20140294 Permit Pkg 12112014 ��OF THEA� City Of Yelm Permit ►vo.: 20140294
7
� � Community Development Department Issue Date: 12/11/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
"'.°"'«`�°" Fax: (360)458-3144
Applicant:
Name: PIZZERIA LAGITANA Phone: 360-894-0640
Address: 309 YELM AVE E
YELM WA 98597
Property Information:
site Address: 309 YELM AVE E Owner: PIZZERIA LAGITANA
Assessor Parcel No.: 22719341901 Subdivision: Lot:
Contractor Information:
Name: PIZZERIA LAGITANA Phone:
Address:
309 YELM AVE E
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: GAS PIPING
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING PIZZERIA LAGITANA $ 25.00
TOTAL FEES: $ 25.00
ApplicanYs 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 of record. I appl g as a contractor, I further certify that I am currently Final Inspection:
registered in th State of Washin n
Signature Date ,c /� ��- Date:
Firm By'
Git� of �e1m
(�6 ) 458-8402
REC#: 00180392 12/11/2014 3.02 PM
OPER: CO TERM: 001
REF#:
TRAN: 33.00OQ BUI�pING PERMITS
201402�� 25.00CR
PIZZERIp LHGTtANA
309 YELM AVE E
PL 25.QOCR
TENDERE�: 25.00 CASM
APPLIEQ; 25.OQ-
CHANGE: r 0
� _ s ��
, a
CITY OF YELM af ry�O y�'�
COMMERCIAL BUILDING PERMIT APPLICATION FORM o��
Project Address: 3�� � � �'`� '�'�c Parcel#:
Zoning; Current Use: Proposed Use:
❑ New Construction ❑ Re-Model/ Re-Roof/Tenant Improvement
❑ Plumbing ❑ Mechanical ❑ Fire PrevenUSuppress/Alarm �^Other
Project Description/Scop of Work: ��--� � 1,'nC
Project Value: � n
Building Area (sq. ft) Parking Garage 1� Fioor 2"d Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUIL�ING 0 �N E,, E„ptANT�n E: �'a I e'1�� �I ���� �.
ADDRESS ��/�C J � A EMAIL ��0./31� t L. C a'-'`t'
CITY ;��'�-�{ STATE �- ZIP TELEPHONE C� ^- c� ^c� �
ARCHITECTlENGfNEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
� CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING COPITRACTOR 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 in ormation is correct and that the construction on,and the occupancy and the use of the
above described property wili in accordanc with the laws,rules and regulations of the State of Washington and the
City of Yelm.
� ,. �� �� / �7
Applicant's Signat re Date
Owner/Contract /Owner's Agen /Contractor's Agent I 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
(360)458-3835
105 Yelm Aoe W (360) 458-3144 FAX
Yelrrc, WA 98597 www.ci.yelm.wa.us