Fire Sprinkler AppCITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: <_:.oi 7d~)n.~y ~~e Parcel
Zoning; Current Use: Proposed Use:
New Construction X Re-Model / Re-Roof /Tenant Improvement
Plumbing Mechanical X Fire Prevent/Suppress/Alarm ]Other
Project Description/Scope of Work: /irl~~ ln.. N ;~ i~,~/~ ><r>a~r~n~.vi4f ~y ~ iirn~~~~~-,
Project Value: ~ SOD
Building Area (sq. ft) Parking Garage 1s' Floor 2ntl Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? _
completed environmental checklist must accompany permit application.
If yes, a
BUILDING OWNER/TENANT NAME: A ,
ADDRESS MAIL
CITY STATE ZIP TELEPHONE
RRCHITECI`/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR Scyaaf Yp,/1,~^i TELEPHONE ~S3 53I 8~7
ADDRESS 3/0;7CSiSE EMAIL
CITY /~e/„~e STATE N~uZIP~LFAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR F,hv fvs~•n,r l2PSf TELEPHONE z3'": > ~~
ADDRESS 20CFPO,~y~r,(ona'd/~>~n~Sii,'><~~~ EMAIL /~a~leviC~t~i>~~~H;xl4e'.«~i ~
CITY a c~u'.'c STATE lrYiF ZIP 9~0~7 FAX
CONTRACTOR'S LICENSE#/=1RESN~I1¢~Bti EXP DATE iCITYLICENSE#3?07-IO~OD10,S2,0
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 v~ill be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yel//m. / / /t
~,-~
AppA~s ig 'tu?e r, -_______~ D e
Owner /Contractor /Owner's Agent Contractor's Agent,% Tenant (PI ase 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 Yel m Auen ue West
PO Bo c 979
Yelm, WA 98597
(360) 958-3836
(360) 958- 9 PP.AX
u~ww.ce.ye~.tdf~i~~ 5-'i 52 Si'S"c~
f r .n 1~i ~.°/ ft~~
B Y- --------------------