3625 BROADWAY CELL SHOP 2024-10-24

BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 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 l(E)everetteps@everettwa.gov l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3625 Broadway,Ste C PARCEL#: clTr Everett STATE WA ZIP 98201 SUITEtUNIT#: C FLOOR M 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANTIBUSINESS NAME(if non-residential): AT& T Cellshop LEGAL DESCRIPTION for new construction: Short Plattsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Cellshop OWNER MAILING ADDRESS: STREET 1955 N. Val Vista Dr. Suite: 110 cl-ly Mesa STATE AZ ZIP 85213 OWNER PHONE: 480-365-9328 IOWNER EMAIL:jody.najera@Cellshop.us CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: l]OWNER Z CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:480-206-7040 Brad 1Vlarucha CONTACT EMAIL:brad@johanseninteriors.com BUILDING INFORMATION VALUATION OF WORK:$40,000 (ValuationASSOCIATED LAND USE PROJECT#(if applicable): 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: PROPOSED USE OF BUILDING:Cell Store Retail HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR OTownhouse ❑Duplex EIADU ❑Multi-Family-#Units: ❑Commercial ElAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ❑Remodel ❑Repair ❑T.L ❑Change of Use ❑Modular ❑Portable ❑Re-roof DExtedor Alteration nTank(above ground) ElAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub E]Tank(above ground) ❑Other: DESCRIPTION OF WORK:Relabeled from a T-Mobile store. New ceilingtile,, paint and carpet squares_ New displays ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before b "ng aj(53)d under any circumstance.f am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and t compl ith t Co tracto Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature Date (Revised 2/8/2021)