20140295 Permit Pkg 12122014 '�a� rH�p,��` City of Yelm Permit ►vo.: 20140295
� ,
� � Community Development Department Issue Date: 12/12/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
'"°`°" Fax: (360)458-3144
Applicant:
Name: DOMINO'S PIZZA DIST. LLC Phone: 360-400-2222
Address: 10501 CREEK ST.
YELM WA 98597
Property Information:
site Address: 10501 CREEK ST SE Owner: DOMINO'S PIZZA DIST LLC
Assessor Parcel No.: 69280000100 Subdivision: PRAIRIE PLAZA Lot:
Contractor Information:
Name: SUNSET AIR INC Phone:
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALL 2 TON DUCTLESS A/C UNIT
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL SUNSET AIR INC $ 29.50
TOTAL FEES: $ 29.50
Applicant's Affidavit: OFFICIAL USE ONLY
I ceRify 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. If applying a actor, I further certify that I am currently Final Inspection:
registered in the State f Washin ton.
Signature Date Z
Date:
Firm r� . /�ri,�- BY�
_ _ _ _ _
Cit� of Y�lm
(36 ) 458-8�G2
REC#: 00180470 12,12/Zp14 7;29 PM
OPER: CO TERM: Q01
REF#; 34615
TRAN: 3:3,0000 BUILQING PERMITS
20140295 29.50CR
DOMINp`S PTZZA DIST. LLC
10501 CREEK ST SE
MECH 29.50GR
TENDERED: 29.50 CHECK
APPLIED; 29.50-
CHANGE: 0.00
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CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:�D S�� ����G S'�"�L� Parcel#:_�p'�l o� (�DU U7j e2U l�
Zoning; Current Use: Proposed Use:
❑ New Constructi n ❑ Re-Model/Re-Roof/Tenant Improvement
0 Plumbing `�Mechanical C, Fire PrevenUSuppress/Alarm ❑ Other
Project Description/Scope of Work: .t�Yl'�l Z � �vCC�I �5j � ���'"�
Project Value: �C�l���vv
Building Area (sq.ft) Parking Garage 15`Floor 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.
BUILDING O NER/T NANT NAME: ��
ADDRESS . I o�-�l MAIL '
CITY � � STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE 3(pn_ �5,(D .-�9S(o
ADDR�SS 2 0 � EMAIL � 'i . �
CITY GZCG ST E��nQ ZIP �St7 FAX 3 D - _
CONTRACTO 'S LICENSE#S EXP DAT 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 Y .
- f� l� l
Ap cant's Sig Date
Ow r/Contractor/Owner's Agent/Contra tor'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
(360)458-3835
105 Yelm Aue W (360)458-3144 FAX
Ye[m, WA 98597 www.ci.yelm.wa.us