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BLD2021-1504+Application+11.2.2021_8.10.26_PM+2498348CITY OF EDMONDS MyBuildingPermit.com Sign Application #1044174 - Dusted Valley Wine Bar Applicant First Name Last Name Company Name Brian Stoddard NW Siqn & Design Number Street Apartment or Suite Number E-mail Address 17201 Beaton Road SE permits(�D_nwsigns.com City State Zip Phone Number Extension Monroe WA 98272 4258446415 Contractor Company Name NW WHOLESALE SIGNS Number Street Apartment or Suite Number 17201 Beaton Rd SE City State Zip Phone Number Extension Monroe WA 98272 (425) 844-6415 State License Number License Expiration Date UBI # E-mail Address NWSIGS*84201 10/7/2022 602156837 permits(a_)_nwsigns.com Project Location Number Street Floor Number Suite or Room Number 201 MAIN ST City Zip Code County Parcel Number EDMONDS 98020 00434400700700 Associated Building Permit Number Tenant Name Dusted Valley Wine Bar Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name * EDMONDS 2020 LLC Number Street Apartment or Suite Number 307 BELL ST 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: 11/2/2021 Submitted By: Brian Stoddard Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Sign Application #1044174 - Dusted Valley Wine Bar Project Contact Company Name: NW Sign & Design Name: Brian Stoddard Email: permits@nwsigns.com Address: 17201 Beaton Road SE Phone #: 4258446415 Monroe WA 98272 Project Type Nonresidential Activity Type Permanent Sign Project Name: Dusted Valley Wine Bar Description of Work: install 3 signs non -lit Project Details Sign 1 Type Other Additional Project Information Total number of signs installed 3 Total number of signs removed 0 Scope of Work Wall or Building Page 2 of 2