20120239 Permit Pkg 08092012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458 -3144
Applicant:
Name: BURNETT CENTER OFFICE LLC
Address: P.O. BOX 1206
YELM WA 98597
Property Information:
Site Address: 9144 BURNETT B
Assessor Parcel No.: 21713340601 Subdivision:
Contractor Information:
Name: BURNETT CENTER OFFICE LLC
Address:
P.O. BOX 1206
YELM WA 98597
Contractor License No.:
Project Information:
Project: COMMERCIAL REMODEL
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
BUILDING
Permit No.: 20120239
Issue Date: 810912012
(Work must be completed within 180 days)
Phone: 253- 208 -3900
Owner: TYPE CURRENT OWNER
NAME
Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
BURNETT CENTER OFFICE LLC
TOTAL FEES:
Applicant's Affidavit:
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 all applicable City of
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
Fees
$2,884.90
$ 2,884.90
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -8402
REC #: 00103296 8/17/2012 1;29 PM
OPER: CO TERM: 001
REF #: 5237
TRAN; 33.0000 BUILDING PERMITS
20120239 2,884.90CR
BURNETT CENTER OFFICE LLC
9144 BURNETT B
BLDG 2,884.90CR
TENDERED: 2,884.90 CHECK
APPLIED: 2,884.90-
CHANGE: 0.00
•
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:���� Parcel #: A \1 � > bQd�
Zoning, Current Use��S2S Proposed Use: \V�\
❑ New Construction ❑ Re -Model / Re -Roof / Tenant Improvement
❑ Plumbing ❑ Mechanical ❑ Fire Prevent/Suppress /Alarm ❑ Other
Project Description /Scope of Work:
Project Value: 1 � �NrsL
Building Area (sq. ft) Parking Garage 1s ` Floosa�2nd Floor 3rd Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OW_E_ N RrrENANT NA E: Caa`n
ADDRESS EMAIL Q.�iS nS -[^t.
CITY �N STAT�)�•ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACT_O_flt!) r+R-►.t— TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMESBING CONTRACT_ ORJk�_ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
M_EC_H_AN_IC_A_L_ CONTRACTOR_ TELEPHONE
ADDRESS EMAIL
CITY' STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation JFCi.
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.
lic nt's Signature Date
Own 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�p RTVI —n_d III of 180 days
�IZUpU�JS AUG 0 8 2012
BY: --------------- -- ---
705 Yelm Avenue West
(360) 458 -3835
PO Box 479
(360) 458 -3144 FAX
Yelm, WA 98597
www.ci.yelm.wa.us
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