20140113 Application 01282014 ���I�Q�D
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:��OZZ-C� ]�GIII h���1 RaI SE�, yP�w� Parcel #: ��3� - 47 - Ob� D
Zoning; � �' � Current Use: Proposed Use:
i] New Construction �I Re-Model/Re-Roof/Tenant Improvement
i � Plumbing �� Mechanical � Fire PrevenUSuppress/Alarm �Other Wlreless s�7�-
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Project Description/Scope ofWork:l��lfiiGGl Id11�"D PXIS�i�vrG Ge/lu/�1^�VJ�r
Project Value: �����UU
Building Area (sq. ft) Parking Garage 1S' Floor 2nd Floor 3�d Floor
Building Height ?� � !�'�"`�� r!.��,,, +?'�: �..�
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Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
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BUILDING OWNERJT€_NAy'NAME: °-/�.f � �. 1. __.
ADDRESS�`'S'i>Ti . ti-, '^'�//r���'-✓r.!'Y'��a �'�. EMAIL ���,? � . �. ��t �,�i �i` �-�'l� :�;%,; ' __
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CITY�c��i����I I STATE ic,>>`f ZIP �`���a(( TELEPHONE _>G-> �-'�rf� -[��l�7
ARCHITECT/ENGINEER ��.� �. � F a i ; ;��r�� LICENSE# :� rr� ��9 �
ADDRESS `��`%- ? � �-��-«: ����-.. i�t/ .� : `� EMAIL
CITY/`�✓f ����r• i StATE �✓,�!/�- ZIP s'',�-� TELEPHONE �?>';' ?'> �' `` - '
GENERALCONTRACTOR `'�'` 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 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
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
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Applicant's Signature �.-` Da4e
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
(360)458-3835
105 Yelm Ave W (360)458-3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us