20110104 142623S5
SMITH FIRE SYSTEMS, INC
1106 - 54 Avenue E SM-IT-HF-S1360T
Tacoma, Washington 98424 PH (253) 926-1880
FX:(253)926-2350
LETTER OF TRANSMITTAL
DATE: 12-29-10
TO: City of Yelm
105 Yelm Ave. W.
Yelm, WA
98597
ATTN: Community Development Department
RE: Yelm Medical Office Building
Foot & Ankle Clinic TI
911 Yelm Ave West
PLEASE FIND ATTACHED THE FOLLOWING ITEMS:
Yelm, WA 98597
JOB NO.: T110194
NO. DESCRIPTION
5 SPRINKLER SHOP DRAWINGS
5 EQUIPMENT DATA SHEETS
1 PERMIT APPLICATION
IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE.
THESE ARE TRANSMITTED FOR: APPROVAL.
REMARKS: PLEASE CALL WHEN OUR PERMIT IS READY TO PICK UP. THANK YOU,
COPY TO: FILE
SIGNED: John Retherford
TITLE: (DESIGNER) ~~~~~~~y~
B Y: _.------
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: i~.0~ Ta ~ oNt e, (3Ctr~ SE Parcel #: ~ / 7 Z `f / O S'o o~ (, do d-Gpa
Zoning; ~~' ~ Current Use: ~'bht+h2S~ proposed Use:
New Construction ! Re-Model / Re-Roof /Tenant Improvement
Plumbing ;Mechanical ~ Fire Prevent/Suppress/Alarm Other
Project Description/Scope of Work: l'IOd'~% e~ Si°~'^ k/e~Y' f° Rrdlnct fielv1./ T1 ce+l+~9
ProjectValue:~2y ~88
'~ "'~`~ ISo3sf sl ntl rtl
Building Area (sq. ft) --Rari~iltg-Garage 1 Floor 2 Floor 3 Floor
Building Height 3° "~
Are there any environmentally sensitive areas located on the parcel? p/R If yes, a
completed environmental checklist must accompany permit application
BUILDING OWNER/TENANT NAME: Fuof -A.~lut Sa +taC .g-SS~~iu'
ADDRESS j6Cy ~+S'~rolo !Pd Sam/ 6 tale 7 EMAIL ti e sS Pm Co.+-~~+s , n e~}
CITY Ta.Mwafc.-STATE t,~9- ZIP `!£;S/Z TELEPHONE 3 6 C~ ~ 7S~f' 333 I
ARCHITECT/ENGINEER T6r3~ LICENSE#
ADDRESS .~19t1 7~'~ A/e y/e710 EMAIL
CITY C°~N^o~td~STATE~ZIP ~9gozG TELEPHONE U~ZS X778' - 153
GENERAL CONTRACTOR Sm~fi/. F~~ SyJ~S TELEPHONE 2S3 mµ8 Z~S9
ADDRESS (10(; SN'/h /e~ EMAIL J°~n (' GS+^'~+f~i-~r-e •co++~t
CITY -Cacow~vt STATE w'~ ZIP 4 Q°Fzµ FAX r5 3 9L6 z3 S U
CONTRACTOR'S LICENSE # SM2TNPSfs6o7EXP DATE CITY LICENSE # SS
PLUMBING
CITY~$T~~E ZIP FAX
CONTRACTOR' LICE~rffSE # EXP DATE CITY LICENSE
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATF 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. ,~ y - _
`I' Y~~~w//~~y v y~ 12 -Z~j-/O
Appli a is Signature ~'ol~r, Ref(¢+^(-~ 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
105 YeFrrz Auen¢e West
Y073oz 179
YeGn, 4I'A 98597
(360) 158-3 ~ ~~ ~ ~~ ~~
(360) 958-3 r" II'IIIIUIfIII'
zaww.ci.yeLr ra u6 G
~ Y:
RGGIS'I~LILEU AS PRC?VIDI:D 13Y I.rU~~ AS
(`l7>1?ST CO'Nl'R PI121d PI205
C(:73i7 ji411"1`}~1F51 (ii')1' tl?2.+2G1",~`,
rrrrcrn~l r~n~re ~»{on4~~
~A91':fbl I1hL SYST-L'\TS INC
11 D(i 5411 t A V iti [3
'I'ACUIdiA R'A 484_>.1