310 Railroad Ave NW �' ��� CITY OF YELM OFFICIALUSEONLY
��p� T�.A�,, 105 Yelm Ave. W. FEE $35.00
'� Yelm, WA 98597 Rec By
4 Comm Dev.Dept..
4
� � (360) 458-8437 OFFICE aiag�e�t. - ��- •�';%'�,7
(360) 458-4348 FAX Insp.Date
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Lic.No.
YELM APPLICATION FOR /1
WASHINGTOPI BUSINESS LICENSE � / �( n�
� l� Y/
Upon receipt of the license application and $35.00 payment, the City of Yelm will conduct an inspection of
the premises for building and fire code conformance. Upon approval from the Yelm Building Department
of said premises, the City Clerk's Office will process the application and mail license to appiicant at
address listed below.
Application is hereby made for a Busaness License for the City of Yelrra
� NEW BUSINESS. C� NAME CHANGE/MAILIPIG ADDRESS CHANGE O�ILY
DATE��I"i
�llSINESS NAME � �� ����.
NATURE OF BUSINESS� 1�C1 Cj�n� �
�l1SIP1ESS LOCATION ADDRESS � � �� �l-1 � I ��� � � V� - /l,� � V �
MAILIPIG ADDRESS 1� �� ��� � �I'�-� I� � �Il,� '"I c'�C� �
.�
EnnAIL sDD�ESS (1-�'�� I'l SC�I'���:� � �YYlQ ) � ' �' ��
ANTICIPATED OPENING DATE I l J� "� 1 I�
/ _l
DAYS 8� HOURS OF OPERATION I Y 1 L� rI �1 � l !� SCl T. � —�
OWNER(S) `�('� ,_� V' 1(�I ('�1'1 ��I ��O 1'�
Address �� � � � � ) � - < - ���� � � �,� 1�
� f iI � 1 City St e Zip
TELEPHONE ��� �C� �-t��`� "i ��I I Z�� 3� Z — � Z�� � _
(Busines ) � (Home/Emergency)
COPITRACTOR'S REGISTRATION NO.
(If applicable)
THURSTON CO. HEALTH APPROVAL NO.
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI) ����� � � � � � I
—�__
Signature �'�T l.�'� �-�� Date � � � `"I �
Page 1 of 1
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TAX REGISTRATION NO: 602137�39 ACCOUNT QPENED: 10/O1 j2014 12:O�:QQ AM
UBI: 6�2137239 ACCOUNT CLOSED: OPEH
ENTITY NAME: ATKIN50N BRET F$e SHAMON l
BUSINE55 NAME: YELM COUfVTRY OUTLET
MAILING ADDRE55: BUSINE55 LOCATION:
PO BOX 2291 310 RAILROAD ST N.W.
1FELM,IYA 98547-2291 1fELM,WA 98547-0000
ENTITY TYPE: SQLE PROPRIETOR RESELLER PERMIT NO: NfA
PERMIT EFFECTIYE: M�A
NAICS CUDE: 445110 PERMIT E}CPIRES: IVfA
NAICS DEFINITIUN: SUPERMARKETS ANU OTHER
GROCERY(EXCEPT
COfVYEfYIENCE)5TORE5
F�R N�N-��MMER�IAL USE (]NLY
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http://dor.wa.gov/images/BRDImage.aspx?tra=QmDBsD 1 m5 f4AgVv3 WxVuBBPaR32S1... 10/15/2014
' �.�� TNFp -� Cit of Yelm
`q �9r J /
0. Ch
Public Works Department
105 Yelm Auenue West
Yelni, WA 98597
YELM
WASHINGTON
Date: _����_
Property Address: � �� ��� /� �f�
Business License Applicant: �� '� ��,y�,FJY�, ��Sd�
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 se►vices.
Installation of a Reduced Pressure Backflow Assembly is required�
❑ Prior to approval of your business license
❑ Within days of hange of ownership
(�] Not Applicabl ..
� �� _ ►���z ,�
Contact Kevin R y, Cit of Yelm Public orks (360J 458-8410
kevinrnaci.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 piant and the City requires all appropriate measures to avoid
fat�, ��is �(�r� yro�S°S fi vi'i i �r�t�����g the �ystem. Section 13.�8.09u Yeim fVlunicipal
Code requires an appropriately sized grease interceptor to be installed prior to the
STEP tank.
Installation of a Grease Interceptor is required:
� �rior to approvaf of your pusiness license
❑ Within days of change of ownership
❑ Not Applicable
Contact Jim Doty, City of Yelm Public Works (360) 458-8411
limd(c�ci.yelm.wa,us for detai/s.