20140170 Fire Alarm Application 03092015 CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: �U , ���= J� � � Parcel#:
Zoning; Current Use: Proposed Use: C�,'� ,_,� <<r,�-c r-
�= New Construction - Re-Model/Re-Roof/Tenant Improvement
= Plumbing � Mechanical y�i e PrevenUSuppress/Alarm � Other
Project Description/Scope of Work:�-ns-�-� �\�.�1'+�r� c:( n v` t-��� G�4�n S�,S�
Project Value� �� -I �� ��J
Buiiding Area (sq. ft) Parking Garage 1 St Floor���2"d Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? �(lt� If yes, a
completed environmental checklist must accompany permit application.
BtlILDING OWNERlCENANT NAME': V��,r� L�,�n�,,�,�, �-z� Ce�,ft� _
ADDRESS .Sc:1 �r:� `�� S�= EMAIL
CITY ' STATE l-,5 ZIP TELEPHONE
ARCHITECTlEEVGINEEFt' LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL C�NTRACTOR �=�t uc cc: TELEPHONE 2S 3��'�`-�'�l�7
CDDRESS i, 1�.,. STATE w �'�- ZIP �j�S3 7 � FAX IL"L��`�x-�..���►Z-(`�,4zr�� LL�...��
CONTRA OR'S LICENSE# G�ik�.'`�3�S�EXP DATE ' CITY LICENSE# ILZI Z
PLUMBING GONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL CQNTRACTOR 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
Ciry of Y,elm. °'
/
,
/� �` � �
A plicant's S' ture Da e
Owner/Contf�act r/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
(360) 458-3835
l05 Yelm Aue W (360)458-3144 FAX
Yelm,WA 98597 www.ci.yelm.wa.us --
�015 �