20130258 Permit Pkg 07082013 Q�O�YH�A�, City of Yelm Permit No.: 20130258
4 � Community Development Department Issue Date: 7/08/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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"'•`"�"`_°" Fax: (360)458-3144
Applicant:
Name: TAHOMA TERRA GOLF COURS Phone: 360-446-3083
Address: P.O. BOX 627
RAINIER WA 98576
Property Information:
site Address: 15425 MOSMAN AVE SW Owner: CADDY SHACK BAR AND
GRILL
Assessor Parcel No.: 21724440200 Subdivision: Lot:
Contractor Information:
Name: TAHOMA TERRA GOLF COURS Phone:
Address:
P.O. BOX 627
RAINIER WA 98576
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work:
Sq. Ft. per floor: Heat T e Electric, Gas, Other
First yp � )�
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING TAHOMA TERRA GOLF COURS $ 34.00
TOTAL FEES: $ 34.00
ApplicanYs Affidavit:
I certify that I have read and examined the information contained within the application and know the same OFFICIAL USE ONLY
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants, #Sets of Prints:
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the State of Washington. � Final Inspection:
..o^ �
Signature^` ` � �;d� �/j-- Dat� ��— '�� Date:
�
Firm � gy;
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Cit� of Yelm
«6 � 458-8402
F2EC#: �0132072 7/08/2013 9:41 AM
OPER: Lp TERM: 001
REF#: ?.3805
TRAN: 33.U000 BUILDING pERMITS
2013U25g 34.00CR
TAHOMA 1ERRA GOLF COURS
15425 MOSMAN At�E SW
P� 34.00CR
TENDERED; 34,00 CHECK
APPLTED: 34.00-
CHANGE; y �
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Pro�ect Address: ���Z"� F����� ���������
1 Parcel#:
Zoning; Current Use: Proposed Use:
w Construction Re-Model/Re-Roof/Tenant Improvement
lumbing Mechanical Fire Prevent/Suppress/Alarm Other
Project Description/Scope of Work: �V��� (,� � �r r'g"%IZ �i2C�tt� �� P�.�h1�j,����J L�n.��5
Project Value: � � u � C�
—�
Building Area(sq. ft) Parking Garage 151 Floor 2"d F�oor 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.
II� BUILDING OWNER/TENANT NAME: ��A- �C..L�-' iS � �
ADDRES' y� �Z 1`1�t�'' lit°J r4n,l y-,��,��J EMAIL
CITY `! �;t-h�'1 STATE ZIP - ' TELEPHONE ''L �•- (-� - ;
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR �� TELEPHONE
ADDRESS c� i �C ' '`Z- EMAIL ��F[^� �tt� � °�.�.1►,�gi,��
CITY ��y'i_.1� 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
iabov e cribed property will be in accordance with the laws,rules and regulations of the State of Washington and the
'I City f Y m.
I
I �'� � � �
Ap 'c '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
r �
I05 Yelm Avenue West (360)458-3835
PO Box 479 (360)458-3144 FAX
Yelm, WA 98597 www.ci.yelm.ma.us