20100033 FIT STOP Permit_Payment 021210City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
Name: FIT STOP
Address: P.O. BOX 13278
OLYMPIA WA 98508
Property Information:
Site Address: 4RQ1l1 HWV BM
Assessor Parcel No.: 64303100800 Subdivision:
Contractor Information:
Name: FIT STOP
Address: MICHELLE LAWRENCE
P.O. BOX 13278
OLYMPIA WA 98508
Contractor License No.:
Project Information:
Project: PLUMBING
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
COMMERCIAL ALTERATION
I=ermit No.: 20100033
Issue Date: 2/12/2010
(Work must be started within 180 days)
Phone: 360-400-4000
Owner: CROSSROADS AT YELM LLC
Phone:
Expires: 0/00/0000
Heat Type (Electric, Gas, Other):
Lot:
Contractor Fees
FIT STOP $ 6,286.00
FIT STOP $ 0.00
TOTAL FEES: $ 6,286.00
Applicant's Affidavit: :OFFICIAL USE ONLY
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 aII applicable City of #Sets of Pnntsi
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 Final Inspection:
rani
Date
®®sy
F'EB 1 ~ 2010
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: /6 9lCi ~f,~~ s"~ 7 .f~"` Parcel #:
Zoning; C~ .5 Current Use: 2c'7s4iL, Proposed Use: ~'e`7f9L
New Construction X Re-Model / Re-Roof enant Improve~~
~Piumbing Mechanical Fire PrevenUSuppress/Alarm :Other
Project Description/Scope of Work:~p i S~f~/~'~ ~L d.~~i/~~~C~m~c ~T ~ Sc-z/~'~
Project Value: ~ooo
Building Area (sq. ft) Parking Garage 1~` Floor~5a0 2"' Floor 3rd Floor
Building Height ~.L r
Are there any environmentally sensitive areas located on the parcel? N c? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: /YU~zo/y/G J ~Y-S' f'
ADDRESS fo. `/2% E AIL
CITYQy~rr,eg STATE(,r.W- ZIP z`~vCJ•~ TELEPHONE ~l-~a -5`G~/-'CJ ~CJ'~-
ARCHITECT/ENGINEER iV LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR CruJrl/~_ TELEPHONE ',
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR C1Gz/n/~~- TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICALCONTRACTOR N 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 describetl 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 /Contractor /Owner's Agent /Contractor's Agent /Tenant (Please circle one.)
Ail permits are non-transferable and will expire if work authorized by such permit is no,Y,b,~$
within 180 days of issuance, or if work is suspended or abandoned for a period of 1,8Q ZI,~ ~ ~~
i;`' IILI IIJIIJII
U 1 ~ -
105 Yelm Avenue West (360) 958-3835
PO Boz 979 (360) 958-3]99 FAX
Yelrn, WA 98597 www.ci.yelm.wn.us
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