20170290 Application 08142017CITY OF YELM 110 010
COMMERCIAL BUILDING PERMIT APPLICATION FORM WV . `
Project Address: '2DZ- IE71ER.u► 1C Parcel #: ZZ13Qi0 D'3
Zoning; G- Current Use: �—� Proposed Use: G
New Construction Re-Model/Re-Roof enant hn rovem
Plumbing Mechanical Fire Prevent/Suppress /Alarm Other
Project Description /Scope of Work: 05MLV t—w's NF UJA-t-t17 1"�. <44�VCOM
Project Value: '24. oco
Building Area (sq. ft) Parking Garage l" Floort"�qO 2nd Floor 3rd Floor
r
Building Height to
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER /TENANT NAME:
ADDRESS SLAL Z.3r 0 EMAIL d
-CITY_C&VMAA STATE ZIP TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHOI`
GENERAL CONTRAC"�OR TELEPHONE aOtl
ADDRESS .770 EMAIL
CITY % ,44r . F--' _S TATE t%✓A ZIP _FAX z
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 TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
Ihereby certify that the above information is correct and that the construction on, and the occupancy and the use ofthe
above described property will be in accordance with the laws, rules and regulations ofthe State of Washington and the
City of Yelm.
..r
Applicant's Sj� a ,.�;;;ri, Date
Owner / ontracto wner's Age 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 peri Tfttvgym
AUG 14 2011
(36 .3-&. ...............
Ave W (360) 458 -3144 FAX
Yel m, W WA 98597 www.ci.yelm.wa.us