806 Yelm Ave E � � / �
'""" C ITY O F YE LM OFFICIAL USE ONLY
� p� THE A�� 105 Yelm Ave W Rec g$35.00
�4�' 9�, Yelm WA 98597 Comm Dev.Dept.
� � (360) 458-8437 OFFICE Bldg Dept �
(360� 458-4348 FAX Insp.Date
�-�' www.ci.yelm.wa.us ���.No.
APPLICATION FOR
Y E L HM TON BUSINESS LICENSE (S,
Upon receipt of the license application and $35.00 payment, the City of Yelm ill 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 will process the application and mail license to applicant at
address listed below.
Application is hereby made for a Business License for the City of Yelm
�I NEW BUSINESS � NAME CHANGEIMAILING ADDRESS CHANGE ONLY
DATE � '� — � �
BUSINESS NAME � 1'l,Yl�z'�-� ULy r�'�'��j � �✓�
i
NATURE OF BUSINESS ( /,.� �1 f����' �
BUSINESS LOCATION ADDRESS ���� �
MAILING ADDRESS �� �� � � - � �` � ��` ��
. � ��� ` �� ��
ANTICIPATED OPENING DATE ��2 ��t�
DAYS 8� HOURS OF OPERATION
OWNER(S) �'�'%� ��� �t
Birthdate � �2-�I � � �
Address �� 1`��� �� �1� � � �� ����
C�ity �tate Z�p
TELEPHONE ��d l 2�� – Q.� ��
(Business) (Home/Emergency}
CONTRACTOR'S REGISTRATION NO.
(If applicable)
THURSTON CO. HEALTH APPROVAL NO.
STATE OF WASHINGTON MASTER BUSINESS UCENSE NO. (UBI) �� Z� �� � � �� �
�
Signature ��� \` J�9"`---- Date � � —�� _
CITY OF YELM
BUSINESS LICENSE APPLICATION
10113
Page 1 of 1
i��shu��t.ai� S�t��t� Ii����ritm�nt of�.ev�e�tu�
���te �u�in��� Rec�rrds I)��ab��e I�e�,�il
TAX REGISTRATION NO: 6a�7�i0994 A�CCQUMT QPENED: 07 f 01 j20Q'� 12:OO:QQ AM
UBI: 6027�#099� ACCOUNT CLU5ED: OPEM
ENTITY N�kME: ANNONI�CHIRQPRACTI[PLLC
BU�INE55 NAME:
MAILING AddRE55: BU5INE55 LOCATION:
PO BOX 941 iS425 STATE ROUTE 507
RAINIER�WA 98576-09�#1 RAINIER�+WA 98576-8583
ENTITY TYPE: LIMITED LIABILITY RESELLER PERMIT MO: N f A
PERMIT EFFECTIYE: N�A
NAICS CODE: 6�1314 PERMIT EXPIRES: M/A
NAICS DEFINITI�ON: OFFItES OF CHIFtOP1�ACTORS
F�F� FIUN-�QMMIER�IAL U�E C1NL'Y
03/��/2014 4:14 PM
http://dor.wa.gov/images/BRDImage.aspx?tra=IOEUozoSYtbZIdHW 1 nCGQDsOgQb/y... 03/03/2014
��f �H�p'Q,�� �'i ty o f Ye l m
4 R7
Public Works Departrrcent
105 Yelm Avenue West
Yelrn, WA 98597
YELM
was'a�HCron
� � ^
Date:
Property Address ��� } � ^�. �
Business License Applicant: �'��1 ' �..1, — 7,{�1�y�,.{ ��i�.�'�j �}�'�( (�_
�
Dear Applicant: /'�--(,�-
Section 13.04.220 YMC requires all commerciai buildings and irrigation systems to have
a Reduced Pressure Backflow Assembly (RPBA) device installed on the water services.
Installation of a Reduced Pressure Backflow Assemb�y is required:
❑ Prior t approval of your business license
❑ � in d ys of hange of ownership
Not Appiicabie
Contact vin Ray, City of Yelm Public Works (364) 458-8410
kevinr(a�ci.yelm.wa.us for details on device opfions 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 ali appropriate measures to avoid
fats, oils and greasPS from entering the system. Section 13.08.090 Yelm Municipal
Code �equires a� appropriately sized grease interceptor to be installed prior to the
STEP tank.
Installation of a Grease Interceptor is required:
-------- _Cl- Prior to approval oT your business license - - -- _ - -- - --- _._ _ _-----_________ .
(� Within days of change of ownership
0 Not Applicable
Contact Jim Doty, City of Yelm Public Works (360) 458-8411
limd(a�ci.yelm.wa,us for�/�tails.