20150345 App.CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: % 3 j s W. l9vIe', Parcel #: tt
Zoning; Current Use: 5"00 1 Proposed Use: 5c -1-oo
❑ New Construction ❑ Re -Model / Re -Roof / Tenant Improvement
❑ Plumbing ❑ Mechanical( Fire
Preve nt/Suppr ess /Alarm ❑ Other
dProject Description /Scope of Work: F-;V- plefr . Ia nIJ 1?e 0) G ce -AI C A T _
Project Value: S Sd y
Building Area (sq. ft) Parking Garage 1" Floor 2nd Floor Td Floor
Building Height IV#q
Are there any environmentally sensitive areas located on the parcel ? /VQ If yes, a
completed environmental checklist must accompany permit application.
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ADDRESS PO l3UX Al -76 G EMAIL
CITY Ye i^�, STATE W/9 -ZIP 8i 5*9 7 TELEPHONE 3 &D 4/ r- Coa/S
ARMIT,,EG;i'I,EN� REE LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ADDRESS 50 5.. $-A t 4 '.F ✓P 3 r /op ' EMAIL r o 0 er e`� � 1 f
CITY /?e.. r. STATE wg ZIP y8"d57 FAX
CONTRACTOR'S LICENSE #C0NVE7-L1TgBQ EXP DATEoi -ZITY LICENSE # I 10 B"U
'(11J1!1BING C�?N`fR1=41)t TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Mtt,_1 L OIalT d1 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
City of Yelm.
Applicant's Sign ure Date
Owner / Contractor / Owner's Agent Contractor's Age Tenant (Please circle one.)
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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 Ave W i "s l)Vj (360) 458-3144 FAX
Yelm, WA 98597 wwwxLyelm.wa.us