20130307 Permit Pkg 09042013 ��F THFp� City of Yelm Permit ►vo.: 20130307
O 'r
� � Community Development Department Issue Date: 9/04/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
w.snirc*on Fax: (360)458-3144
Applicant:
Name: SAFEWAY#1619 Phone: 425-201-6405
Address: MAILSTOP 2017 POB 29097
PHOENIX AZ 85038
Property Information:
Site Address: 1109 YELM AVE EAST Owner: SAFEWAY
Assessor Parcel No.: 85810000100 Subdivision: Lot:
Contractor Information:
Name: MARKET CONTRACTORS Phone:
Address: STEPHANIE
10250 NE MARX ST
PORTLAND OR 97220
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: MODIFY MGR'S OFFICE, IT AND CUSTOMER SERVICE TO ALLOW EXPANSION OF TWIN
STAR CREDIT UNION
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING MARKET CONTRACTORS $ 895.53
TOTAL FEES: b 895.53
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 i the S�ate of Washingto .
Signatur� Date /� Date:
Fi rm S BY:
Cit� of Yel�
(36 ) 458-8402
REC#: 0013'1443 9/04/2013 12:57 PM
OPER: CO TERM: 001
REF#; 12565
TRAN: 33.0000 BUILDING PERMIT�
2U130307 895.53CR
SAFEWAY #1619
1109 YELM AVE EAST
BLDG 895,53CR
TENOERED: 895.53 CHECK
APPLIEQ; 895,53-
CHANGE; 0.00
CITY OF YELM
COMMERCIAL BUILDiNG PERMIT APPLICATION FORM
Project Address: � �O q����lm__�'�i Parcel#:
Zoning; Current Use: Proposed Use:
Ll New Construction �Re-Model/Re-Roof I Tenant Improvement
L1 Plumbing U Mechanical U Fire Prevent/Suppness/AfaRn U Other
Project DescriptionlScope of Work M� �Q�CtA�.s d�U. ���.���L U�r s��t�
�'�O CXX:7 at t � �-fia�►�—T<.'�C. ��r cr.�d�t un r or-�
Project Value: �
Buiiding Area(sq.ft) Parking Garage 1�'Floor�_2nd Fioor 3i°Floor
Building Height
Are there any environmentaily sensitive areas located on the par�cet? I�Q_ if yes,a
completed ernironmental checklist must ac:company permit application.
BUILDING OWNEWTENANT NAME:
ADDRES$ I �- EMAIL • O�'Y?
CtTY t VU� STATE��ZIP TELEPHUNE S�,11•, dS
ARCHITEGTIENGINEER LICENSE#�
ADDRESS �1��
� CITY STATE ZIP TELEPHUNt �
GENEF2AL CON7'RAC7C�R C TELEPHONE� CG I
ADQ ESS�QZSD n� EMAIL t C 11'�'X►- :�{l'ZtG G�
CITY STATE ZIP �L"w FAX ' '
CONTRACTOR'S LICENSE#IV�Pt�.��L—� 13.12EXP DATE9 CITY UCENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
C(7Y STATE ZIP FAX
CONTRACTOR'S LtCENSE# EXP DATE_CIIY LICENSE#
MECHANICAL CONTRACTOR __TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
Copy of City Mftlgatfon documentation(TFC).
1 t►ereby certNy that the abave intormat{on is correct and that tM construcfion on,and the occupancy and�e use of the
above describcd property witt be in sccordance with the faws,rvles and regulaUons of the State ot Washington and the
,�--City of Yelm.
� � �������-
ican s Signa Dat
Owner I Contractor!Owne�' A nt/Conttactor's Agent I Tenant (Please circle ane.}
All permits are non-transferable and wi{I expire if work authorized by such permit is not begun
within 180 days of issuance,or if wark is suspended or abandoned for a period of 180 days
105 Yetm AuexiueWest (360)45&-3S33
PO Boz 479 (360)43�31��FAX
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