20130180 Permit Pkg 05022013 '�'"��T��.�`��' City of Yelm Permit ►vo.: 20130180
w '�,
� � Community Development Department Issue Date: 5/02/2013
4 � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELIVI
""`"'"'�'°" Fax: (360)458-3144
Applicant:
Name: 40TH ST ASSOCIATES Phone: 425-822-5522
Address: 520 KIRKLAND WAY, STE 100
KIRKLAND WA 98033
Property Information:
site Address: 1201 YELM AVE E 101 B Owner: 40TH ST ASSOCIATES
Assessor Parcel No.: 22730110400 Subdivision: Lot:
Contractor Information:
Name: HALVORSON CONSTRUCTION GROUP Phone:
Address: MARK
12515 WILLOWS RD NE, STE 220
KIRKLAND WA 98034
Contractor License No.: HALVOCG908M6 Expires: 9/05/2014
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: WHITE WALL TI. FUTURE TI WILL BE RESPONSIBLE FOR IMPACT FEES AND HEALTH,
SAFETY AND ADA REQUIREMENTS
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Th i rd
Garage
Basement
Fees:
Item Contractor Fees
BUILDING 40TH ST ASSOCIATES $ 345.26
TOTAL FEES: $ 345.26
Applicant's Affidavit: OFFICIAL U:SE 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 f record. If applying a a contractor, I further certify that I am currently Final Inspection:
registered in the State ashi gton.
/ . � Date:
Si nature • Date �
By:
Firm ,S �I�
�
I
i
Cit� of Y�lm
(36 ) 456-84��2
REC#: 001263�.7 5/02/2013 9.1q AM
UPER: CO TEC�M: 00�
REF#: GI
TI�AN�A�VORSON CONSTRICTION��C�NSE �
BUSINESS LICENSES & 35.00CR
�RAN: 33.0000 BUILU345.26�RITS
20130180
qOTH S� ASSOGTATES
1201 YELM AVE �4�1�1�8�
BLDG
T�NQEREG: 38U.26 UTHER
AC'PLIED: 380.26-
CHANGE; �4��_J~yy0.00
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: IZ�I Gas� �e�w� �td�,,�P�vK,Ull��g rarcei#: � 22�30 ' II(�400
Zoning; �'.'. Current Use: `RET/�IL Proposed Use: �T�1L-
New Construction )( Re-Model/Re-Roof/Tenant Improvement
Plumbing Mechanical Fire PrevenUSuppress/Alarm Other
Project Description/Scope of Work: l:a�, �i�^��� dew�►'s� WQ-�- �e�o -t�'� ��. � 1�bV�-
00 loe i wa.U. , �vnovL C1�la{�n5 ''�oonnG ,�lttimloi�� �rov�'S la�t„s -Fo✓
Project va�ue: � I� rZ.6S— a�a�e��- .;S.�c� J
Building Area(sq. ft) Parking Garage N/A 1S�Floor � Gl7sF2nd Floor N/,� 3fd Floor �/A
Building Height
Are there any environmentally sensitive areas located on the parcel? 11�0 If yes, a
completed environmental checklist must accompany permit application.
Bt1{LDING OWNER(CENANT NAME: �` C � - ' � Wes� v ro Ves,Ihc-
ADDRESS 5ao K��kl�.��l Wfl� � Su��t IDb EMAIL Kris��@rr�.�.n-��c.Cc�w�
CITY K�raClav�c� STATE ZIP $0 TELEPHONE (u�c-) 822- 5522
ARCHITECT{ENGINEER C�A{ �rsc�2 v ' LICENSE#
ADDRESS 2ov1� I�o� � Zo EMAIL r'�t� ��aa�rcl�±.covv� _
CITY Sea \e� STA E�iA_ZIP 98155 TELEPHONE 206 -
GENERAL CONTRACTOR ������� ���uc�w�, C oudELEPHONE 25 -
ADDRESS �2�'�5 f.+�l/ow �/ ' �EMAIL vviarl�n @ H0.lvavice,���e�u�nv�.
CITY �rK� STATE�_ZIP qF103�(FAX ��fZS'�(0 8-ISO I
CONTRACTOR'S LICENSE#{{ALvoGG9o8M6 EXP DATE_CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
� CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTCJR 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
above described property wi11 be in accordance with the�aws,rules and regulations of the State of Washington and the
City of Yelm.
f,�j ' �aG�l.3
Applic nt's Signature
Date �'
Owner/Contractor/Owner's Agent I Contractor's Agent I Tenant (Please circle one.)
All permit i by such permit is not begun
within 18i g A L V O R S 0 N �d for a period of 180 days
Mark Gulin
Chief Estimator
f
�` Halvorson Construction Group,LLC
105 Yelm A� GENERAL CONTRACTOR (360)458-3835
PO Box 479 12515 Willows Road NE,Suite 220 (360)458 ��VED
Yelm, WA S Kirkland,WA 98034 www.ci.y . .
Tel:425-658-1500•Cell:206-495-3663
Fax:425-658-1501 APR 2 6 2013
markg@halvorsonconstruction.com
LIC#HALVOCG908M6
BY: