20050775 SE Permit Pkg 110906Nov 09 06 02:39p Laura Williams
•~v• VV YVVV va vi ~C1IM V/L
City of Yelm
Community Qevclopment Departrrient
Bullding Dlvislon
Phonv; (390) 45&8407
Fay; (3A0) 458-3'Id4
Appl+pnt
Name: Croasroads Communlly Cn~h
Address: P.O. Box 2909 C~tq: Yelm
Propeity Irnormatfon:
SiteAddress: 1p2 Yelm Ava, Ea6t
3604007879 p.1
JDV Y:JO J1Y`Y r.V1rV1
Perrnit No; SE-05-0775-YL
Issue Date: t1~09120pg
(Wo~1c mu~t be stdRed wlthln 180 days~
Receipt No:
Rsses~.vor Ps,~oet No. 64400600900 Subdivisron~
Can~acCor Infamstian:
Nams: Contad:
Addrpss: Clry;
Conlracta Llunse No: EKpires:
ProJect JnlQnpadoa: •
Prqect: C~oa6raads Communlry Chu~sh
DeSCription of WoAc' A Boord Sign
Sq. FI, perfloor. {lstj Q (2nd) p (3rd) 0 Garage a
Meat Type (Elechk, Gas, Other)~
Fees: - ~ .
Ilem Ilem Fee Beae Amt Unif Fee Unit Re2e
T07AL FEES: ~^ ^^
~1~ ~-J.~ ~
~~ ~~ ~ ~
`~~
C~
Phone:
Stote; WA Zip 98597
Lol:
Phone~
State: Zip•.
8u61r1666 Lic9~6B:
8asement 0
Na. Unib Unk Oe~c
Appllchrit7s,Affedavfr '
I cerUty thaf f have read arsd ezamined the infortna6ort contained within Ihe application and koow the oame
lo be lrw and correc~. I also certify that the proposed struoture is in conformiry with aU appliwhle Cily o(
Yelm regulatlons Incluaing thvx goveming zvMng ar-d land subdlvlslon, and In addlilon, all covenanls.
aasertwnls and res[rictiona of roconi.,lf app(yin a contraclor, 1[ut~er certify that I am currentty
:~pl~Mrsd fn tha S1ate of Waahinglan. ~'
_ "'"~~ :~' ~~ 9 ~ ~ .
.,.. ^ ^ - ~; - 'i
5lgnituro ~` ,~ r ~ ~/ •~ Ci.c,-~. _Dals ~ ~ _ ~ (~ ~
_. _F"R' JT~ `~r '~l~'o~{ ~. ('l E o ~F r c~ /S~I k "a - ~ 1 _ .. . ...._. .
~ ~1 Sa16 of Piints:
Flnal ln.spactipn;
4at9 ' .
~ sY~-- - ---- ---- - .._.. ... . .
TOTAL P.O]
08/62/2065 22:42 5635847 DE50R~H E BAKER P~GE 61
o~,ofT"~~ City of Yelm
_
~ ~
` `~ Co-r~munity DeL•elopment Depa~•finent
~~ SPECIAl EVE'NT APPLICATJO~V
OFFICIAI, t15E ONLV
~
^ ~f~ Y~L _.~~~~ fEt N N
-~ u
.
'~~~; eete ece~~ea
r
M Of I Ipr 20
LIMlTED TO 14 DAYS~ ~ TIMES PEFi CALENDAR YEAR
~~
NAME OF PRO.-EC T_ fI U~r y r~ r o~~ct~, G~nr~s ~rv~1A S~~ ~, e~
-aac
APPL/CANT C v~
Mailing Address
City, State and Zio ~t.c_1~~,~A ~C' Sa~-
Telephone 3~o -yQri,~-7~7~1 EMAIL Sarn~,~1-~b~,r~eti(3~o;w~ - n-2
s
OWNER s z,~
Mailing Addre~s ~-
City, State and Zip ~
Telephone EMAIL ~
SUMMARY OF REpUEST L' s`
~ ~ ~o ~ ~~v~
/~11 r ~o
`~ JV1 ~r~ s w1
STARTDATE AS
END DATE Ao~n~ , o '^
PROPERTY DESGRIPTION
General Location Go,r,.s~„r o~ ~I1,1,r,~, o~v~ ~ 1 s~ ~-~~~e~
Site Address I O2 ~.1,Q. vY~ 0~1f~
Assessor's Tax Parcei Number (o ~/'~DOG~OU~f~C7
1 a~irm that aN answers slater+ien;s ana ~nformation aoove anc s~~mmetl wun [nis aa0~~canon arE Co'raleu a~~
accura~e ~o me ccs~ o! my k~owteoae I aiso a~f~rm that I am t~e ov--~er ~I t~e suC~ea sne or arn tluiy au~ncr•.e. cy
!ne owner to aC w~tn respea lo tn~s aop~~cat~;,n Furtr,er. 1 Qranl perm~ss~on trom ~ne cwner ~o a~y a~C aii
emplOyees anC *EprFSe~l2Aves af t~e City of YEIm ana otner aovernmer.tai agenc~es tc erter ~pon an~ mS".e~
sa~d property a! redsonab~y neCessary 1o G~octss t~~s apG~~tabon i a~ree to pzr au ~ees ol -ne c:-y ~~a~ z,p~r ~o
M~S apD~~cabon •
Signed~fl~~ C.~~ Dele (~- ~ ~
!03 I'r/n~ .1r~nu~ Ili~f ~360) JS6~3d3i
PO Bor J; ! /J60) ~SS-3l~ / F.i1
)'•~.r~, ~r,~ 9e597 _ ~•r•r•_ci..•~,.~.~~•,~c
~~