20060616 SE Permit Pkg 062006~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax:(360)458-3144
Contractor Informa
Name:
Address:
Contractor License No
Sq. Ft. perfloor: (1st) 0
Heat Type (Electric, Gas, Other):
Fees: ~ . ~ H , . ~..~ ~
Item
TOTAL FEES:
S~~ ~ ~
City: Yelm
Subdivision:
Permit No: SE-05-0616-YL
Issue Date: 06/20/2006
(Work must be started within 180 days)
Receipt No:
Phone: 458-4141
State: WA Zip 98597
Lot:
Contact: Phone:
City: State: Zip:
Expires: Business License:
(2nd) 0 (3rd) 0 Garage 0
Item Fee Base Amt Unit Fee Unit Rate
----------- ----------- ----------- -----------
ao.oo
~J c,c./~C 2Z, o ~
Basement 0
No. Units Unit Desc
rplicant's 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.
Sig re ~/N/~/~~~.~/~Q~fd1 Date (n~~4J~
# Sets of Prints:
Final Inspection:
Date:
City o f Yelm
~ d ~
YELM
wn s..i..cTO«
Community Development ~epartment
SPECIAL EVENT APPLICATION
OFFICIAL USE ONLY
Fee NONE
Date Received
By
# of 4 for 20
LIMITED TO 14 DAYS, 4 TIMES PER CALENDAR YEAR
NAME OF PROJECT r r
APPLICANT -
Mailing Address . C : ~ .
City, State and Zip ( ~ ~ ~
Telephone EMAIL
OWNER
Mailing Address ~ ~
City, State and Zip y"
Telephone~ ~ - EMAIL
SUMM Y OF REQUEST
` _ ~
START DATE ; -~~ ~~O(o
END DATE '~-,~- (?~~
PROPERTY DESCRIPTlON
General Location ~ ~Y' ~ ~ ~-~ `-~ L ' ~ ~"lti e '
Site Address `i ' ~<< • L lw~.-
Assessor's Tax Parcel Number j~ l
1 affirm that all answers. statements and informat~on above and submitted with this application are complete and
accurate to the best of my knowledge I aiso affirm that I am the owner of the sub~ect s~te or am duly authorized by
the owner to act w~th respect to this applicat~on Further, I grant permiss~on from the owner to any and all
employees and representat~ves of the C~ty of Yelm and other oovernmental agenc~ES to enter upon and ~nspect
said property as reasonably necessary to process th~s applicat~on I agree to pay all fees of the c~ty that apply to
this application.
Sig ed ~ ` Date ~t~ '~- U ~
10$ }'elm Acenue 11est (360) JSd-3b35
PO Box 179 (360) aa8-31~t-f F.i~
~~elm, N'A 9d~97 u•u~u~.ci.~e/m.u•a.us