07-0356 Permit file 092407of TNFA~ City of Yelm
~~ ~~~ Community Development Department
~ m
Building Division
Phone: (360)458-8407
LM Fax: (360) 458-3144
Applicant:
Name: Hepburn Construction
Address: 10215 Grove Rd. City: Yelm
Property Information:
Site Address: 10501 Creek St. SE
Assessor Parcel No. 69280000100 Subdivision:
Contractor Information
Name: Applicant Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Yelm Travel
Description of Work: TI
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other): OTHER
Permit No: BLD-07-0356-YL
Issue Date: 09/2412007
(Work must be started within 180 days)
Receipt No: 50393
Phone: 458-4137
State: WA Zip 98597
Lot:
Phone:
State: Zip:
Business License:
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
---------------- ------ ------ ------- --------- ------
Building Permit -Other 111.25 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $111.25
Applicant's Affadavit:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of # Sets of Prints:
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington. Final Inspection:
Signature fl Date ~~' 2 Z~
- - Da
B
Firm .
i
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: ; ; :_ ~ ~ _ ' t ~ " `_~ '-- Parcel #:
Zoning; Current Use: Proposed Use
^ New Construction ~' Re-Model / Re-Roof /Tenant Improvement
^ Plumbing a Mechanical i~ Fire Prevent/Suppress/Alarm i I Other
` i
Project Description/Scope of Work: ~,f~/)~I~l~~ (; /~/~'~~_- , '. ,~ ~ ~~'• ~~1 ~" '!-~ j~ `~~y~~ `r~ft~~• ~Gb~
~ ~•
1, i ,
Building Area (sq. ft) Parking Garage 1 S' Floor 2nd Floor 3rd Floor
Building Height ' '
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: - ~ 11-„ i
ADDRESS ~- L ~ -- >~ EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR'~'~1 ~ ~~~ '1 TELEPHONE ~;'r - ~' '
ADDRESS r !- ~ /;,~~ ~ ~~ EMAIL
CITY _ ~ STATE -~''-~ ZIP ' ~ FAX ~~
CONTRACTOR'S LICENSE #,'=, ,',L1t; EXP DATE 'CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
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 of the
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
.- -
Applicant's Signature Date
Owner /Contractor /Owner's Agent /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 Y'elm Aoenue West (360) •158-3835
YO Bor 479 (360) 458-314 J F.4X
}'eGn, WA 98597 u~u~u~.ci;yelm.u~a.us