20160193 Permit Pkg 04182016City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: T & D WOOD LLC
Address: PO BOX 698
YELM WA 98597
Property Information:
Site Address: 210 103RD AVE NE
Assessor Parcel No.: 22730110202 Subdivision:
Contractor Information:
Name: Washington Energy Services
Address: 3909 196th St SW
Lynnwood, WA 98036
Contractor License No.: WASIRItSBGINs
Permit No.: 20160193
Issue Date: 4/18/2016
(Work must be completed within 180 days)
Phone: 360- 458 -2255
Owner: T &D WOOD INC
Lot:
Phone: 7t)(11 • 37$ • Q% -7
Expires: _ dd /1-7
Project Information:
Project: PLUMBING
Description of Work: REPLACE RUUD_RHEEM G75 -125
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
Contractor
WESCO
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be tru nd correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm re- lion ding those governing zoning and land subdivision, and in addition, all covenants,
easeme ts4n restrictions of record. If applying as a contractor, I further certify that I am currently
register in t tale of shington.
Signatur, Date
Firm
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mi
(36 ) 458 -3244
REC #: 00228982 4/18/2016 2:00 PM
OPER: CO TERM: 001
REF #: 3229
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20160193 25.00CR
T & D WOOD LLC
210 103RD AVE NE
PL 25.000R
TENDERED: 25.00 CHECK
APPLIED: 25.00-
CHANGE: 0.00
2C*,001G3
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 210 103rd Ave SE Parcel #: 22730110202
Subdivision: BLA Supermarket Grocery
Zoning; BLA04- 0069YL Current Use: Proposed Use:
I_; New Construction I Re -Model / Re -Roof / Tenant Improvement
Plumbing I Mechanical ❑ Fire Prevent /Suppress /Alarm _ l Other
Project Description /Scope of Work: REPLACE RUUD /RHEEM G75 -125
Project Value: $6500
Building Area (sq. ft) Parking Garage 151 Floor 2nd Floor 3`d Floor
5,860 sq ft
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUIL rrlE IAN I � T &D Wood LLC
ADDRESS 210 103rd AVE SE EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE (360) 485 -2255
AR ji 0)) ��IENG[NEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
( C bR Washington Energy Services TELEPHONE (206)378 -6927
ADDRESS 3909 196th St SW EMAIL
CITY Lynnwood STATE WA ZIP 98036 FAX
CONTRACTOR'S LICENSE # wASHiFssslnls EXP DATE09 /1 -CITY LICENSE #
PLUMBINd C;C3NTRAGTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACT-p". TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
1 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. /
a /tog/
Applicant's Sign t Date
Owner / Contraccor / wner'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
105 Yelm Aue W (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us