3930 HOYT AVE PHYSICIANS EYE CLINIC 2025-09-30

BUI1 ING PERMIT APPLICATIC CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 i(E)PermitServices@everettwa.gov i(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3930 Hoyt Ave PARCEL#: 0201459 cln. Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Physicians Eye Clinic LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Tom Jones Jr. OWNER MAILING ADDRESS: STREET 3930 Hoyt Ave CITY Everett STATE WA ZIP 98201 OWNER PHONE:4252592020 1OWNER EMAIL: CONTRACTOR COMPANY NAME:King's Drywall Repair LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):KINGSDR957C2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)'_=416842001000"f CONTRACTOR ADDRESS: STREET3409 McDougall Ave Suite 207 cIn Everett STATE WA ZIP 98201 CONTRACTOR PHONE:425-778-7262 ICONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Maintenance Director CONTACT NAME: CONTACT PHONE:4252592020 Brandon Teachout CONTACT EMAIL:BrandonT@Iasikdrs.com BUILDING INFORMATION VALUATION OF WORK: $5000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:ASC PROPOSED USE OF BUILDING:ASC HEAT SOURCE: ❑Gas ZElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi-Family-#Units: (]Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply); ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:We need to update the existing firewall by adding 12"-18" of sheetrock and sealing all penetrations to the top of the existing wall. The work will be done along the North wall of the ASC that borders a long hallway. This is approxim ly 45ft of wall that will need the additional sheetrock. DEC 0 2 2023 ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done p�suan_ o �PP,,e,rml.mus comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations mtFstrst buti3�iW�vr�ing from the Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 4C� Owner/Authorized Agent Signature Date (Revised 412112022)