20140263 Permit Pkg 10162014 ��0� TH�A� City of Yelm Permit No.: 20140263
7
� � Community Development Department Issue Date: 10/16/2014
d �
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
""'""'""'" Fax: (360)458-3144
Applicant:
Name: MT RAINIER PROPERTIES (B) Phone: 360-561-8820
Address: 9144 BURNETT RD SE
YELM WA 98597
Property Information:
site Address: 9144 BURNETT B-1 Owner: MT RAINIER PROPERTIES
Assessor Parcel No.: 21713340601 Subdivision: Lot:
Contractor Information:
Name: MT RAINIER PROPERTIES (B) Phone:
Address:
9144 BURNETT RD SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: TI,ADDING 2 EXAM ROOM TO EXISTING SPACES
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING MT RAINIER PROPERTIES(B) $ 137.36
TOTAL FEES: $ 137.36
Applicant's 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 f record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in t State of W shington.
Signature Date � i Date:
Firm BY�
Cit� of Y�lm
(3� ) 45�-8402
REC#: 00175256 �p�16�2�14 �2:2� PM
QPE�� �� TERM: 001
REF#:
TRAN: 33,OU00 BUILDING PERMITS
20140263 137,36CR
MT RpINIER PRUPERTIES (B)
9144 BURNETT B-1
BLDG 137.36CR
TENDERE�; 137.36 OTHER
APPLIED; 13�.�6-
CHANGE: �"-�
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: -I�"1� ��YL�� Parcel #:
� Zoning; Current Use: Proposed Use:
❑ New Construction ❑ Re-Model/ Re-Roof/Tenant Improvement
❑ Plumbing ❑ Mechanical ❑ Fire Prevent/Suppress/Alarm ❑ Other
Project Description/Scope of Work: �tA1�CJ1 '{k�r0 ��1�
Project Value: � 3�� ^
Building Area (sq. ft) Parking Garage 1� Floor 2"d Floor 3�d Floor
Building Height SI �.
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME:MZ'� ' ' �
ADDRESS�lyy�'��� EMAIL
CITY STATE �cti.. ZIP�_TELEPHONE •
ARCHITECTIENGINEER LICENSE#
ADDRESS EMAIL
CiTY STATE 21P TELEPHONE
GENERAL CONTRACTOR ,n.e. � e , ELEPHONE�d� 'SL► ��j
ADDRESS( w��.!�} .,,.,e,;� SE EMAIL
CITY STAT w ZIP '(�S'9� FAX
� � CONT ACTOR'S LICENSE#Gf0 '1' L. EXP DATEb�I CITY LICENSE#
PLUMBING CONTF�ACTOR 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 Im.
b.�� .
A lic t's S g re Date
O ner/Contractor 1 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
- _. _._ �
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OCT 14 2014
360)458-3835
105 Yelm Aue W ` ¢�g�� �=�:- --�----�-
Yelm, WA 98597 w�.ci.yel�a.us
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