20040191 Permit Pkg 111904City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Blue Bottle
Address: 309 Yelm Ave. East
Property Information:
Site Address: 309 Yelm Ave. E
Assessor Parcel No. 22719341901
Contractor Information:
Name: Applicant
Address:
Contractor License No:
City: Yelm
Subdivision:
Contact:
City:
Expires:
Permit No: SE-04-0191-YL
Issue Date: 11/19/2004
(Work must be started within 180 days)
Receipt No:
Phone: 458-4611
State: WA Zip
Phone:
State: Zip:
Business License:
Lot:
Project Information:
Project: Blue Bottle
Description of Work: One banner for indoor music event, max size 16 square ft.
A-board sign for anniversary , max size 2x3
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other):
Fees
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- ----------- ----------- ----------- ----------- ----------- -------------
Building Permit - Other 0.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $0.00
ApplicanYs Affadavit:
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 futher certify that I am currently
~ registered in the State of Washington.
Signature
Date
Firm
OFFICIAL USE ONLY I~
# Sets of Prints: II
Final Inspection:
Date:
By:
O~~f THFp~~ City of Yelm
4 ~.
~ `~ `~ Community Deuelopment Department
SPECIAL EVENT APPLICATION
Y E~. M R e c e i v~~ OF~FICIAL USE ONE
WASMINGTON Da~e ReCeived
NOV 1 9 2004 BIeNO.
NAME OF PROJECT
APPUCANT I' -.~..
Mailing Address ~~ ~ F
City, State and Zip ~ w~
Telephone ~! - EMAIL > ' c; ~ '
OWNER
Mailing Address ~~ -
City, State and Zip
Telephone ~ EMAIL t ~'
SUMMARY OF REQUEST ' ~i`
~
' k~ ~ - ~d-`t ~ f ~ -
PROPERTY DESCR/PTION
General Location ~CJ ~7 ,~L~~12~~C~ ~
Site Address v~---~~--- Land Area (acres)
Section Township Range
Assessor's Tax Parcel Number ~~'71'~3~l9v~
Full legal description of subject property (attach separate sheet if necessary)
I affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property as reaso, bly neces~ary to process this application. I agree to pay all fees of the city that apply to
this application. / ~ ,~ , "~
~ ,
Signed Date ~~~~ ~~ ~ ~~
105 Yelm Auenue Wesf (360) 458-3835
PO Box 479 (360) 458-3149 FAX
Yelm, WA 98597 u~wu+.ci.yelm.u~a.us