20170113 Permit Pkg 01192017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SAFEWAY, INC
Address: PO BOX 85001 98015 -8501
BELLEVUE WA 98005
Property Information:
Site Address: 11 (16 VFI M AVF F
Assessor Parcel No.: 85810000100 Subdivision: N/A
Contractor Information:
Name: SAFEWAY, INC
Address:
PO BOX 85001 98015 -8501
BELLEVUE WA 98005
Contractor License No.:
Expires:
Permit No.: 20170113
Issue Date: 1/19/2017
(Work must be completed within 180 days)
Phone: 206 - 455 -6530
Owner: SAFEWAY
Phone:
Project Information:
Project: COMMERCIAL REMODEL
Description of Work: MINOR PHARMACY REMODEL TO INCREASE REFRIGERATOR CASE SIZE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
BUILDING
Contractor
SAFEWAY, INC
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 s a contractor, I further certify that I am currently
.
registered in the of Washington
Signature Date
Firm �L.c% at�lGZ'C /� L(3n7�i�CEC�11i�
Lot: N/A
Fees
$ 650.06
$ 650.06
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Mm
(36 , 458 -3244
RECD': 00256813 1/19/2017 10 :31 AM
OPER: CO TERM: 001
REEF : 62986
PAID BY:
TRAM: 30.0000 BUSINESS LICENSE
ELITE COMMERCIAL CONTRACTOR
BUSINESS LICENSES & 35.000R
IENDERED: 35.00 CHECK.
APPLIED: 35.00-
CHANGE: 0.00
401,70 // "�
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 8 _y'_11A!1 ffyr L' - Parcel #: ls�_6/0000 /CdC)
Zoning; Current Use: Cet Proposed Use:_S4.Vf
New Construction )(Re -Model / Re -Roof / Tenant Improvement
Plumbing I Mechanical �I Fire Prevveent/Suppress /Alarm Other
Project Description /Scope of Work: /.yoQ A.lfflt5e� l(LAZ
Project Value:
Building Area (sq. ft) Parking Garage lst Floor_.>�_2nd Floor 3`d Floor
Building Height 7
Are there any environmentally sensitive areas located on the parcel? /�f_ If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENAK NAME l�
ADDR S E EMAIL
CITY d STATE ZIP 'TELEPHONE S' lO
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTR TOR 7 `�,p,-W�l'�;A42TELEPH0NE - `' cC�
ADDRES feel C , C :g
CITY STATE ZIP s "3) ff - - '
CONT ACTOR'S LICENSE #cs >rr'CC cez- EXP DATE2Ab CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR 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.
A�pWeantls Signa Date
Owner / Contract 1/ Owner's A� Cbntractor's Agent / Tenant (Please circle one.)
All permits are non- tran3ferable 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
p G 3 z 7F
JAN 1 -
(3f1M58 -3835 ---------
105 Yelm Ave W (,3W) 43'5 -Tr4 M
Yelm, WA 98597 www.Ci.yelm.wa.us
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