20160134 Permit Pkg Bldg 04142016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: RICK CHRISTENSEN
Address: 11915 CLEAR LAKE RD
EATONVILLE WA 98328
Property Information:
Site Address: 16605 106TH AVE SE
Assessor Parcel No.: 64303400502
Contractor Information:
Name: RICK CHRISTENSEN
Address:
11915 CLEAR LAKE RD
EATONVILLE WA 98328
Contractor License No.:
Project Information:
Project: COMMERCIAL REMODEL
Description of Work:
3503 RESTAURANT TI
Sq. Ft. per floor:
First 3503
Second
Third
Garage
Basement
Fees:
Permit No.: 20160134
Issue Date: 4/14/2016
(Work must be completed within 180 days)
Phone:
Owner: RICK CHRISTENSEN
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other): HEAT PUMP
Item Contractor
BUILDING RICK CHRISTENSEN - 04/14/2016
FIRE FIRE & SAFETY NORTHWEST
MECHANICAL SUNSET AIR INC
PLUMBING AFFORDABLE PLUMBING
FIRE SPRINK KNIGHT FIRE
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 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 further certify that I am currently
registered in the State o Wa --- LO
Signature Date
Firm
Fees
$57,550.84
$ 0.00
$ 75.00
$ 132.00
$ 878.87
$ 58,636.71
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of
(36 ) 458 -3Y�lm 244
REC #: 002.28416 4/14/2016 3 :48 PM
OPER: CO TERM: 001
REF #: 57550.84
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20160134 57,550.84CR
CHRISTENSEN, RICK
16605 106TH AVE SE
BLDG 57,550.84CR
TENDERED: 57,550.84 CHECK
APPLIED: 57,550.84-
CHANGE: 0.00
e2Dl�Dl34
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address.- /� �U S' /4���ti`° Parcel #: 6 q,30,3
Zoning; ( °J'� Current Use: Proposed Use:
New Construction _- Re -Model / Re -Roof / Tenant Improvement
Plumbing Mechanical ❑ Fire Prevent/Suppress /Alarm Li Other
Project Description /Scope of Work:
Project Value:
Building Area (sq. ft) Parking Garage 1s' Floor 2nd Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: /r7
ADDRESS - 'eJ = EMAIL IF, F. .i,f Te,- x; , -�
CITY STATE ZIP 9t TELEPHONE -z s : — 6 _77 00 3 t'
ARCHITECT /ENGINEER J LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR rr< s TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation JFC).
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 Signature Date
Owner / Contractor / 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
ICO���7� SCANNED
201 FEB 19:...
(360) 458 -3835
105 Yelm Ave W .................. f360) 458 -3144 FAX
Yelm, WA 98597 B
www.ci.yelm.w¢.us