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SIGN PERMIT APPLICATION fECEOVE <br /> CITY OF EVERETT PERMIT SERVICES ❑c <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 32g)Iev <br /> dar&69 23c�lgNake Dr ox. <br /> WASHINGTON CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I( erettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OF EV <br /> PROJECT SITE ADDRESS: STREET aS .31 (�C�{�C�� PARCEL#: ermlt S.efVices <br /> CITY ��C/1�-�l STATE ZIP ZO I <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): Co•n.rvj tr <br /> CONTACT INFORMATION <br /> ,1 OWNER NAME: [r�c/��( E•2y Ce'.Pr A)/C <br /> OWNER MAILING ADDRESS: STREET `t <br /> CITY STATE `4_I J`"t/J'- ZIP Z,V <br /> Aj <br /> OWNER PHONE: �g O/W�NER EMAIL: <br /> CONTRACTOR CONTACT NAME: I D(YIM Ir1�C. b r <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS L CENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET �Z,/S3�/ <br /> CITY _ (/�iQyia� STATE `�(, 4— ZIP -c�y <br /> CONTRACTOR PHONE: 7�� %�� r/ CONTRACTOR EMAIL: /�v2/� 1L.gP,flS'�G c'ZIP <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,OTHER(Please Specify) /V,41 ad ICA )4-"JC:^' <br /> CONTACT NAME: 0,Ci/ ) CONTACT PHONE: �Z� 3i� <br /> CONTACT EMAIL: <br /> SIGN PERMIT INFO R1nATION <br /> VALUATION OF WORK:$ ��®o 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:.57 Cv4.,!g o OL/ � sfs i l,v <br /> If Afs74'_- d 4-f /3L�� A-1 S3/ �rJ 02� &Al Sd <br /> if <br /> -39 P ll &vL"Z-5 14,V.�) 1011 1- 4YL ICFIAI (ytl� ram/I <br /> SIGN DIMENSIONS: <br /> 12 <br /> Sign 1: Width: Height: Square Feet: G <br /> Sign 2: Width: Height: Square Feet: <br /> Sign 3: Width: Height: Square Feet: <br /> SIGN TYPE&QUANTITY;X�Vall/Awning/Canopy-Qty: / ❑Window-Qty: ❑Electronic Changing Message-Qty: <br /> ❑Projecting-Qty.- ❑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.l 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.1 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# C <br /> Owner/Authprized AgerR'Sig ature ` aTe (Revised 21812021) <br />