20180346 PermitCITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: /DS' 1,1W 122 CI -E Y�C(4¢U�#: T1110 A000�gon
Subdivision: (1ALot #: Plan #ed /07 Zoning: /Q 1
New Construction Re -Model / Re -Roof / Addition Home Occupation Si n
Plumbing Mechanical Mobile / Manufactured Home Placement O er
Project Description/Scope of Work: RE X ct.It/ Zee, !_e7�I✓6r CA,3lie-8
Project Value: -6-7J d 61
Building Area (sq. ft) 1" Floor 2ntl Floor 3"' Floor_ Garage -2 car 3 car_
Covered Patio Covered Porch Patio Deck Al V(
# Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Crde O -e)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: ari's yre fn -e A
ADDRESS /,g it /.(w a uQec F VIe-4/OW EMAIL QRC Zzoy
CITY&I-�'t STATE*ZIP !SS?7TELEPHONE 3jCO� d7Z0
ARCHITECT/ENG
CITY
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
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 mitigation agreement with Yelm Community Schools, if applicable.
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
cityof elm.
Applicant's Sl6nature Dat
Owner / Contractor / Owner's Agent / Contractor's Agent (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 Avenue West
Yelm, WA 98597
WWW.ci.yelm.wo.us
(360) 156-383..,
(360) 458-3144 FAX