20170127 Permit Pkg 02162017Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20170127
Issue Date: 211612017
(Work must be completed within 180 days)
Name: ROSEMONT RETIREMENT Phone: 503 - 588 -3505
Address: 215 KILLION RD
YELM WA 98597
Property Information:
Site Address: 215 KILLION RD NW Owner: ROSEMONT RETIREMENT
Assessor Parcel No.: 21724120404 Subdivision: N/A Lot:
Contractor Information:
Name: UNITED ROOFING SOLUTIONS Phone:
Address:
3703 FULLER LANE SE
OLYMPIA, WA
Contractor License No.: Expires:
Project Information:
Project: ROOF
Description of Work: PARTIAL RESHEET REROOF. NORTHSIDE OF BLDING FRONT ENTERANCE.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
ROOF
Contractor
ROSEMONT RETIREMENT
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 res ions of record. If applying as a contractor, I further certify that I am currently
registered in the to of Washfg'� �
Fi
Fees
$ 377.25
$ 377.25
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(36 1) 458 -3244
RECD': 00260193 2/16/2017 3:08 PM
OPER: CO TERM: 001
REEF : 140369
PAID BY:
TRAM: 310000 BUSINESS LICENSE
UNITED ROOFING SOLUTION
BUSINESS LICENSES & 35.000R
TRAM: 33.0000 BUILDING PERMITS
20170127 3772CR
ROSEMONT RETIREMENT
215 KILLION RD NW
ROOF 377.2!CR
TENDERED: 412.25 (HECK
APPLIED: 412.25 -
CHANGE: 0.00
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM n
Project Address: (5 ^l �[ I W Parcel #:
Zoning; Current Use: Proposed U
New Construction )< Re -Model /(e -Roof Tenant Improvement
Plumbing 7 Mechanical ❑ Fire Prevent/Suppress /Alarm ❑ Other _' Q
r1% 1 1 n / tjorl- 1
Project Description /Scope of Work: ra rl O y rL�5V1Q� ', /�( 1'C7L 1�- f'i'Urtf E
Project Value: $ a51L4 �)` .Q2
Building Area (sq. ft) Parking Garage 1" Floor 2nd Floor 3`d Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? Un4�110wrl If yes, a
completed environmental checklist must accompany permit application.
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ARCHITECT /ENGINEER IV /Qt LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
CITY UI EF h -J14— STATEZIP FAX -'X:70 -
CONTRACTOR'S LICENSE #18N i-PEV_SgOOM EXP DATE t$ CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL 7
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. )) r�
1 OZ' /
)DD licant' i nature Da e
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
105 Yelm Ave W
Yelm, WA 98597
(360) 458 -3835
(360) 458 -3144 FAX
www.ci.yelm.wa.us