <br /> ,2 -z o ff X 2 t <br /> SIGN DIMENSIONS: at <br /> f <br /> Sign 1: Width: 2. Z .) Height: ,0 -'If -Is/ <br /> Z L 3 <br /> Square Feet: <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: rc Height: Square Feet: <br /> MN TYPE&QUANTITY: Waii wningICanopy-Qty: I DWindow- <br /> QtY: DElectronic Changing Message-Qty: <br /> OProjecting-Qty: OFreestanding-Qty: -Type(monument etc.): <br /> ;IGN LIGHTING: ❑Non-Iluminated J Illuminated-Type(backlit cabinet,etc.);_L nit'Yr rod 4„6 *requires a separate electrical permit <br /> LAN REVIEW REQUIREMENTS:Submit 2 hard copies.of sign plans with permit application to Permit Intake Drop Box. <br /> CKNOWLEDGEMEN7:•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 /> rrrent 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 /> wilding 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 /> W I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> j f�I �� P RMIT# <br /> j 22...02.-- 00 3 <br /> Nnerh horized Agent Signature Date (Revised 2/8/2021) <br />