20130122 Permit Pkg 06172013 �o �'�'� City of Yelm Permit No.: 20130122
q`� � Community Development Department Issue Date: �J//� ��l �j
(Work must be dompl ed within 180 days)
Building Division
Phone: (360)458-8407
"""„,""°" Fax: (360)458-3144
Applicant:
Name: YELM COMMUNITY SCHOOLS Phone: 360-458-6128
Address: PO BOX 476
YELM WA 98597
Property Information:
site Address: 1315 YELM AVE W Owner: YELM COMMUNITY
SCHOOLS
Assessor Parcel No.: 21724210500 Subdivision: Lot:
Contractor Information:
Name: YELM COMMUNITY SCHOOLS Phone:
Address: ERLING BIRKLAND
PO BOX 476
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: COMMERCIAL ADDITION
Description of Work: HIGH SCHOOL PORTABLE PLUS GAS PIPING
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING YELM COMMUNITY SCHOOLS $ 150.00
PLUMBING YELM COMMUNITY SCHOOLS������I $ 25.00
TOTAL'FEES: $ 175.00
Applicant's 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 Sta f Washingto
Signature �r/� G! � Date � � ' � Date:
Firm BY�
Git� af Y�l�
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REL',#: OCJ1�i�575 6/17;�U13 8:�6 AM
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RFF#: 22918
1�RAN; �3,OOOQ 8U1LDIfVL; PERMI�fS
2G13U122 25,00��
YELM COMMUNITY SCHOOLS
1315 YELM AVE W
FL 25.�OCR
TFNDEREU� 1�5.a0 CHECK
APPLTED: 25.00-
GHANG�: �"����� Q.00
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:l�/$ ��/„q ��� (,(J Parcel#:
Zoning; Current Use: Proposed Use:
-� New Construction _; Re-Model/Re-Roof/Tenant Improvement
� Plumbing -J� Mechanical -� Fire PrevenUSuppress/Alarm J Other
Project Description/Scope of Work: ��3 5 L�:� E 7o D o� �a��E
ProjectValue: � Z�DC),°`�
Building Area(sq.ft) Parking Garage 1S`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:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP 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 C�NTRACTOR G'^' � Ed �n TELEPHONE 3l0� ° �f 3 - ��1(0
ADDRESS t . Qox yZ(� EMAIL G Ea a� ,C6�
CITY ('L �rr � e� STATE � ZIP �So 1 FAX
CONTRACTO 'S LICENSE# G Ea�K����a�EXP DATE CITY LICENSE#
Copy of City Mitigation documentation(TFC).
1 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.
�y �J� �3
Applicant's Sig ature Date
Owner/Contractor/Owner's Agent/Contractor's Agent/Tenant (Piease 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 wwzy.ci.ye�.�e�.�IVED
JUN 14 2013
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