15425 SR507 �■■ CITY OF YELM OFFICIALUSEONLY
� Q'� ��Jb�� 105 Yelm Ave. W. FEE $35.00
Rec By
�Q� '�,. Yelm, WA 98597 Comm Dev.Dept.
`
� �� (360) 458-8437 OFFICE Bidg Dept./�, a t� ,
(360) 458-4348 FAX Insp.Date
ww�nr,ci.yelrra.wa.�s
Lic.No.
APPLICATlON FOR
YELM BUSIIVESS LICENSE � >���
WASHINGTOPI
�
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.
App6icatio� is hereby made for a Business License for the City of Yelm
� NEW Bl9SIN�SS � NAME CHANGEIMAILING ADDRESS CNANGE ONLY
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DRTE i _ =��;,�-'�:.;;
BIJSIPJESS I�AME i��.�i°' }���' ���§� ��I�b-�
NATIlRE OF BIJSINESS ,�✓'����i�'� �'-�nit� �r'�< f=="�v,�l�`y _
BUSIPIESS LOCATION ADDRESS iS'�z� S��i� �7�J�`7 , 'y�r��i ��%� �-��5`��
MAILIPIG ADDRESS /�-�j' -,:� �i�1 C � �t-' ���LN'1 � �;? %�`G�-->,%� �
EMAIL ADDRESS �, ��s�i�i��'�`��' t�'r�i�'%K%��U��'�
1
APITICIPATED OPENING DATE ;'.�5 F�l� .��/�
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DAYS 8� HOUf�S OF OPERATION 1 L��� -�f� l /�f�i�� -�t;i�'� �- r�! �;��ti `'?�;`�'^J
OwNE�(S} ,,4�C%�tN !-�i:k.���
Address ��1� ��t�,%��'�` l%(�--C ��`1 (���t;� r``� % -�
C' y State Zip
TELEPHOPIE ,�,�_��,? -� ';7� ����-�;K�;�_,r,�
(Business) (Home/Emergency)
COIVTRACTOR'S REGISTRATION NO.
(If applicable)
THURSTON CO. HEALTH APPROVAL NO.
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI) �v�'3�' .� .��i C..i
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Signature ---�=-'---= - �
Page 1 of 1
���slungtoiz �t�te� I�epaz-�ment of Re�'�IlU�
�t�te� Busutess Re�cc�t�ds I)at�b�se Detaii
TAX REGISTRATIOM NQ: 603455970 ACCOUNT OPENED: ai�ai,'2015 12:Od:OQ AM
UBI: 60�455970 ACCOUNT CL05ED: OPEN
ENTITY NAME: PACKER JOHN K
BUSIME55 NAtME: KEEP aMD BEAR/kRhiS
MAILING ADQItE55: BU5INE55 LOCATIUM:
15136 DURAMT Dlt�E 15136 UURANT DR SE
YELM�WA 9859?-$799 YELM�WA 9859?-8799
ENTITY TYPE: SQLE PROPRIETOR RESELLER PERMIT NO: A32 29�16 16
PERh1IT EFFECTIVE: 12 j2�f 2014
NAICS CODE: 4�l l la PERMIT EXPIRES: 12/25/2016
NpICS DEFINITION: SRORTING G�aQS STQRES
F�]R N�N-�t�MMERCIAL USE t]NLY
02 f 13 f 2015 3:45 PM
http://dor.wa.gov/images/BRDImage.aspx?tra=s4LrdXU/K3 UIJe+,TkFL236kfH5 85 CySx... 02/13/2015
��f TH�f,�',�� Ci ty o�' Ye l m
� �
Public Works Department
10� Yelm Avenue 6G'est
Yelm, WA 98597
YELM
W4SHINGTON
Date: p2 l �^'l �
Property Address: l � 7 a5� �. �f�-, � 7 � q���
�
Business License App(icant: ��Y� �G�.�e�'
Dear Applicant:
Section 13.04.220 YMC requires all commercial buildings a�d irrigaiion systems to have
a Reduced Pressure Backflow Assembly (RPBA) device installed on the water services.
installation of a Reduced Pressure Backfiow Assembly is required:
❑ Prior to approva( of your business license
�O Within �ys�e�h„�nge of ownership
� Not Applicable
P,. ,��:_.._ ��>
F �- �
Contact Kevin Ray Ci�' f Yelm Public Works 360 458-8410
( )
kevinr(a�ci.�elm.wa.us �r 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 p(ant and the City requires ali appropriate measures to avoid
fatc nilc anr�l yro��°S fi v�i� ^ciiici iiiy iIi@ sysie�i�. SECiion i 3.uzs.uyu Yeim iviunicipai
Code requires an appropriately sized grease interceptor to be instalied prior to the
STEP tank.
lnstallation of a Grease interceptor is required:
� �r�a� to approvai oT your pusiness iicense
❑ Within days of change of ownership
❑ Not Appiicable
Contact Jim Doty, City of Yelm Public Works (360) 458-8411
limd(c�ci.yelm.wa.us for details.