20180356 ApplicationCITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
�7 JI W f ggooz.5y1 532 0l Rei llhs
Project Address: !/ � SG Parcel #: 21� bl f a2—q_
Zoning;
Current Use: Proposed Use:
New Construction a -Model / Re -Roof / Tenant Improvement
Plumbing Le6ii=anical 5 Fire Prevent/Suppress/Alarm LOther 1
Project Description/Scope of Work: T V Y�(�
�r� o�
Project Value: � I o
Building Area (sq. ft) Parking Garage 1St Floor _2nd Floor 3`d Floor.
Building Height
Are there any environmentally sensitive areas located on the parcel? _
completed environmental checklist must accompany permit application.
BUILDING OW R/IE JNT NAME: £I
ADDRESS t -7 EMAIL
CITY5PYln STATEN7%ZIP TELEPHONE '
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
If yes, a
MECHANICAL CONTRACTOR lf�
0.
CYItTELEPHONE ' O
ADD SS Vl) Y�
EMAIL U - Yle4-
CITY ,Q STATE
zip6l%
FAX
CONTRACTOR'S LICENSE #
EXP DATEI I CITY LICENSE
Copy of City M tigation documents ion (TFCJ.
I hereby certi that thea ore " ormation is co tt and that the construction on, and the occupancy and the use of the
abpve descri a prop. will in accordant wiF the laws, rules and regulations of the State of Washington and the
City of Yel I j
-KRJ ft, vi) � I, � qfo
Applica 's na aDate
Owner ntracto Owner's gent / 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
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us