20100196 Permit Pkg 11082010City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Apple Physical Therapy
Address: 2904 4th Ave NE #300
Puyallup WA 98372
Property Information:
Site Address: 201 TAHOMA BLVD
Assessor Parcel No.: 217424130602 Subdivision:
Contractor Information:
Name: SUNSET BUILDERS
Address: FRANK
3108 C STREET SE
AUBURN WA 98002
Phone:
Contractor License No.: SUNSE61140LS Expires: 1/13/2011
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: 3652 SF TI FOR APPLE PHYSICAL THERAPY FIRE SPRINKLER
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Lot:
Heat Type (Electric, Gas, Other): COMBO-SEE NOTES
3652
Contractor Fees
EVERGREEN REFRIGERATION $ 105.50
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 regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
re o s ,Lton~. ,~, /J
Signature i ~~/+L~ ~ Date l~` ~ ~v
Permit No.: 20100196
Issue Date: 11/08!2010
(Work must be completed within 180 days)
Phone: 2538406448
Owner: APPLE PHYSICAL THERAPY
Sets of Prints:
final Inspection:
Date:
By:
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: r~n ~ /a.~,~~rn~,~ ~J/Q( Parcel #: o~ ~ 7 ~.y/ 30~ n0
Subdivision: Lot #: Plan #: Zoning:
^ New Construction ^ Re-Model / Re-Roof /Addition ^ Home Occupation Sign
^ Plumbing Mechanical ~~ Mobile /Manufactured Nome Placement ^ Other
Project Description/Scope of Work: orb
Project Value: ~ ~
Building Area (sq. ft) 151 Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms` Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
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BUILDING OWNER NAME:
ADDRESS ~`~'ff0 G~~ fes S-,<. She /oy EMAIL
CITY~,~~~~a, STATE~_ZIP 9sSl a TELEPHONE ~
ARCHITECUENGWEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCQNTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRF~CTOR'S LICE~`VSr= =-` EXP Clfa?-E CITY LlCCNSE ~=
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE an4 -~7»~3 -/7yy~ ~/7
ADDRESS EMAIL L~rMiae~,EV~,('arr~_coM
CITY 5~~,1~ ST TE r~ -ZIP 9~l/Dfs FAX
CONTRACTOR'S LICENSE #~ti., ~/•? ~rR[ 95yA~EXP DATE~CITY LICENSE # /o ~ yo/o 79 . y
Copy of mitigation agreement with Yelm Community Schools, if applicable.
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 viii 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 1 Owner's Agent /Contractor's Agent (Please circle one.) '•~.
All permits are non-transferable and will expire if work authorized by such permit is n begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue 4{
Yelm, WA 98597
www.ci.yelrn.wa.us
~~~~~~
~) 458-383 ~iJ
BY:_____