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CITY OF Y'ELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address: ~~-~ ~ ~~'~'~"~~ ~~~ ~ ~ Parcel #: ~ ~ ~ 2~" ~~~~'~ Zoning; ~~ - Vtl.i,/tE~~ ~~Current Use: N~ % Proposed Use: -~uxy~c~t, `~k'-fit New Construction ~ Re-Model 1 Re-Roof /Tenant Improvement Plumbing Mechanical Fire PreventfSuppress/Alarm Other Project Deseripti ionlScope of Work: ~~ 1 ~.Z. ~141~Stt ~~ ~1~~'1 ~~~~ Project Valuer L ~ J ~ ~ ~' ~%' Building Area (sg. ft) Parking Garage 15' Floor 2°~ Floor 3'~ Floor Building Height Are there any environmentally sensitive areas located on the parcel? ~~' If yes, a completed environmental checklist must accompany permit application. BUILDING OWNERITENANT NAME: ~'-~~~ H~ Si ~ c~t,.~ ~E ._ GLRup~ C lath' . ADD SS ~-`fi~4 ~-'TG~ /kt/~f 4-~C. 3~[7 EMAIL CITY ~ A~.irv t~ STATE ihj~ ZIPTELEPHONE°~ZS~ ~ rS4-c - ~ ARGHITECTIENGINEERI~II~- ,~Rt'~hz+i,~5 LICENSE # ~ ! 3~ ADDRESS ~` ,(~~ _ ~ Ll"l-t ~,~n. S~ EMAIL ~~S `~ i~ . /~~c~ikli-l: t`.T .[i~~'t CITY~'e~Gc~Mti~ STATE ~fA~- ZIPTELEPHONE ~3 -~iSZ-`~~F~!4 GENERAL ~$ 'r' TELEP t--tG , c CITY ~, ~~ a-N STATE "W A ZI P~ CONTRACTOR'S LICENSE # o~ t- FAX EXP DATE CITY LICENSE # PLUMBING CONTRACTOR ~fiFGn-+i~7 TELEPHONE ADDRESS 1=MAIL _ _ _ CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR [?~~~-°+~-~'~ TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENS/= # EXP DATE CITY LICENSE # Copy of Gity PAitigation documentation (TFG). I hereb certify that the above information is correct and that the construction on, and the occupancy and the use of the abo cribed property will be in accordance with the laws, rules and regulations of the State of Washington and the Gi of Ye p lcant's Signat _ Date Owner 1 Contractor! er's Agent Contractor's Agent i Tenant (Please circle one.) All permits are non-transferable and will expire if work authorized by such permit is not begun within 18©days of issuance, or if work is suspended or abandoned for a period of 180 days a 105 Yedm- Avenue tVYest (36U) 458-3835 PO Bex 4?9 (360) 458-3144 FAX Yebn, WA 9859? wwu?.ci.yei!rn.we~.u.s