20130121 Permit Pkg 02152013 � City of Yelm Permit No.: 20130121
� Community Development Department Issue Date: 2/15/2013
� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
"' ' Fax: (360)458-3144
Applicant:
Name: ALLSTATE INSURANCE Phone: 360-415-8606
Address: 10501 CREEK ST SE#3
YELM WA 98597
Property Information:
Site Address: 10501 CREEK ST SE 3 Owner: ALLSTATE INSURANCE
Assessor Parcel No.: 69280000300 Subdivision: Lot:
Contractor Information:
Name: BOB HOWARD JR CONSTRUCTION Phone: 360-701-7757
Address: BOB HOWARD
P.O. BOX 1260
YELM WA 98597
Contractor License No.: BOBHOHJ965P0 Expires: 10/20/2010
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: REPAIR DAMAGE FROM CAR, REPLACE DOOR,WINDOW, BRICK VENEER AND FRAME
DAMAGEDICF
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING ALLSTATE INSURANCE $ 206.66
TOTAL FEES: $ 206.66
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 applyin as a contractor, I further certify that I am currently Final Inspection:
registered in the f W ington.
Signature Date 2 —�.� —�� Date:
Firm � O�� G��/ ��/` �O�s'%-/'GP� %/O/�( BY�
Cit� of V�lm
(36 ) 458-8402
REC#: OU119867 2/15/2013 11:46 AM
OPER: CO TERM: 001
REF#: y434
TRAN: 33.00�U BUII.DTNG pEC�MTT�S
2C)130121 206.66CR
ALLSTATE INSURANCE
1�501 CREEK ST SE 3
BLDG 206.66CR
�fENDERE�: Z06.66 CHECK
APPLTED; 206,66-
CNANGE: � O,bO
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: f�� �,� C✓��� l�S � � Parcel#:
Zoning; Current Use: Q/�I`(C� Proposed Use:
New Construction ' Re-Model/Re-Roof/Tenant Improvement
Plumbing Mechanical : Fire PrevenUSuppress/Alarm �Other
� �,�c
Project Description/Scope of Work:�?f/.�"r/v� �X/ef r c%°✓1 (�✓�l�
Project Value: 5���. ,c>
Building Area(sq. ft) Parking Garage 1 S`Floor 2"d Floor 3�d Floor
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: �1c�n/� 1/�. I��cnf� r4//�S Z«7-r ./N.Sca�.�v,���
ADDRESS fo.SC�I C•"��'�' s-T" '�_.3 EMAIL r��vel�rFi������4!(SfrR��(��-,�
CITY Y� (wi STATE �'� ZIP `T:�S�j TELEPHONE �/S�'° CvE�!-, %
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR�o�tbL✓,���'R C�.u�sfr^� TELEPHONE.�E-C1� 7c`=�/- 7�5`'7
ADDRESS P �'. ,a'�X / �- G c> _EMAIL�j h �r L Lc�Cc�,.�.�r�s�,���j
CITY y e c v�, STATE ��t ZIP ��S`9'� FAX
CONTRACTOR'S LICENSE# 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 accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
� �` _ �- /.�Z�-/�'
Appli ant's ignature Date
Owner/Contractor/Owner's gent/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 Auenue West (360)458-3835
PO Box 479 (360)458 �
Yelm,WA 98597 www.ci.y l al �1 �V�1`�
FEB 12 2013
BY: