20120326 Permit Pkg 12042012 aF�H�p� City of Yelm Permit tvo.: 20120326
aw ,
� � Community Development Department Issue Date: 12/04/2012
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
Fax: (360)458-3144
Applicant:
Name: JEM CONSTRUCTION INC. Phone: 253-843-2765
Address: 29506 8TH AVE S
ROY WA 98580
Property Information:
site Address: 2Q7 FIRST ST S Owner: TYPE CURRENT OWNER
NAME
Assessor Parcel No.: 64420100400 Subdivision: N/A Lot:
Contractor Information:
Name: JEM CONSTRUCTION INC Phone:
Address:
29506 8TH AVE S
ROY WA 98580
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: GAS PIPING TO GENERATOR
Sq. Ft. per floor: Heat Type(Electric, Gas, Other):
First
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING JEM CONSTRUCTION INC $ 25.00
TOTAL FEES: $ 25.00
ApplicanYs 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 all applicable City of #Sets of Prints:
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:
registered� he State of Washington. ``
"— Date:
Si n ure . Date –'� ^l
By:
Firm
c�ty �� ye�m .r� �M
�360� 458--8G02 10,1
121�`��2012
R�G R,G�1121 �RM: 001
OPE �14�5
R�F#� �ICENSE
30.OQ00 �d1J5INESS�IC 3�,OOCR
�(RAN',�M GO�S�RIlC�ION 6U5
�,USIN�SS LIC�NSES �
P, p�.RM��fS
OUC�D BuILDZN� UOCR
�CRAN'. �'�. 2 IN�.
�U12�EM CON�TRUC1�aN
�p� F1.R�� �rt � 25.00GR
pt �0.00 CHECK
TENQERED: 60.�0^
APPI.I�.D� .�.---��0
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
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Project Address:�C 1 l - � .S Parcel#:
Zoning; Current Use: Proposed Use:
N Construction ' Re-Model/Re-Roof/Tenant Improvement
, lumbing Mechanical Fire Prevent/Suppress/Alarm �Other
Project Description/Scope of Work:�rl(��}�ir�ly. - h�l�'.�C��'L
Project Value: �O u�
Building Area(sq.ft) Parking Garage 15`Floor 2"d Floor 3rd F�oor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: � 1Z I�i tl iL�l�
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR �� �TELEPHONE � - �- � �
ADD SS � � ' � EMAIL�C`�����'- �,�1 ��a`l'M
CITI� `STATE�_ZIP FAX��3-��°�1tn�5
—�' rXP DAT CITY LICENSE#
R'S LICENSE# � C; E�'
CONTRAC � d
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 accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
- ; ��-�-/ �
{ , , r ,r rZ 4 -�
�'JApplicant'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 (360)458-3835
PO Boz 479 (360)458-3144 FAX
Yelm,WA 98597 www.ci.yelm.wa.us