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BLD2021-1458+Application+10.22.2021_11.15.20_AM+2478182CITY OF EDMONDS Sign Application #1039100 - STATE FARM Applicant First Name Last Name Brian Brosnan Number Street Apartment or Suite Numb 2710 104th St.CT S. City State Zip Lakewood WA 98499 Contractor Company Name RAMSAY SIGNS Number Street 727 S. 96th St. City State Zip Seattle WA 98108 State License Number License Expiration Date UBI # HEATHN1981JE 3/30/2022 602195548 Project Location Number Street 22618 HIGHWAY 99 MyBuildingPermit.com Company Name Heath Northwest er E-mail Address bbrosnan(a_heath northwest. com Phone Number Extension (253)495-7091 401 Apartment or Suite Number Phone Number Extension (206) 623-3100 E-mail Address bbrosnan(aD_heathnorthwest. com City Zip Code County Parcel Number EDMONDS 98026 27043000403500 Associated Building Permit Number Tenant Name State Farm Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Floor Number Suite or Room Number 1 113 First Name Last Name or Company Name BOO HAN PLAZA III LLC Number Street Apartment or Suite Number 3880 STEILACOOM BLVD City State Zip LAKEWOOD WA 98499 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: 10/22/2021 Submitted By: Brian Brosnan Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Sign Application #1039100 - STATE FARM Project Contact Company Name: Heath Northwest Name: Brian Brosnan Email: bbrosnan@heathnorthwest.com Address: 2710 104th St.CT S. Phone #: (253)495-7091 401 Lakewood WA 98499 Project Type Nonresidential Activity Type Permanent Sign Scope of Work Wall or Building Project Name: STATE FARM Description of Work: INSTALL (1) ILLUMINATED SET OF CHANNEL LETTERS ON A RACEWY READING: STATE FARM" Project Details Sign 1 Type Channel Letters Additional Project Information Total number of signs installed 1 Total number of signs removed 0 Page 2 of 2