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20130127 Permit Pkg 03122013 o� � City of Yelm Permit No.: 20130127 � Community Development Department Issue Date: 3l12/2013 � (Work must be completed within 180 days) Building Division Phone: (360)458-8407 " '°" Fax: (360)458-3144 Applicant: Name: PROVIDENCE HEALTH SYSTEM Phone: 360-493-7722 Address: 413 LILLY RD NE OLYMPIA WA 98506-5166 Property Information: Site Address: 201 TAHOMA BLVD SE Owner: PROVIDENCE ST PETERS Assessor Parcel No.: 45170000100 Subdivision: Lot: Contractor Information: Name: ALDRICH&ASSOCIATES Phone: 425-483-1313 Address: 810 240TH STREET SE BOTHELL WA 98021 Contractor License No.: ALDRIA*202RU Expires: 2/09/2011 Project Information: Project: COMMERCIAL REMODEL Description of Work: TI, COMPLETE IMAGING ROOM Sq. Ft. per floor: First Heat Type(Electric, Gas, Other): COMBO-SEE NOTES Second Third Garage Basement Fees: Item Contractor Fees BUILDING ALDRICH&ASSOCIATES $ 368.36 TOTAL FEES: $ 368.36 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 in the_$tst�of Wa� Signature �� '�/ "�/ .-�-- Date �/Z./3 Date: Firm �,,D�ZlGr'� �-�,r�>•J'j�`.j BY. �°�: �� ' Transmittal Date: February 11, 2013 Sent To: Gary Carlson Fax: (360)458-3144 Phone: (360)458-3835 City of Yelm 105 Yelm Avenue West P.O. Box 479 Yelm, WA 98597 From: Gina Dais Project: Providence Yelm CT Project#: 12050 Sent by: ❑ Mail � UPS ❑ Hand ❑ Courier ❑ Ofher Copies Date Pages Description 1 2/11/2013 Buildin Permit A lication 2 2/8/2013 Providence Yelm CT CD Drawin s These are transmitted as checked below: � For your approval ❑ Approved as submitted ❑ Resubmrt copies for approval ❑ For your use ❑ Approved as noted ❑ Submit Copies for distribution ❑ As you requested ❑ Return for correctrons ❑ Return Corrected prints ❑ For review and comment ❑ For your records ❑ Other NOTES Gary, Per our phone conversation a few weeks ago, please accept this application for a building permit for the Yelm CT project at the Yelm Medical Office Building. Kind Regards, � Gina Dais gdais@tg barchitects.com Created on 2/9/20I3 130 PM � Transmittal ro Gary Cadson � page 1 of 1 <... . .� t 4 � n.��3� � �. 1 V Su ,__ �, i <�.�, c + ��o� ., i � , ��, . f�r � ,�3 � i ��U,, � Y��. �..��v. , ,.. ..�,�.� �, ^ o � City of Yelm Permit No.: 20130127 p'� Community Development Department Fee Calculation Worksheet 4 Building Division Phone: (360)458-8407 w�'"'""°" Fax: (360)458-3144 Applicant: Name: PROVIDENCE HEALTH SYSTEM Phone: 360-493-7722 Address: 413 LILLY RD NE OLYMPIA WA 98506-5166 Property Information: Site Address: 201 TAHOMA BLVD SE Owner: PROVIDENCE ST PETERS Assessor Parcel No.: 45170000100 Subdivision: Lot: Project Information: Project: COMMERCIAL REMODEL Description of Work: TI, COMPLETE IMAGING ROOM Sq. Ft. per floor: First Heat Type(Electric, Gas, Other): COMBO-SEE NOTES Second Third Garage Basement Fees: Item Units Fees BUILDING PERMIT ESTIMATED VALUE 12,800 $ 223.25 BUI�DING PLAN REVIEW 0 $ 145.11 TOTAL FEES: $ 368.36 PAYMENTS MADE: $ 0.00 BALANCE DUE: $ 368.36 �1�. �fi�8�8�0� (36�) 4 1:Og PM t�0122084 3/17��13 REG#� TERM; 0�1 OPER� .��016 REF#: 33.0000 6UZ�QZN� PERMTI'S T�AN; g6�,36CR 2013�121 SYSTEM p UOV T AHOMA ��-VD �E 2 366.36CR g�.pG 368.36 CHECK TENDERED: 36g.36— A�PLIED: �, -------"_o.on CHANCaE; . ��, 3 a �� CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address: 911 E Yelm Ave Parcel#:z��2at3osoo,21724130500,21724130602 Zoning; C-� Current Use: vacant lot Proposed Use: �B� - Business �I New Construction � Re-Model/Re-Roof/Tenant Improvement �I Plumbing �I Mechanical �l Fire PrevenUSuppress/Alarm � Other Project Description/Scope of Work: Interior build-out of first floo�shell space into at CT Scan (363SF) Project Value: $12,800 outpatient medical office building Building Area (sq. ft) Parking Garage NA 1S� Floor 17.456 2"d Floor 15.9003'd Floor NA 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. � '�� ' � Providence St. Peter Hospital (Geoff Glass) BU1��G; �t�� , ADDRESS 413 Lily Road NE� EMAIL qeoffery.glass(a)_providence.org CITY Olympia STATE WA ZIP 98506 TELEPHONE (360)493-7722 AR��`��'�`,,,,,�,� ,� � ��,� 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 - C�EN��;�.,�� ,��,f ��`�� Aldrich &Associates TELEPHONE (425)483-1313 (Jonathan Fast) ADDRESS 810 240th Street SE EMAIL�fastCa�aldrich-assoc.com CITY Bothell STATE WA ZIP 98021 FAX (425)486-1018 CONTRACTOR'S LICENSE# 22301 EXP DATE2/s/��CITY LICENSE# 09-000050.0 PLUM��C��C�� ; tbd TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# hAEC��"��., '� ,,,.,��`� Evergreen RefrigerationTELEPHONE (206)763-1744 (Richard Baldwin ADDRESS 72� South Kenyon Street EMAIL richard@evergreenhvac.com CITY Seattle STATE WA ZIP 98108 FAX_(206) 763-2389 CONTRACTOR'S LICENSE# EVERGHH910J0 EXP DATE tbd 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 Y I 2 � l� /13 Applica t's Signature Date Owner/Contractor/ ner'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 Yelm Auenue West (360)458-3835 PO Box 479 (360)458-3144 FAX Yelm, WA 98597 www.ci.yelm.wa.us � � � � `� +� — � � —F -- �� QF �� -- be � �9 -- � �_, J � >, E �p�7 � °m O O - l �- CC 5 v I $ ;` I� __ � —— _o -I d�y p�l Y � o a J`8g _ � �� , � x E ��e F� v o o i i � , � � �� - — � - -- � � � � �.,.�r � 8 �� 3 � - ie �, , . . � � � �� Z �� *m a c�i N e� ;e �„ n . _ . � � I v : 9t ' oF � I v . � Qg A � m & Fi �3 is Z - I � ' T i i� �m � -- --�`f � F°� � $ �$ �� P � $ '� i� 0€ � F� p �3 � - -- I W �mm �� 3 � a aa "R� I Fe � "s "xw i� ��N ` ��m -.� � T E'�,_a7e�a�> � � ff � g \ ;�,y.,�y�m 0�. ��Z �"c �o �" � \ i��jG{?+°}� �m i„ � ,��N A 5 �F I � T T08�-f f �N e & �z � � 1 ��gr€,`�E'� ; E ?� ` � ��90 " m ��}��. � �e �� a ,,, g y � � — — — � — — — — — — — — — — — — - — - - - - - - - � � � Q ' � � i � ,� �� i , � � � � i i Rzi++� i I I ° s � �' a R � 9 C' S2 4" :� � I � � s � � � � � � m� � � I E m � � n `> y a �` z F �^ r'�I � R �- � ��g D � m 5 $ � � a S Ig � � I ^ R�� n � g ". 8 � Z • � � ➢�s w � Q p � � � � em�8g^S� � n trn la I � �- - - ��-r,�-r�� m � I - - - - - - - - - I ��$�� z � I I - - - - - -r- - - Jx ^ � I I e� a,�inF I � I � d� � � I js; - s=� I n � I � � I � n � � � � I I � n � _� ea ee m �$a =s - s}',,% ______ 7 &�;�m�m ^ �� a� . Y � - �n - o s� v . & - ^°' � ro €sn3�z m� acn �Q � z = c� �� €� �@ a g a � � �,,�H,,, � : ag "A� c� �� ,�Z g� � o � v�i E' D s� �� E m p �9 n :� o• o � Q�ass�� '� E� Fg oD Kz = � g Z .� n m� � 8a n � � ��. �c� � ��` m sa�� m� ➢ � � �' �m o =� n €� � 1T1 fnf� 4 8�� m °8 a � 'gn"n°� a " ��a.� � °�0�:0 07o PQ � m =< v�i eF � �° g�� G Z � o�,:,� z 9 F �maidm D m o 8m � �g m Q ��zF�; � `� X E�a ° �� o �O°' "'$��m � �� _ � �� °A fll � � �� C gD� � � m �' = o£"�� £ � m � 0 2� D g= o � � � � _�� o � � m � � � ~�� 'a 9 4 R + ��£�� 2��€ O gp �sv< m ` m _� in `a a a t�� O � �� 9 F�03 � � C 70 -0 : ;P§�� '� �/I m �� i.� ; � 4 d � 3 €� ��ZO � m n��.$ c �� w ��P� ` . � � �a �� ,�-n � � �o= _ � �q �� m � s � 53g�° g � ai� �a �O � � � � ...��. za>$e z ,a�i Seoy ° � Ti� �'y N�1 ��9 VJ C'n ��.i^` I S g 9 � mm Y�� C $�- °� �o �r � m n �� S Townzen & Associates Plan Approval The plans submitted for review are approved in accordance �� '��`I��""`-"` with local and state applicable standards. This approval does ; not relieve the applicant of the responsibility of compliance A P R 1 7 2013 � with the applicable codes. ❑Approved with comments�Approved as submitted $�; _ : — .:-., �w.�'1 Date��l6��?j �(� l,� C� l� �