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,iGN PERMIT APPLICATION ECEOVE <br /> CITY OF EVERETT PERMIT SERVICES D <br /> E V E R E T T SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 3200 C Stre F}}ogr IMn Drop <br /> WASHINGTON CONTACT INFORMATION: (P)425.257.8810 1(E)everetteps@everettwa-.gov I(W) a ttwa. Ven'ni r <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET IWb -C (, PARCEL#: U g 62'] e r(111t Servirps <br /> b ` <br /> GTy Evc yLit STATE ZIP <br /> SUITE/UNIT#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): S jih <br /> CONTACT INFORMATION <br /> OWNER NAME: �( �j}(, t9 (ASS 1 <br /> OWNER MAILING ADDRESS: STREET Z�Zq OS] n1 Ii3fJ b <br /> cnY W.trist Ul 1 STATE Cl ZIP <br /> OWNER PHONE: 11 OWNER EMAIL: V� <br /> CONTRACTOR CONTACT NAME: M( ✓ S I vl <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): p/�� S 323� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED 31 <br /> CONTRACTOR ADDRESS: STREET 160 g/ <br /> CITy to - vC vvi O st-T. WA ZIP U <br /> CONTRACTOR PHONE: (36 C) q7 q- 1325 1CONTRACTOR EMAIL: �(,{j mbo trl 0 (om <br /> PRIMARY CONTACT: ❑OWNER fACONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (-g �J C,N I• $(psSp <br /> J(J(.li L-�ov dcn CONTACT EMAIL:-Dilimlopq 6cn @ srntai �. COM <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ i f 0 DO-00 1ASSOCIATED 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 /> 1,Y)II'a TXW G11(An1nel krkv v C01 Sjps J one tt,nhvn� ngtaccn-%� 1v exiLlonj <br /> yob( siv)- <br /> SIGN DIMENSIONS: q r <br /> Sign 1: Width: r!} �t Height: t Square Feet: Lq�'15 sr <br /> Sign 2: Width: jl I� Height: '3r Square Feet: <br /> n <br /> Sign 3: Width: 3 1'gt Height: Z' Square Feet: <br /> SIGN TYPE&QUANTITY: Wall/Awning/Canopy-Qty: 3 ❑Window-Qty: ❑Electronic Changing Message-Qty: L <br /> ❑ «Projecting-Qty: Freestanding-Qty: j -Type 61tin.9 Pad(, y -EAt.0 <br /> SIGN LIGHTING: ❑Non-Iluminated Killurninated-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:1 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 1 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# 5� -7 Q� — <br /> OvA41Authorized Agent Signature Date (Revised 21812021) S <br />