20110124 Permit Pkg 01202011City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: CITY OF YELM (I)
Address: 105 YELM AVE W
YELM WA 98597
Property Information:
Site Address: 9AR SF[_11N1~'1 CT CF 1
Assessor Parcel No.:
Contractor Information
Name: CITY OF YELM (I)
Address:
105 YELM AVE W
YELM WA 98597
Contractor License No.:
Project Information:
Project: BUILDING
Permit No.: 20110124
Issue Date: 1/20/2011
(Work must be completed within 180 days)
Phone: 360-458-3244
Owner: CITY OF YELM
Phone:
Expires: 0/00/0000
Description of Work: PARTITION WALL FOR SCADA SYSTEM
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING CITY OF YELM (I) $ 0.00
TOTAL FEES: $ 0.00
Applicant's Affidavit:
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
Yelm reg lations including those governing zoning and land subdivision, and in addition, all covenants,
easeme sand res rictions of record. If applying as a contractor, I further certify that I am currently
Subdivision:
Lot:
'ICIAL USE ONLY
s of Prints:
Inspection:
Firm ~ I By:
~oIIC~ 12
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:2.~~0 2'~`~ ~- . Parcel #:
Zoning; Current Use: Proposed Use:
New Construction - Re-Model / Re-Roof /Tenant Improvement
Plumbing Mechanical -Fire Prevent/Suppr~es~s/Alarm ,Other
Project Description/Scope of Work:_ Y)C~-~~~(Sk ~-c~cL~ 1 ~ SCG~~GL. SI~~dL'-l~tn.
Project Value: _G ~'\,I n ['_
Building Area (sq. ft) Parking Garage 1 S` Floor 2"d Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
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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 #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
1 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.
~ :~_ v-~~ 1 v L
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
I05 Yelm Avenue West
PO Box 479
Yelrn, WA 98597
(360) 45 ~ ~ y~ y7
(360) 45 V
www.ci. .wa.us
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