20140248 Permit Pkg 09102014 �`�oF t��p,� City of Yelm Permit No.: 20140248
,
� 7� Community Development Department Issue Date: 9/10/2014
� � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELM
'"•""'"°"°" Fax: (360)458-3144
Applicant:
Name: VERIZON WIRELESS Phone: 845-356-8390
Address: PO BOX 867
MONSEY NY 10952
Property Information:
site Address: 16220 RAILWAY RD SE Owner: RONALD SMITH
Assessor Parcel No.: 64300700600 Subdivision: Lot:
Contractor Information:
Name: VERIZON WIRELESS Phone:
Address: BUSINESS LICENSES
PO BOX 867
MONSEY NY 10952
Contractor License No.: 10886 Expires: 12/31/2015
Project Information:
Project: LAND SITE PLAN REVIEW
Description of Work:
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SITE VERIZON WIRELESS $2,000.00
NEW COMMERCIAL BUILDING VERIZON WIRELESS—Issued on 3/23/2015 $1,066.68
TOTAL FEES: $ 3,066.68
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. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the S te of Washington.
Signature Date �,���/ r Date:
Firm H� By�
S�r4�� �
cit� of Y�lm
(36 ) 458-3244
REC#: 00190454 3/23/2�15 11:27 AM
OPER: CO TERM; 001
REF#: 2017
PAIQ BY:
TRAN: 33.0000 BUILDING PERMITS
20140248 422.93CR
VERIZON WIRELESS
16220 RAILWAY RD SE
BLD-COM1 422.93CR
TENDERED: 422.93 CHECK�.�I�
APPLIED: 422.93-
CHANGE; 0.00
Cit� af Y�lm
(3� ) 458-8402
REC#o 00170�83 8/2fl;2U14 10:57 AM
OPE�� Cl� TERM: QO1
RFI�#; 1�313
Tf�AN. �99.00�0 MISG I'AYMEN�S
TECHNOLOGY A�SQ.
k�UTLOING COD� �Fr 64;3,75CR
rENpERELI: b43.75 GHECIi
AP�LIEQ: 643.75-
CHANGE: `�____._�.00
�lt� D� ��1�1
(36 ) 458-8402
REC#: 00170285 8/28J201� �0;58 AM
OPER: CO TERM: 001
REF#; 18315
TRf�N: �y�,UO(l0 MTSC PA'�'PICNTS
TEIaHOLOGY
�iU1Ll�ING CODE FEE 2,OOO,QOCR
TENDEREL7: 2,�i)O.GO CNtCK
APPLIE[): 2,UtlO.00-
�HANGE: �— 0,00
s
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 16220 Railway Rd. SW Yelm,WA Parcel#: 64300700600
Zoning; Industrial Current Use: Unmanned Proposed Use: Unmanned Telecom
e ecom
X New Construction Re-Model/Re-Roof/Tenant Improvement
Plumbing Mechanical Fire PrevenUSuppress/Alarm Other
Verizon Wireless proposes to modify an existing unmanned tclecom facility with
ProjeCt DesC�lptlo�/SCOpe Of WOfk: thc addition of(16)vanel antennas mounted on exisitine 149.6'monovole.Also,
15'x 30'equipment lease area within a�existing fenced compound.
Project Value: $50,000
Building Area(sq. ft) Parking Garage 1g'Floor�30 sqft2�d Floor 3`d Floor
Building Height Total Height of Tower: 149.6' Proposed Antennas Height: 140'
Are there any environmentally sensitive areas located on the parcel? N/A If yes, a
completed environmental checklist must accompany permit application.
_ .
BUILDING OWNEWTENANT NAME: SBA Site LD. #WA42065 Contact:Joe Rozanc
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE (7021581-2663
�4RCHITECT/ENGINEER LDC.Inc. LICENSE#
ADDRESS 14201 NE 200th St. Suite l00 EMAIL
i CITY Woodinville STATE��ZIP98702 TELEPHONE�425) 806-18b9
GENERAL CONTRACTOR Legacy,Bob Irvin�_TELEPHONE (253)686-0142
ADDRESS EMAIL
CITY Bellevue STATE WA ZIP 98008 FAX
CONTRACTOR'S LICENSE#WALEGACTIOOSKD EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR N/A TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL CONTRACTOR TBD TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of City Mitigation documentation(TFC).
I ereby certify that the ove formation is correct and that the construction on,and the occupancy and the use of the
a ov described prope will b in accordance with the laws,rules and regulations of the State of Washi�gton and the
C Yelm.
W
A lic Signatu e Date
O ner/Contractor O er's Agen /Contractor's Agen Tenant (Please circle one.)
All permits are non- sferable 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
r___
�.�± : : .�,..r � "��
. �
(360)958-3835
105 Yelm Aue W j (360)458-31�14 FAX
Yelm,WA 98597 �-_ _� _.-...--------- 4 www.ci.ye�m.wo.us