1500 Yelm Ave W C ITY �F YE LNl OFFICIAL USE ONLY
��4'� T�p 105 Yelm Ave. W. FEE $35.00
,`�Q �,,�► Yelt'31, WA 9�597 CommYDev.Dept. +� III /;
� � (360) 458-8437 OFFICE Bidg Dept.
(360) 458-4348 FAX Insp.Date
www.ci,�elm.wa.us
Lic.No.
YELIVI APPLICATION FOR
�a���H�r�N BUSINESS �ICENSE � J � y�
/ l
Upon receipt of the license application and $35.�0 payment,the City of Yeim 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 as hereby made for a Business License ior the City of Yelm
� NEW BU IN S� � NAME CHANGE/MAILING ADDRESS CHANGE OIVLY
DATE
BUSiNESS NAME � ( �� � �1 Y��I.��A L�i��J��V�C ,
NATURE OF BUSINESS --1''�11�ti1.���'� , 7�t�� ��
BUSINESS LOCATION ADDRESS _� JL,'� ���CV�'�l ��,;� � �1� , ��VL�
MAILING ADDRESS � �L'� �,� �f i �� :�t' ' �L'' �j�� ;' ���' -}-
EMAIL ADDRESS (J�S�..Y�v^�'�° I��i\�(ti'�, �� � , �'V"1
ANTiCIPATED OPElVING DATE � l � q d�
,�` _� �����- �
DAYS 8�HOURS QF OPERATIQN 1' 1 �+1�-l.� ' �
{� ,, ,�+ �, ,
OWNER(S) �� 1 �.�� � LL.t.��(1G�I 1��..
Address :�t7�`� ���,.V`�1C�CA�--� ��.,'a.� �.U► �11.� "i,���
-�, �City State Zip
TELEPHONE `} �^�
(Susiness} (Home/Emergency)
CONTRACTOR'S REGISTa2ATION NO. ���
(If applicable)
THURSTON CO. HEALTH APPROVAL�O.
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. {UBI) l.kG'� ���,L; ��
Signature Date � f �� ��
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�� Unified Bu�i�t�ss ID �: 601 290 5t42 ���
� Dcroestia Prafit Corpor�tian Bursiness ID �; �. ��
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�k� Location: � ��
' Expiras; 32-31-2015 :�'
�;� C & �' MaT012S, INC. �
� LINCOLN flF Oi.YMPZA
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�{� 2201 CARRIA6E ST 5W
, OLYMPIA WA 48502 5707
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- TAX REGIS7RATION UNEMPLOYMEN�' INS�URA�iCE
�';� INDtlS�'RIA{. YNSURANCE
MINOR WDRK PERMIT
MOTQR VEHICLIE DEALER #2867
��
���� CITV LICENSES/REt3ISTRATI0N5:
� dLYMPIA �ENERAI BUSINESS
�� DUTIES OF MINQRS:
�.
� Office vrcrk,filing,answering phanes
3�
LIC£NSINCi RE�TRICTZiJNS; ;�.
`:� Court permission and a variance frone L&I is rsquired to hire mi�ors
under the e�e of 14 in non-asriculture jobs. �al� 360-902-53Ib or �� `:
� email #�ensaf�ty�ini,�a.gav for 3nformation.
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� Th�s dacument lisYs the regis�rateons,endnr.iements,and ticenses authar�zed for tfie business ..Y..-•..r
I ,$
� n�necia6cave,ffyacc.�e�inrgtfiudcxunverrt,theticensaeecertifiesd�eirdorrn�ir�nontheapplication �
�' was compiete,mm��e,and accurate tn�best of his or i�er knowledge,.m,d thaz bus�ness wi II be
' conducted in compliance rrith all app#icaF►le Washingtpn s�tate,eouncy,and city regulations. fl�rector��7cysartment of Revenue
�o� THE p�f',y� l� Z�� �f l Q G m
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Public Worhs Department
IOi Yelm Auenue 6Vest
Yelm, WA 98597
YELM
wasr�ir�cror�
Date: ���5
,
Property Address: ��� ��� �" � /�j/��/Q /'���jjl�
Business License Appiicant: ]�G ��G�-a�QY' �" JQ�h � 0��
Dear Appiicant:
Section 13.04.220 YMC requires a(I commercial buildings and irrigation systems to have
a Reduced Pressure Backflow Assembly (RPBA) device installed on the water services.
Instailation of a Reduced Pressure Backflow Assembly is required:
� ❑ Prior to approval of your business license
❑� Within '�ys of change of ownership
Not Applicab(e
J� �„'�-v...
!
Contact Kevin ay, �ty of Yelm Public Works (360) 458-8410
kevinr(a�ci.yelrrt,wa.us for detai/s on device options and �nspect�on
requirements.
Fats, oils, and greases entering the City of Yelm STEP sewer system can adversely
affect the operation of the pfant and the City requires all appropriate measures to avoid
fatc nilc Nnrul yro�c�os f�^vi i t ^ciiici ii�y ii2 sysie�i�. Seciion i 3.vis.u9u Yeim iviunicipai
Code requires an appropriately sized grease interceptor to be instailed prior to the
STEP tank.
lnstallation of a Grease lnterceptor is required:
� ���o� to approvai of your business (icense
❑ Within days of change of ownership
❑ Not Applicable
Contaet Jim Doty, City of Yelm Public Works (360) 458-8411
limd(c�ci.yelm.wa.us t'or details.