20100211 Permit Pkg 12062010City 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 Owner: YELM MEDICAL OFFICE
BLDG, LLC
Assessor Parcel No.: 21724130602 Subdivision: EAGLE PLAZA Lot:
Contractor Information:
Name: PROVIDENCE HEALTH SYSTEM
Address: ROBERT WATILO
413 LILLY RD NE
OLYMPIA WA 98506-5166
Contractor License No.:
Project Information:
Project: COMMERCIAL REMODEL
Permit No.: 20100211
Issue Date: 12/06/2010
(Work must be completed within 180 days)
Phone: 360-493-7194
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
BUILDING PROVIDENCE HEALTH SYSTEM
TOTAL FEES:
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
registered in the ,State Washington. _
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Firm
Fees
$ 2,766.96
S 2,766.96
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
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Permit No.: 2010021 ~
Fee Calculation Worksheet
Phone: 360-493-7194
N Owner: YELM MEDICAL OFFICE
°f BLDG, LLC
Subdivision: EAGLE PLAZA Lot:
NCE HEALTH SYSTEM, 2ND FLOOR
Heat Type (Electric, Gas, Other): COMBO-SEE NOTES
Units Fees
221, 500 $ 1,676.95
0 $ 1,090.01
TOTAL FEES: $ 2,766.86
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 2,766.96
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 201 Tahoma Blvd SE, suite 204 Parcel #: z172a13o6o0, 21724130500, 21724130602
Zoning; C-1 Current Use: 'B' -Business proposed Use: 'B' -Business
New Construction x Re-Model / Re-Roof /Tenant Improvement
Plumbing I Mechanical -Fire Prevent/Suppress/Alarm ~ Other
Project Description/Scope of Work: Interior build-out 2,215 SF clinic on the 2nd Floor of the MOB
Project Value: $221,500
Building Area (sq. ft) Parking Garage NA 1St Floor 17.456 2"d Floor 15.900 3'd Floor NA
Building Height 35'-0"
Are there any environmentally sensitive areas located on the parcel? no If yes, a
completed environmental checklist must accompany permit application.
ARCHITECT/ENGINEER TGB Architects LICENSE # 3626 (L. Kent Gregory)
ADDRESS 21911 76th Ave W Suite 210 EMAIL gdais@tgbarchitects.com
CITY Edmonds STATE WA ZIP 98026 TELEPHONE -
(GENERAL CONTRACTOR Aldrich & Associates TELEPHONE (425) 483-1313 (Brendon Warme)
ADDRESS R1 n 2anth Street SE EMAIL bwarme analdrich-assoc.com
CITY Bothell STATE WA ZIP 98021 FAX (425) 486-1018
CONTRACTOR'S LICENSE # 22301 EXP DATE2~9i11CITY LICENSE # 09-000050.0
PLUMBING CONTRACTOR esign/Build -TBD TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR Design/Build -TBD TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFCI.
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 1 Contractor / wner's Agen J 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
FILE C
105 }'elrn Auenae West (360) -158-3835
PO Box 479 (360) 458-3194 FAX
}'elm, WA 98597 u~u~u!.ci ;yelm.ula.us
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Transmittal
Date:
Sent To
From:
Project:
Sent by:
October 25, 2010
Gary Carlson Fax: (360) 458-3144
City of Yelm
105 Yelm Avenue West
P.O. Box 479
Yelm, WA 98597
Gina Dais
Providence Timeshare Clinic
^ Mai! ®UPS ^ Hand
Phone: (360) 458-3835
Project #: 08062
^ Courier ^ Other
Copies Date Pages Description
5 10/20/2010 __ _ Timeshare Permit Submittal -Drawings
2 10/20/2010 _ _ Timeshare Permit Submittal -Project Manual
1 10/20/2010 Timeshare Permit Submittal - CD
These are transmitted as checked below:
® /•br your uppruru! ^ .9pprurc r1 us submiNrd ^ Resubmit copies frn• upproral
^ lv,r potu• usr ^ .apprurrd u.r nrnrd ^ Suhntit Copies Jor dishihulion
^ :9s you reyuesved ^ Return Jur• cnrrectiurrc ^ Return Corrected prints
^ For rerien• and cnrnment ^ For patu• reca'cls ^ Other
NOTES
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BY: --------------------
Crrared on I U 19 ?01 U 6:29 Y\1 Trammittal (o Gan Cadmadoc pace I of I
t !_ , ?i8 I S'{7 21911 76th Ave W, Suite 210 Incurpoiated in the `~r:~~~ ~ ~ ~,v•=,' ~~ ~ tgba
f ,_ /~ J803 Edmonds WA 98010 www.tgharchrtectcm
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Transmittal
Date:
Sent To:
From:
Project:
Sent by:
November 4, 2010
Gary Carlson Fax: (360) 458-3144 Phone: (360) 458-3835
City of Yelm
105 Yelm Avenue West
P.O. Box 479
Yelm, WA 98597
Gina Dais
Providence Timeshare Clinic Project #: 08062
^ Mai! ®UPS ^ Hand ^ Courier ^ Ofher
Copies Date Pages Description
2 11/4/2010 Timeshare Sheet A2.12
- -- -
2 11/4/2010 _ Timeshare Sheet A2.22 _ _ _ _
2 11/4/2010 Timeshare Sheet A7.00
These are Transmitted as checked below:
® hor• row• approval ^ .~pprol•ed crs submiNed ^ Re.cuhrnit copies Jor approrul
^ Far your use ^ Approved us noted ^ Subrni! C'opies.for disu~bulivn
^ .As you rc guested ^ Return %r ca•rections ^ Return Corrected prints
^ Hot reriell• and cornrnc'nt ^ For tour recard.c ^ Other.
NOTES
Gary,
Per our email correspondence on 11/4, please accept these revised sheets as a resubmittal for the Timeshare
clinic.
Kind Regards,
,~~ \
Gina Dais
U ~~~~~~
B Y: --------------------
('rated on IU I~r '_Ulb b:29 P~1 ~ lransniunl to G;m Carlsun.duc pace I of I
- t 45778.1530 2191 1 76th Ave W, Suite 2i0 Incorporated in the State of Washinyton ~ tgba
f 41 x.774.7803 Edmonds WFl 98026 www.tgbarchitects.com