Palisades Pump House Bdg AppCITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~c5> ~ l~aciSiyr,~Fs Si 5c' Parcel #: ~ 7~~ GG` c~c G~ L} E;
Zoning; ~ ' / , ~'- ~ Current Use:_ ~-/ ~-
a ~ Proposed Use: C~- ~
~ New Construction ^ Re-Model / Re-Roof /Tenant Improvement
^ Plumbing ^ Mechanical ^ Fire Prevent/Suppress/Alarm ^ Other
Project Description/Scope of Work: ~1.frf7'E~ (3 or~,.;~ EtQ j~ .,, ,~ S •f~~>'r' c ~/
Project Value: l CCU. O UCH
Building Area (sq. ft) Parking Garage 1St Floor C 7~ 2"d Floor 3~d Floor
Building Height /3~.-Z rr
Are there any environmentally sensitive areas located on the parcel? ~ ~ If es, a
Y
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: LL `
ADDRESS ~~c: c ~ `fb, ,••}~~ ;~ - ~ 3c ~ EMAIL
CITY G,~CE-y STATE i~.',~ZIP YS~C~3 TELEPHONE 36o y - ~C'C3L-
ARCHITECT/ENGINEERx-~ ~S(~4a,~ ~~ ~r L ~ LICENSE #
ADDRESS ~Zc C Iln .~i1C` $~s ~3oi EMAIL
CITY L,~C~--7 STATE K1.A ZIP ~A~03 TELEPHONE 3~C~) "h O~ G
GENERAL CONTRACTOR ~ 'Sid, <</~ TELEPHONE ~c --60 ,'L
ADDRESS ~~ ?~'t` i'~Y ~. ,~ 'r - - c:: r EMAIL
CITY Ltd-cry" STATE~_ZIP ~ ~" FAX ' ~ ~) 4 _" ~ ~~ 74 7_.,
CONTRACTOR'S LICENSE # •~17EL~14 EXP DATEvy7 ITY LICENSE # of ~~OZ5i~l6 5
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR 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 YgJm.
Applicant's Signature Dat
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
!ua retm avenue west (360) 458-3835 z Im ~ C I V E D
PO Box 479 (360) 458-3144 F`° ~^ '-
Yelm, WA 98597 www.ci.yelm.wa.us
U ~ 0 2 7~n8