20040138 Permit Pkg 090704Applicant:
Name: Casa Mia
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Address: City
Property Information:
Site Address: 134 Prairie Park
Assessor Parcel No. Subdivision
Contractor Information:
Name: Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Casa Mia 2nd Anniversary
Description of Work: Special Event Banner for 2nd Anniversary
Sq. Ft. perfloor: (1st) 0
Heat Type (Electric, Gas, Other):
Fees:
Item
---------------------------
Building Permit - Other
TOTAL FEES:
Permit No: SE-04-0138-YL
Issue Date: 09/07/2004
(Work must be started within 180 days)
Receipt No:
Phone:
State: Zip
Lot:
(2nd) 0 (3rd) 0 Garage 0
Item Fee Base Amt Unit Fee Unit Rate
----------- ----------- ----------- -----------
0.00 0.00 0.00 0.0000
$0.00
Phone:
State: Zip:
Business License:
Basement 0
No. Units Unit Desc
----------- -------------
0.0000 $1,000
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
# Sets of Prints:
Final Inspection:
Date:
By:
69/67/2004 12:65
FEB-1B-2003 00;20
Yelrn CDD
YELM CASA MI~
PAGE 61
360 459 3144 P.02
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SP~ECIAL EVENT A.FPLICA7'IDN
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f~iie
NAME OF PROJEGT I G~-
M~iling Address'^~
City, State and Zip_
Telephone ~ C~U -
Mailing nddres
City, State and
Telaphone
General Location 1~~l t-'~ i r~ ~/~ -~-
Site Address I.and Area (acres}
~ection Township Range
Assessor's Tax Parcel Number
~ull legal description of subject properky (attach separate sheet if necessary)
I ofirm thal 8II snswers, ststements and infortnetion above and submitted with this apD~~~b~ ~~ ~mplete and
aCCU~at~ CO lh9 b9St O( fl1y kflOw~edg~. I 0190 BfTlm11t1at I nm the owner of thv subJad aita or am duly 6~u4hori~d by
tf~ owner m sat wlth ~espec! to thls appllaellon, Furthar, I arant pertnlssion from the owner to a~y and all
employees antl representaSives of the City of Yelm and othe~ govemmerrtsl agencies to enter upon and lnspect
seid property es reesona~~y neoeseary to process U-i~ e~pUcation. I agroe to pay all feee of tho clty fhst ~pply fn
thls epplloatian.
3664663133
~a6 YeL», A~Bn~~ W.ee (aso) 468-.98ae
pp ~; s79 (860) 4b&8144 FAX
Ya1m, WA 98SB7 u,wtv.ciyetrrawo.w