17100 SR 507 SE C ITY O F YE LM OFFICIAL USE ONLY
��� TNE A�� 105 Yelm Ave. W. Rec g$35.00
� �� Yeim, WA 98597 Comm Dev.DQpt. Qln� p��
(360) 458-8437 OFFICE -�, ' '
Qn M Bldg Dept. � t.` � 1. +t i
(360) 458-4348 FAX Insp.Date
Lic.No.
YELM APPLiCATION FOR
WASHINGTON BUSINESS LICENSE �l D� /�
iv
Upon receipt of the license application and $35.00 payment, the City of Yelm will conduct an inspection of
the premises for building and fire code conformance. Upon approval from the Yelm Building Department
of said premises, the City Clerk's Office will process the application and mail license to applicant at
address listed below.
Application is hereby made for a Business License for the City of Yelm
�NEW BUSINESS C� NAME CHANGE/MAILING ADDRESS CHANGE ONLY
DATE_ �O" I� -7 O}�-I
BUSINESS NAME__ {ZC�11 I`l 1��V� V 1����r �L�¢' C G�Y�� �, PL LCe
NATURE OF BUSINESS I�kf'C�.I�I C G��. j G�1Z�vYL -�k'1 S�'"'
BUSINESS LOCATION ADDRESS_I r� I (�(a �}�-;�tP ��,i� S��-� �� Y� ��.n `��� c��c,, 7 �y��t�-MGLY�'�
MAILINGADDRESS ��i-I'-� t C_�C?'��hI��F=,1� �',� S � Tf'�'lIV"lC) 11�1� ������
EMAIL ADDRESS G�r'. �:�Glrl t ,S i rnPS�j►'1�'�; C;�yY�Gt� � L p�y1
ANTICIPATED OPENING DATE I l- I I' C�� �-�'
DAYS 8�HOURS OF OPERATION 1 t,l�'., � - ,�j� , Cj�-[Y1V� �(�`. Cj..� �..t.- c�_�
OWNER(S) �C�llfll ° I I�s �1v�nC��L>�
Address l�l�-I�-IIa �,'rn����Pr y2� S� T�►r1t►�l ����r �$cj S�1
TELEPHONE C3i�C�)y ap-- Rp��� C�� State � Zip
( 3 0)y�t ��5�
(Business) (Home/Emergency)
CONTRACTOR'S REGISTRATION NO. Y1I//i
(If applicable)
THURSTON CO. HEALTH APPROVAL NO. Y1 �G�1
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI) (D Ci_ ��� 3�j(p
^ ^ r
Signature Date (U--�� ' 7 i)1�
Page 1 of 1
���huz�ta� S�t�t.e I)ep��tT�tm�nt +��`R���enu�e
���t�e �u�in��s l�+e�c�rc�s I���t��ase I���t�til
TA}{ REGISTRATION NO: NON-REYEIVUE ACCQUNT QPENED: 10 f 15,�2'014
UBI: 6d344439�6 ACCOUNT CLUSED: OPEN
ENTITY NAME:
BU5IME55 NAME:
MAILING ADDRESS: BUSINESS LUCATION:
17100 STATE ROUTE 507 SE 17100 STATE ROUTE 507 5E
YELM,WA 9859�-OOOQ 1FELM,WA 9859�-0000
ENTITY TYPE: LIMITED LIABILITY RESELLER PERMIT NO: N,�A
PERMIT EFFECTIYE: N�A
NAICS CODE: 99999�0 PERMIT EXPIRES: N/A
NAICS DEFINITION: N/A
F�R N(�N-��MMEF�CIAL USEO�NLY
io/�a/zaia s:a6 nr�
I�
http://dor.wa.gov/images/BRDImage.aspx?tra=yulRG7ajaBuRh919xOiGbg==&rsp= 10/20/2014
4�f TNF A'Q.y-� Ci ty o f Ye l m
a M
Public t�Vorks Department
10<5 Yelm Avenue WesC
Yelm, WA 98<i 97
YELM
WASHINGTON
Date: �����•
Property Address: `�� (�� _�� ,� � �
Business License Applicant: �G�1� ���j(�. J11'Y�.-���
Dear Applicant:
Section 13.04.220 YMC requires all commercial buildings and irrigation systems to have
a Reduced Pressure Backflow Assembly (RPBA) device installed on the water services.
Installation of a Reduced Pressure Backflow Assembly is required:
❑ Prior to approval of your business license
❑ Within days of c ange of ownership
� Not Applicabl
_ l D!Fv7����
/
Contact Kevin Ra Cit of Yelm Public Works� (360) 458-8410
kevinr(a�ci.yelm.wa.us for details on device options 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 all appropriate measures to avoid
fat�, �;is N(�ul yro�S°S fi vi'i't 2ilt2i iii� the system. Seciion i 3.u8.0yu Yelm iViunicipaf
Code requires an appropriately sized grease interceptor to be installed prior to the
STEP tank.
Installation of a Grease Interceptor is required:
❑ �rior to approvai or your pusiness (icense
❑ Within days of change of ownership
❑ Not Applicable
Contact Jim Doty, City of Yelm Public Works (360) 458-8411
limd(a�ci.ye/m.wa.us for details,