20100212 Permit Pkg 11222010City of Yelm
Community Development Department
Building Division
Phone: (3B0) 458-8407
Fax: (360) 458-3144
Applicant:
Name: FOOT AND ANKLE SURGICAL ASSOC.
Address: 1610 BISHOP RD SW #7
TUMWATER WA 98512
Permit No.: 20100212
Issue Date: 11/22/2010
(Work must be completed within 180 days)
Phone: 360-754-3338
Property Information:
Site Address: 201 TAHOMA BLVD SE 208 Owner: YELM MEDICAL OFFICE
BLDG., LLC
Assessor Parcel No.: 21724130602 Subdivision: EAGLE PLAZA Lot:
Contractor Information
Name: FOOT AND ANKLE SURGICAL ASSOC.
Address: JESSICAL STUDEBAKER
1610 BISHOP RD SW #7
TUMWATER WA 98512
Contractor License No.:
Phone:
Expires: 0/00/0000
Project Infonnation:
Project: COMMERCIAL REMODEL
Description of Work: 1503 SQ. FT FOOT AND ANKLE TI
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second 1503
Third
Garage
Basement
Fees:
Item Contractor
BUILDING FOOT AND ANKLE SURGICAL ASSOC.
TOTAL FEES:
COMBO-SEE NOTES
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 conformRy 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 jn-~e State of Washing n
Signature /J/J/[ n,,o ~~~~,' ~~
C \b r
Firm 7F73f ~ 5~,4~ y~/ c5//YG..i _ /J ~ ~.'lr ,i ~~ll /
Fees
$ 2,110.92
S 2,110.92
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
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TkAN: ';.;.0000 BIiItDING F`Ef~'~ITS
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FOQT AND ANKLE SLkrICAt_ ASSOC.
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CHANGE:
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 201 Tahoma Blvd SE, Suite 208 Parcel #: 21724130600, 21724130500.21724130602
Zoning; C-1 Current Use: '8' -Business Proposed Use: 'B' -Business
New Construction 2~ Re-Model / Re-Roof /Tenant Improvement
Plumbing 'Mechanical Fire Prevent/Suppress/Alarm I ! Other
Project Description/ScoAe of Work: Interior build-out 1,503 SF clinic on the 2nd Floor of the MOB
Project Value: $150,300
Building Area (sq. ft) Parking Garage~fA 151 Floor 17.456 2"d Floor 15.9003rd 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_ I~V~ZIP 98026 TELEPHONE -
~~NERALCONTRACTOR TBD TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
~'LUMBING CONTRACTOR Design/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 (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.
Appli s Signature Date
Owner / Contractor I wner's Agen l 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 Yelm A~~enue West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
I'el~n, WA 98597 u+u~w.ciwehn.uui.us
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Transmittal
Date: October 25, 2010
Sent To: Gary Carlson
City of Yelm
105 Yelm Avenue West
P.O. Box 479
Yelm, WA 98597
From: Gina Dais
Project: Foot and Ankle Clinic
Sent by: ^ Mai! ®UPS
Fax: (360)458-3144
^ Hand
Phone: (360) 458-3835
Project #: 09009
^ Courier ^ Other
Copies Date Pages i Description
5 10/20/2010 _ Foot and Ankle Permit Submittal - Drawi~
2 10/20/2010 _ Foot and Ankle Permit Submittal -Project Manual
1 10/20/2010 i Foot and Ankle Permit Submittal - CD
These are transmitted as checked below:
® /•br rrnu~ uppruru! ^ Apprured us subnt!!re'd ^ Ke.cubrrtit copies Jot approi ul
^ l~br your use ^ :1plum ed as Holed ^ 5uhntit Copies jor disb•ihution
^ : Is rou regursre'd ^ Rclurn jor rorrecrioac ^ Kcturn Corrected prints.
^ I~irr rerierr card cununcnt ^ ,~~rrww• records ^ Other
NOTES
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