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BLD2021-1255+Application+9.9.2021_1.26.35_PM+2400127CITY OF EDMONDS MyBuildingPermit.com Sign Application #1017427 - Thrive Kids Dental Applicant First Name Last Name Company Name CJ Williams Western Neon Number Street Apartment or Suite Number E-mail Address 2902 4th Ave S cj(cD-westernneon. com City State Zip Phone Number Extension Seattle Wa 98134 (206) 682-7738 Contractor Company Name WESTERN NEON INC Number Street Apartment or Suite Number 2902 4th Ave S City State Zip Phone Number Extension Seattle Wa 98134 (206) 682-7738 State License Number License Expiration Date UBI # E-mail Address WESTEN10990E 9/7/2023 601041722 cj(awesternneon.com Project Location Number Street Floor Number Suite or Room Number 10032 EDMONDS WAY 102 City Zip Code County Parcel Number EDMONDS 98020 00610700200600 Associated Building Permit Number Tenant Name Thrive Kids Dental Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name Unknown Unknown Number Street Apartment or Suite Number 10032 EDMONDS WAY 102 City State Zip EDMONDS WA 98020 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 9/9/2021 Submitted By: CJ Williams Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Sign Application #1017427 - Thrive Kids Dental Project Contact Company Name: Western Neon Name: CJ Williams Email: cj@westernneon.com Address: 2902 4th Ave S Phone #: (206) 682-7738 Seattle Wa 98134 Project Type Nonresidential Activity Type Permanent Sign Scope of Work Wall or Building Project Name: Thrive Kids Dental Description of Work: install one wall mounted building sign and one sign cabinet added to existing pylon. Project Details Sign 1 Type Building Mounted Additional Project Information Total number of signs installed 2 Total number of signs removed 0 Page 2 of 2