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BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />WAa NINOTON then drop of completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-88101 (E) PermilServicesahwerethm.gov I RM everettwamov/oermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: swEET923 Hoyt Ave PARCELM 03854-175-012-00 <br />am, Everett STATE WA de 98201 <br />SUITEIUNITM FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT18USINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction: Shod Plat/subdivision: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME:Alexander Katz and Phoebe Jensen <br />OWNER MAILING ADDRESS: STREET 923 Hoyt Ave <br />cry Everett STATE WA z,R 98201 <br />OWNER PHONE:781-454-9089 <br />OWNER EMAIL: aleXkatz323@gmaii.COm <br />CONTRACTOR COMPANYNAME:One Call Home Repair 0, <br />WASTATE CONTRACTOR LICENSE #(REQUIRED):ONECACH8Z 3B <br />CITY OF EVERETT BUSINESS LICENSE #(R QUIRED): <br />CONTRACTOR ADDRESS: ADDRESS: sTREET1912 Everett Ave <br />c,r, Everett STATE WA nR 01 <br />CONTRACTOR PHONEA25-470-5254 <br />1CONTRACTOR EMAIL:Info@oneaallisall.net <br />PRIMARY CONTACT: p OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Alexander Katz <br />CONTACT PHONE:781-454-9059 <br />CONTACT EMAIL:alexkatz323@gmail.com <br />- BUILDING INFORMATION <br />VALUATION <br />OF WORK: $80,000 <br />ASSOCIATED LAND USE PROJECT # (if applicabIs): <br />(Va atbnah.1 <br />noodle the cravats fa ma et value of am r, materials, am equipment <br />needed to cwnpbte 0ewwkwhether acNal/ Pam ornot.) <br />EXISTING USE OF BUILOING:Single Family Residential <br />PROPOSED USE OF BUILDING:Single Family Residential <br />HEAT SOURCE: ©Gas IZEleciric OOther <br />BUILDING TYPE: (l]SFR OTownhouse ODuplex OADU OMulti-Family -# Units:_ OCommercial OAccessory Structure <br />TYPE OF PROJECT(check all that apply): ONew Construction OAddltion ORemodel ❑Repair OT.I. OChenge of Use <br />(]Modular OPortable ORe-roof OExterior Alteration []Tank (above ground) c Stru e <br />OFence over 7ft high ORackSlorage OPooVHot Tub Munk (above ground) ©Other: all only <br />DESCRIPTION OF WORK:There is a 2r3" wall that is present only for ftia4aur ose of fr cabinets. , <br />ACKNOWLEDGEMENT. I have raviewetllMs applkalion end confirm the mimmel/on containedhomin /s We and correct. Work done pursuant to thispemdl must comply with <br />current Wderal, state, and local law. The gmneig ofa pemuf only authorizes appmved work end no devlalkms therelmm. Deviagons must firsi be authorized in mii ing from the <br />Building Ofcial before being sulhodzed under any circumstance. ) am the owner, or I am authorized by the ownerolthis property to perform the workfor which application Is made, <br />and I comply with the Slate Contractors Lew 18..27 RCW and 296.20ait WAC. <br />Cgy of Everett Official Use Only <br />tl-7/5/2022 FVWIT # <br />Owner/Ault razed' eht Signature Date (Revised 42112022) O <br />a <br />