Stirrett Johnson AppCITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 201 Tahoma Blvd SE Parcel #: ztrzatsosoo, 2t724t3osoo, znzatsoso2
Zoning; C-1 Current Use: vacant lot Proposed Use: 'B' -Business
New Construction x Re-Model / Re-Roof /Tenant Improvement
x Plumbing x Mechanical Fire Prevent/Suppress/Alarm Other
Project Description/Scope of Work: Interior build-out of first floor outpatient medical office building
Project Value: $1,300,000
Building Area (sq. ft) Parking Garage NA 1s` Floor 17.4562ntl Floor15.9003rtl Floor Ng_
Building Height 35'-0"
Are there any environmentally sensitive areas located on the parcel? no If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNERlTENANT NAME: Yelm Medical Office Building LLC (Scott Ritter)
ADDRESS 2840 Crites Street West, Suite 104 EMAIL scottiritter(c~comcast.net
CITY Tumwater STATE~/y~ZIP 98512 TELEPHONE (360) 292-7850 (ext 121)
ARCHITECT/ENGINEER TGB Architects LICENSE # 3626 (L. Kent Gregory)
ADDRESS 21911 76th Ave W Suite 210 EMAIL gdais@tgbarchitects.com
CITY Edmonds STATE WA ZIP 98026 TELEPHONE_(425) 778-1530
GENERAL CONTRACTOR Aldrich & Associates TELEPHONE (425) 483-1313 (Brendon Warme)
ADDRESS 810 240th Street SE EMAIL bwarme analdrich-assoc com
CITY Bothell STATE WA ZIP 98021 FAX (425) 486-1018
CONTRACTOR'S LICENSE # 22301 EXP DATEz/s/ttCITY LICENSE # 09-000050.0
PLUMBING CONTRACTOR Stirrett Johnsen TELEPHONE (360) 692-6128 (Rich Arper)
ADDRESS 5555 Westgate Road NW EMAIL rfarper(a)siimech.com
CITY Silverdale STATE WA ZIP 98383 FAX (360) 698-1832
CONTRACTOR'S LICENSE # STIRRJ*28136 EXP DATFsn/toCITY LICENSE # os-oozoso.o
MECHANICAL CONTRACTOR Evergreen RefriperationTELEPHONE (206) 763-1744 (Richard Baldwin)
ADDRESS 727 South Kenyon Street EMAIL richard@evergreenhvac.com
CITY Seattle STATE WA ZIP 98108 FAX (206) 763-2389
CONTRACTOR'S LICENSE # EyERGHH910J0 EXP DATE a/tt CITY LICENSE # to be determined
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. ~^
Ap~' nt's Signa ure Date
Owner /Contractor / wner's Agen /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 Yedm Auen ua Wast (360) 958-383 ~.
PO 13os 479 ! C-- !` (360) 458-31
Yelny WA 98597 ~~i~--^-/~~r• /~~ www.ci.yedn4na.us
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