20070135 Mechanical Permit 10092014 �pF �HFP� City of Yelm Permit ►vo.: 20070135
7
� r7� Community Development Department Issue Date: 10/30/2013
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(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
Fax: (360)458-3144
Applicant:
Name: YELM DENTAL CLINIC Phone:
Address: 502 YELM AVENUE WEST
YELM WA 98597
Property Information:
Site,4ddress: 502 YELM AVE W Owner: YELM DENTAL CLINIC
Assessor Parcel No.: 21724142200 Subdivision: Lot:
Contractor Information:
Name: YELM DENTAL CLINIC Phone:
Address: JUDD SHERMAN
502 YELM AVENUE WEST
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: TODAY'S DENTAL
Description of Work: Demo existing 2 buildings on 2 parcels, new 4530 sf dental office w/p arking, site devel, street
frontage improvements 3/29/2007-TM Received application. File ID'SPR-07-0135-YL', Case#_
1526
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor �pl�I '� Fees
MECHANICAL AIRTIGHT HVAC $ 134.20
PLUMBING YELM DENTAL CLINIC $ 167.00
SITE YELM DENTAL CLINIC $ 750.00
NEW COMMERCIAL BUILDING YELM DENTAL CLINIC $17,807.03
TOTAL FEES: $18,858.23
ApplicanYs 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 in the State of Washington.
Signatu Date �� � 9 � / Date:
Firm r BY�
.
Cit� of Y�lm
(36 ) 458-8402
REC#: 00174286 1Q/09/2014 1:�0 PM
OPER: CO TERM: 001
REF#:
TRAN: 33.�000 BUIL�134.20CRTT�
20070135
YELM DENTAL CI�INIC
502 YELM A'VE W
MECH 134.20CR
TENDERED: 134,20 OTHER
APPLIED: 134.20-
CHANGE: ����
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: �0�, ,���/; �d��, �0�� Parcel#:
� Zoning; Current Use: Proposed Use:
❑ New Constructio ❑ Re-Model/ Re-Roof/Tenant improvement
❑ Plumbing �echanicai ❑ Fire PrevenUSuppress/Alarm ❑ Other
Project Description/Scope of Work: �✓�Cs ��,c�� .�� �/7� �/���'zr
Project Value:�.) \) , �
Building Area (sq. ft) Parking Garage 7�O 1� Fioor 2"d Floor 3�d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checkiist must accompany permit application.
BUiLDING QWNERlTENANT NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECTIENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP 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#
MECHANIC�-CONTRACTQR�� - TELEPHONE S ° � 5
ADDRES i�'p �e�`� �'S7 �l�st l�l�/rf/,•� EMAIL
CITY ���"��ae STATE�_ZIP_���FAX
CONTRACTOR'S LICENSE EXP DAT�o-2i ITY LICENSE#
���t����°, � ���s�— a�
Copy of City Mitigation docu ion'jT ).
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�`elm.
d� -t � � �� � �
A plicant's Signature Date
O ,�er/Contractor 1 Owner's Aaent I Contractor's Aqent/Tenant (Please circle one.)
`� k� "' Paul Glasgow
Af,� {. authorized by such permit is not begun
wi � `` � � °`"I"' ��•abandoned for a period of 180 days
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`�, „ A/RTIGHT
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' ��-..�.��.�..�.c Heatzng e'r Air Conditioning (360)458-3 -� ,,_ , ;�� =���� `�
1�? � " (360) 458-3 44 FAX
Z� ����������� Office 360-455-�455 www.ci.yel .wa.�C j Q 7 20�4
Cell 360-528-�422
�, I .: Airtighthvaci@gmail.com
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