20170310 Permit Pkg 09082017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: YELM CHRIOPRACTIC
Address: 514
YELM WA 98597
Property Information:
Site Address: 514 YELM
Assessor Parcel No.:
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor:
Fees:
Item
First
Second
Third
Garage
Basement
BUILDING PERMIT ESTIMATED VALUE
Subdivision:
Permit No.: 20170310
Fee Calculation Worksheet
Phone:
Owner: TYPE CURRENT OWNER
NAME
Heat Type (Electric, Gas, Other):
Units
5,000
TOTAL FEES:
PAYMENTS MADE:
BALANCE DUE:
Lot:
Fees
$ 111.25
$ 111.25
$ 0.00
$ 111.25
ry-1 C L-% 0 F i t C `-� 3� � c7
2oc�3
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: S I i'YI r` �� Parcel #: -b q Q00 7 �,-7 3 U U
Zoning;
Current Use: Proposed Use:
New Construction Re -Model / Re -Roof Tenant Improvement
Plumbing Mechanical Fire Prevent/Suppress /Alarm n Other
Project Description /Scope of Work: To,J, O V �f r Q c14
Project Value: -4,5 odd ' 00
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 Owl D6 r A
ADDRESS EM IL
CITY L STATE�ZIP )5591 TELEPHONEy 8 30
¢ -r
// LICENSE #
U _ADDRESS O .3oLt,55 EMAIL
CITY V I I ,M STATE_J�IZ�ZIP qRS - TELEPHONE
GENERALCONTRACTORCG , h ( 5li{et
ADDRESS JSa �(ti�� ycrS ^c)K 2
CITY l-.a l STATE � ZIP ti S�' s
CONTRACTOR'S LICENSE # CH If L S 25— A- 0 -Y-EXF
PLUMBING CONTRACTOR
ADDRESS
CITY STATE ZIP
CONTRACTOR'S LICENSE #
TELEPHONE 31,C`7LI E - 22,2-1
EMAILc�ti LG CL4
�FAXZU0 - -714 �/ -U ci L
DATE %t ITY LICENSE # I 1- t U 1� 7
TELEPHONE
EMAIL
FAX
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.
I l-7
Applicant's ignature Date
Owner / Con ctor / Owner's Agent / Contract is 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
(36(1) 4,)6-5660
105 Yelm Ave W (360) 458 -3144 FAX
www.cLyelm.wa.us
Yelm, WA 98597