10501 Creek St NE _ _ _ _ _ _ ._ _ _
_ __
CITY OF YELM OFFICIALUSEONLY
��0� T�/�� �5 105 Yelm Ave. W. FEE �s.00
q '�� � Yeim, WA 98597 Rec By
Comm Dev.D t.
� � �, (360) 458-8437 OFF{CE Bldg Dept
� (360) 458-4348 FAX Insp.Date
www.ci.yelm.wa.us
Lic.No.
YELM � �'PLICATlON FOR
WASHINGTON BUSINESS LICENSE
Upon receipt of the license application and$35.0�payment,the City of Yelm will conduct an inspection of
the premises for building and fire code conformance. Upon approval from the Yelm Building Department
of said premises,the City Clerk's Office wiil process the application and mail license to applicant at
address listed belaw.
Application is hereby made for a Business License for the City of Yelm
� NEW BUSINESS L� NAME CHANGE/MAILING ADDRESS CHANGE ONLY
DATE $/I(J�I�
BUSINESS NAME���IfV1 P� ��I�"Y� 0�r1 d ���e SS
NATURE OF BUSINESS��56`nG'�� �'�'`�'n�'n Q--
/ 0 Oi GrceK. ,
BUSINESS LOCATION ADDRESS(�}" Fi Y�'S�V��P55 5��� `��,M� WA �18�R'7
MAIUNG ADDRESS � Ud �6Y��1S6`l� �Z� . JG TP�f��V1c� �%�" �I
ANTICIPATED OPENING DATE ��! , � i 3
DAYS 8 HOURS OF OPERATION VO�C'�DuS "de��i Y1G � C��aE'�Yl'�"S
OWNER(S) i]('��iC'��tf�e ���A�(
Birthdate o� '��//�`1�p
Address ��C�3 50�n�5a� �/t�2�-��SG �V�iv��,(..cS'� ���C
City . State Zip
TELEPHONE �l� 3�I�'I"9�I5 3�.��>�f�b C7Z�/Z
(Business) ( ome/Emergency)
CONTRACTOR'S REGISTRATION NO.
(If applicable)
THURSTON CO. HEA�TH APPROVAL NO.
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI)�� �7� s�/Z
Signature
'�i� Date g I� � J
i
i
Page 1 of 1
��=�a:�l�ul�t�rt ►�t�ite I���r�i�tine���t r�f 1�.��cTe�nt�e
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TA?C REGISTRATIQN tM0: 6Q3271562 ACCQUNT OPEhIED: 0�;�01,'2013
UBI: 60327156� ACCOUHT CL05ED: QPEM
ENTITY NAME: MAGEL KATHERINE M N
BU5INE55 MAN1E: EMPOWER HEALTH f1ND FITME55
MAILING ADDRE55: BU5IME55 LOCATION:
17003 J011N�QN CREEK RD SE 116 S 11TH ST
TEMIMO,WA 98589-9540 MOUMT YERNON,WA 9827�#-4026
EMTITY TYPE: SOLE PROPRIETOFt RESELLER PERMIT MO: M,fA
RERMIT EFFECTIYE: Mj'�4
MAICS CQDE: 51162Q PERMIT EXPIRES: tVi�4
fM�4IC5 DEFINITIOM: SP�RTS 1#Nd REtREATI�DN
INSTRUCTION
F�DR NC1N-��MMIER�IAL USE QMLY
O8r'19r'2013 4:51 PP�'I
http://dor.wa.gov/images/BRDImage.aspx?tra=03 EHcm7uOMhsGnj 3T34UbFgVBjJ2oZ... 08/I 9/2013
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YELM
WASHINCTON
Date p� `l�
Property Address ��,.�� /�� � ���'. ____�Ii!��__ ^ _ ��SS
� ----_
Business License Applicant: �QI'�y'�� ��� _ _____ _ ___ ______
�
Dear Applicant:
Section 13.04.220 YMC requires all commercial buildings and irrigation systems to have
a Reduced Pressure Backflow Assembly (RPBA) device installed on the water services
Instaliation of a Reduced Pressure Backflow Assembly is required
❑ Prior to approval of your business license
❑ Within days of change of owne�ship
�plicable
Contact Kevin Ray, City of Yelm Public Works (360) 458-84�0
kevinr�ci.yelm.wa.us for details on device options and inspection
requirements.
Fats, oils, and greases entering the City of Yelm STEP sewer system can adversely
afFect the operation of the plant and the City requires a�l appropriate r7�easures to avoid
fats, oils and greases from entering the system. Section 13.08.090 Yelm fViunicipal
Code requires an appropriately sized grease interceptor to be instalied prior to the
STEP tank
Installation of a Grease Interceptor is required:
C Prior to approva( of your business license
❑ WithinF;� days of change of ownership
��o�f Applicable
��-
Confacf Jim Doty, City of Yelm Public Works (360J 458-8419
jimd(c�ci.yelm.wa.us for details.