20100211 Permit Pkg 01132011City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: PROVIDENCE HEALTH SYSTEM
Address: 413 LILLY RD NE
OLYMPIA WA 98506-5166
Property Information:
site Address: 201 TAHOMA BLVD SE
Assessor Parcel No.: 21724130602 Subdivision
Contractor Information
Name: PROVIDENCE HEALTH SYSTEM
Address: ROBERT WATILO
413 LILLY RD NE
OLYMPIA WA 98506-5166
Contractor License No.:
Project Information:
Project: COMMERCfAL REMODEL
Permit No.: 20100211
Issue Date: 1/13/2011
(Work must be completed within 180 days)
Phone: 360-493-7194
Owner; YELM MEDICAL OFFICE
BLDG, LLC
EAGLE PLAZA Lot:
Phone:
Expires: 0/00/0000
Description of Work: 2215 SF TI FOR PROVIDENCE HEALTH SYSTEM, 2ND FLOOR
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): COMBO-SEE NOTES
Second 2215
Third
Garage
Basement
Fees:
Item Contractor
PLUMBING STIRRETT JOHNSON
Applicant's Affidavit:
I certify that t have read artd examined the information contained within the appiication and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yetm regulations including those gov 'ng zoning and land subdivision, and in addition, all covenants,
easements an t coons of reco . If pplying as a contractor, I further certify that I am currently
registered in the S to of Washin ton.
Signature Date ~ ~~/`~
Firm
Fees
$ 83.00
Ci ~~ of Y~l~
t:3f,0> 458'840
REC#: 00050781 1f13i~011 1~:3E, F'~i
17F'ER: CO TERdf: 001
REF#: 94315
TRA~I: 33.0000 BfJILDING FER~ITTS
t0100~11 93.OOCR
FR~JUT.DEP~CE HEATH SYSTEM
~Ol TAHO~iA HLUD SE
F'L 83. G?N,h'
TE~DEREFi: 83.0() CNE('K
AF'F'LIEU: 83.00._
CHANGE: 0.00
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 911 Yelm Avenue East Parcel#:21724130600, 21724130500, 21724130602
Zoning; C-1 Current Use: Vacant proposed Use: "B" -Business
^ New Construction ~7 Re-Model / Re-Roof /Tenant Improvement
~] Plumbing ^ Mechanical ^ Fire Prevent/Suppress/Alarm ^ Other
Project Description/Scope of Work: T.I. for New Bldg - 2nd Floor (providence Time Share)
Project Value: $27 , 890
Building Area (sq. ft) Parking Garage NA 1 S` Floor 17, 45~nd Floor 15 ~ 4~° Floor NA
35'-0"
Building Height
ARCHITECT/ENGIN EER TGB Architects LICENSE # 3626 ( L. Kent Gre ory)
ADDRESS 21911 76t Ave West, Suite EMAIL gda is tgb architects.com
CITY Edmonds STATE WA ZIP 98026 TELEPHONE (425) 778-1530
GENERAL CONTRACTOR Aldrich & Assoc TELEPHONE (425) 483-1313
ADDRESS 810 240th St S.E. EMAIL bwarme@aldrich-assoc.com
CITY Bothell STATE WA ZIP 98021 FAX (425 486-1 (l1 8 _
CONTRACTOR'S LICENSE # ' '73) EXP DATE~C~ITY LICENSE #~~5TJ:0
PLUMBING CONTRACTOR irre - o nsen, 'f~L•EPHONE -
ADDRESS 5555 Westgate NW EMAIL rtarper sjimech.com
CITY Silverdale STATE WA ZIP 983$3 FAX (360) 698-1832
CONTRACTOR'S LICENSE #STIRRJ*28186 EXP DATE~~TY LICENSE # 10-002660.0
MECHANICAL CONTRACTOR Evergreen Re rig TELEPHONE (206) 763-1744
ADDRESS 727 S Kenyon Street EMAIL richard@evergreenh~tac,com
CITY Seattle STATE WA Z!P 98108 FAX (206) 763-2389
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.
~l-L-+~- December 27, 2010
Applicant's Sig ture Date
Owner 1 Contractor !Owner's Agent 1 Contractor's Agent 1 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 Avenue West ~6
PO Box 479 (36}J ~
Yelm, WA 98597 w~uw.ci.yelm.wa.us
~ L..• ...
~ Y: --------------------
Are there any environmentally sensitive areas located on the parcel? NO If yes, a
completed environmental checklist must accompany permit application.
Sti rrett
Johnsen
Tn ~
December 28, 2010
City of Yelm
105 Yelm Avenue West
Yelm, WA 98597
Attn: Gary Carlson
mechanical contractors
5555 WESTGATE RD. NW. • SILVERDALE,WA 98383 • ST-IR-RJ '28186
(360) 682-6128 FACSIMILE (360) 698-1832
RE: Yelm Medical Office Building -Providence Time Share 2"d Floor Tenant Improvement
SJI Job Number 10-464
Dear Gary:
Attached are 5 sets of drawings, a completed permit application and a copy of our Yelm
business license. Please issue a plumbing permit for the Providence Time Share T.I. on the
second floor. Contact me at the above phone number when the permit is ready and we will
send someone to your office with a check to pick it up.
Sincerely,
ojuela
attachments
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IS HEREBY LICENSED TO OPERATE
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Suspen a star eater a orn
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Cross-braces (2} lvao Included to captrre water heater within the piatforn
Static load rating 6D0 pounds with ZX safety factor (depending on struduraf anchorage)
Includes PVC drain kwdy 1" MIPT x 1" FS
Galvanized steel construction
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