20180347 20181007125347CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: . PC-, fj Parcel #: �U+ 70 2— 1 D (U
Zoning; T-5 Current Use: U&JOCZ-4 P+ 6-0 Proposed Use: 6114 &YZAt•bfT166
New Construction Re -Model/ Re -Ron' Tenant Improvement
Plumbing Mechanical Fire Prevent/Suppress/Alarm Other
Project Description/Scope of Work: ber-ILE
Project Value: 3�
Building Area (sq. ft) Parking Garage �l I" Floor 71757 1_07At,?at.p�, T�
Building Height2i�
Are there any environmentally sensitive areas located on the parcel?N t� If yes, a
completed environmental checklist must accompany permit application,
BUILDING OWNERPFENANT NAME:
ADDRESS 1 1-2-5-40 EMAIL 'DiQ►r_�T-FpflerJ5 .7,
CITY PLa STATE L_ ,A- ZIP -q0 TELEPHONE_Xe2 Z&e) q 4S#
ARCHITECT/ENGiNEER NLPr LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR _ TELEPHONE ,3 d 7o'
ADDRESS 9'L-10 2 CGv E Zo EMAIL &1QZF4, Ste,- CLC , eVAA
CITY U5vjCj STATE L,�/ZIP S/b FAX
CONTRACTOR'S LICENSE #11F;6,-_`ik$1EXP DATE Sz ►`I CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL.
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DA'L'E CITY LICENSE #
MECHANICAL CONTRACTOR �7U L TELEPHONE
ADDRESS E MAIL
CITY 'STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use ofthe
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City ofYelm.
�6 1�
Applicant's ature Date
Owner ntrac caner'. Ag t / Contractor's Agent / Tenant (Please circle one.)
All permits are non -transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Ave W
Yelm. WA 98597
(3 60) 45 8-3 83 5
(360) 458-3144 FAX
www.ci.yelni.wa.us