20160270 Permit Pkg 06292016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: FASA FAMILY WELLNESS, PLLC
Address: 1610 BISHOP RD SW STE 101
TUMWATER WA 98512
Property Information:
Site Address: 7f11 TAI- nRAA 921 vn CC
Assessor Parcel No.: 45170000100
Contractor Information:
Name: FASA FAMILY WELLNESS, PLLC
Address: TERRENCE & SARA HESS
1610 BISHOP RD SW STE 101
TUMWATER WA 98512
Contractor License No.:
Permit No.: 201 60270
Issue Date: 6/29/2016
(Work must be completed within 180 days)
Phone: 360- 400 -3338
Owner:
Subdivision: EAGLE PLAZA
Expires:
Phone:
Project Information:
Project: OTHER SPECIAL EVENT
Description of Work: YELM COMMUNITY HEALTH FAIR. AUGUST 19, 2016
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
SE
Contractor
FASA FAMILY WELLNESS, PLLC
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 and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm re �,Its l ions includin those governing zoning and land subdivision, and in addition, all covenants,
easeme an restrictio of record. If applying as a contractor, I further certify that I am currently
register d in th State o Washington.
Signatur Date �Q
Firm E -1k�6� �-r_ ... . �.A (. 0 A
Lot:
Fees
$ 0.00
$ 0.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
JUN /28 /2016 /TUE 11:28 AM
FAX
No,
ou((00 J-1 O
P. 001
AUG /04/2015/TUE 12:14 PM FASA Y'ELPI
FAX
No.360 -400
-3330
P,002/003
City of Yelm. D
a Community Development Department
RionSPECIAL EVENT I TEMPORAR Y USE
APPLICATION
\4 Special Event Sign Permit (limited to 14 days, 4 times per calendar year)
Temporary Use (property owr+er permission letter required)
(see REVERSE for regulations)
r
NAME OF PROJECT ` n l 1 4e „ ! � l g`
APPLICANT /BUSINESS NAME
Mailing Address I'i5 Q k A f 1
City, State and Zip cR ,,, s
Telephones c✓i- 3 EMAIL
City of Yelm Business License Number t C�
SITE OWNER
Mailing Address
City, State and Zip
Telephone 3
SITE ADDRESS /LOCATION Qo j 1h
SITE PARCEL NUMBER
SUMMARY OF REQUEST
ol
1'c+ 1�� G ru'cS (EIn
START DATE END DATE
1 affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also afriirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the city ofYafm and Other governmentnl agencies to enter Upon and inspect
said Propefy as reasonably necessary to process this application.
Signed i
ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning $action Building Section
105 Ye17►aAve4ue West
Yalm, Wei 98597
0 Y" --------------------
(060) 4$8-38135
(350) 4G8 -x144 FAX
Wmw_eiyelm.wea.us
Yil�l■
JUN/28/2016/TUE 11:28 AM FAX No. P,002
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