20090198 Permit Pkg 101909City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No.: 20090198
Issue Date: 10/19/2009
(Work must be started within 180 days)
Applicant:
Name: JOSH CALLAHEN
Address: 16229 CURRY CT.
YELM WA 98597
Property Information:
Site Address: 1 8779 Ca IRRY CT
Assessor Parcel No.:
Contractor Information:
Name: JOSH CALLAHEN
Address: JOSH CALLAHEN
16229 CURRY CT.
YELM WA 98597
Contractor License No.:
Phone: 360-790-5096
Owner: JOSH CALLAHEN
Subdivision: Lot:
Phone:
Expires: 0/00/0000
Project Information:
Project: RESIDENTIAL ADDITION
Description of Work: DECK AND ROOF COVER
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Heat Type (Electric, Gas, Other):
Fees:
Item Contractor Fees
BUILDING JOSH CALLAHEN $ 38.78
TOTAL FEES: $ 38.78
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 as a contractor, I further certify that I am currently
registered in tty~State of Washington. _~ .__ ~
Firm
of Prints
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ate:
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: t (v~a~~~ Uf~^-iC~'S~ Parcel #:
Subdivision: Lot #: Plan #: Zoning:
?C New Construction Re-Model / Re-Roof /Addition Home Occupation Sign
Plumbing Mechanical Mobile /Manufactured Home Placement Other
Project Description/Scope of Work: [~2..C: k ~r~vsZ/~
t~Zs
Project Value: ~ `JD
Building Area (sq. ft) 15~ Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One)
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICE-NSE #
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
aboved'~cribed property will be in accordance with the laws, rules and regulations of the State of Washington and the
City f elm.
__. _ /'~
pplicant's Ignature /Date
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
Received
105 Yelrn Avenue West " " ' ~ - """' (360) 458-3835
Yelm, WA 98597 (360) 458-3144 FAX
mwm.ci.yelm.wa.us
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
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