20120288 Permit Pkg 09262012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: TIM 8 NANCY LARSEN
Address: PO BOX 5120
YELM WA 98597
Property Information:
Site Address: 106 FIRST ST
Assessor Parcel No.: 64400500800 Subdivision:
Contractor Information:
Name. ORCA NW
Address:
P O BOX 2246
YELM WA 98597
Contractor License No.: ORCANN1964K1 Expires.
Permit No 20120288
Issue Date: 9/26/2012
(Work must be completed within 180 days)
Phone. 360 - 458 -7110
Owner: TYPE CURRENT OWNER
NAME
Lot:
Phone:
5/27/2014
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: REMODEL SOUTH ELEVATION BY REMOVING WINDOWS AND REPLACING WINDOWS
Sq. Ft. per Floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
BUILDING
Contractor
ORCA NW
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined t information contained within the application and know the same
to be true and correct. I also certify th the proposed structure is in conformity with all applicable City of
Yelm regulations including tho g 9i erning zoning and land subdivision, and in addition, all covenants,
easements and restrictions rec6rd. If applying as a contractor, I further certify that 1 am currently
registered in the /9 ,t/ %
Signature Date / z �
Finn
Fees
$ 206.66
$ 206.66
OFFICIAL USE ONLY
# Sets of Prints:_
Final Inspection:
Date.
By:
City of Yell
(36 ) 458 -8402
REC #: 00106317 9/26/2012 4:48 PM
OPER: CO TERM: 001
REF #: 4578
IRAN: 33.0000 BUILDING 206.66RMITS
20120288
LARSEN, TIM & NANCY
106 FIRST ST
BLDG 206.66CR
TENDERED:
206.66 CHECK
APPLIED:
206.66 -
CHANGE:
0.00
•
•
•
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 106 I Si- Y- rPe4 50K14 Parcel #: yuooso ogoo
yet+ >? wi
Zoning; Current Use: Proposed Use:
❑ New Construction X8 Re -Model / Re -Roof / Tenant Improvement
❑ Plumbing ❑ Mechanical ❑ Fire Prevent(Suppress /Alarm ❑ Other
Project Description /Scope of Work: i2 Pw.evP j Wo
w:kpeh/S t vtw P +: N A n/ f
Project Value: �6.000• 0 O f n ° ti S
{w /l iwo ti B
Building Area (sq. ft) Parking Garage 1B' Floor 2ntl Floor 3rd Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? %/A If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: t Wt La
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CRNTRACTOROrc'a N, a! west TELEPHONE ?6o- 9s5 `�oY�
ADDRESS [-4. ( elx 2 Z V 4 EMAIL C> rca tow C � -K caJl� - ti tY
CITY )✓2 n- STATE-LA�/ZIP R frS9 7 FAX
CONTRACTOR'S LICENSE # uI N 964 1 EXP DATE CITY LICENSE #
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- ance with the laws, rules and regulations of the State of Washington and the
City of Yelm. /�
�--1 7- Z s- I z
Applicant's Signature Date
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
105 Yelm Avenue West
PO Box 479
Yelm, WA 98597
(360) 458 -3835
(360) 458 -3144 FAX
www.ci.Yelm.wa.us
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