PL-05-0031
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
PL-05-0031-YL
Issue Date 01/26/2005
(Work must be started within 180 days)
Receipt No
35005
Applicant:
Name B&H Builders
Phone:
458-3277
Address. P O. Box 1959
City' Yelm
State. WA Zip 98597
Property Inforl"l1atioh
Site Address 514 Yelm Ave. West
Assessor Parcel No 21724141502
Subdivision. N/A
Lot: N/A
Contractor 'Information:
Name:
Contact:
Phone:
Address.
City'
State:
Zip.
Contractor License No
Expires:
Business License:
Project Information
Project: Therapeutic Associates
Description of Work: Plumbing upgrade
Sq. Ft. per floor' (1 st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other): OTHER
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- -------------
Plumbing Permit 3400 2000 1400 7 0000 2.0000 Fixture
Traffic Facilities Charge 797.25 000 797.25 7500000 10630 Peak PM Trip
TOTAL FEES $831.25
Applicant's Affadavit:
OFFICIALUSE.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
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 futher certify that I am currently
registered in State of Washin ton.
# Sets of Prints:
Signature
Date 1-) c, -0 \---
~'By:
Firm
RECEIVED
"-""" '<'~~.p;;'
. - D;' .. lit ~._' . ..~, '",..__
****EIGHT HUNDRED THIRTY ONE DOLLARS & 25 CENTS
RECIO:IVED FROM
B & H BUILDERS
POBOX 1959
YELH, WA 98597
458-3277
PLUMB PER 34.00, TRAF 797.25
SITE 514 YELH AVE W
DATE REC NO
01/26/05 35005
HISCELLANEOUS RECEIPT
JANINE
- .
. -~.
...1"
RECEIPT No 35005
AMOUNT
831.25 CHECK
REF NO
7305
Applicant:
Name B&H Builders
Address: POBox 1959
Project Information
City of Yelm
Community Development Department
Building Division
Phone (360) 458-8407
Fax: (360) 458-3144
City' Yelm
Project: Therapeutic Associates
Description of Work: Plumbing upgrade
Site Address. 514 Yelm Ave. West
Fees
Item
Plumbing Permit
Traffic Facilities Charge
Acct Code
Item Fee
Permit Fees Schedule
Permit No PL-05-0031-YL
Phone
State' WA Zip 98597
458-3277
Assessor Parcel No 21724141502
Sase Amt Unit Fee
2000
0.00
1400
797.25
7 0000
Unit Rate No Units Unit Desc
2.0000 Fixture
750 0000
1 0630 Peak PM Trip
032 001-322-10-00
3400
420 120-344-85-00
797.25
TOTAL FEES
$831.25
Project Address: 5}t.f ~-eJ)m t+I-L L0
Parcel #.
Received
JAN 2 -: 2005
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Zoning; \
Current Use:
Proposed Use
U New Construction U Re-Model/ Re-Roof / Tenant Improvement
U Plumbing U Mechanical U Fire Prevent/Suppress/Alarm
Project Description/Scope of Work:
Project Value:
u Other
Building Area (sq. ft) Parking Garage
Building Height
151 Floor
2nd Floor
3rd Floor_
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
BUILDING OWNERlTENANT NAME i<. Ca .
ADORE S 3'YiIO - 10;;1.00 /W.(.. :>
CITY STATE ~ ZIP Cfff:ff,
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
r D ,. c....
EMAIL p~fb~Y\-e..lA-.:pvu.ve.CD1-)
TELEPHONE (~-4-5'l{~ 5'13
ZIP
LICENSE #
EMAIL
TELEPHONE
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
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 Yelm..___
-.-::'-'-7 ~
~. ../~_.__.~--"
.... AppliCant's Signature
Owner / Contractor J Owner's Agent J Contractor's Agent / Tenant
/-- ;;l()-O S
Date
(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
(860) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us
105 Yelm Avenue West
POBox 479
Yelm, WA 98597
FILE COpy