20090008 Permit Pkg 011609Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No: SE-09-0008-YL
Issue Date: 01/16/2009
(Work must be started within 180 days)
Receipt No:
Name: Jackson Hewett Tax Service Phone: 360-923-4610
Address: 805 College Street SE, Ste. F City: Lacey State: WA Zip 98503
Property Information:
Site Address: 211 Yelm Avenue West
Assessor Parcel No. Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Jackson Hewett Grand Opening
Description of Work: Grand Opening Balloon
January 31 -February 14, 2009
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
Applicant'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.
Signature
Date
Firm
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
APPLICATION
Special Event Sign Permit (limited to ~a days, 4 times per calendar year)
Temporary Use (property owner permission letter required)
(see REVERSE for regulations)
NAME OF PROJECT ~ ~ ~~• ~~ ~- S ~~ ~~ n~
APPLICANT/BUSINESS NAME -ra ckb.- _ ~s v,,y~l- `T~ S r~
Mailing Address ~oS" C~IITs r s ~ st ~~ n
City, State and Zip ~=c~e~ . h.~'i- 4t's^~-~
Telephone. ~~ 4 Q z~ - ~f~r ~ EMAIL
City of Yelm Business License Number
SITE OWNER !~ d (~: o„ L
Mailing Address (-, f~4
City, State and Zip
Telephone EMAIL
SITE ADDRESS/LOCATION
SITE PARCEL NUMBER
SUMMARY OF REQUEST
START DATE ~ - ~ I - o ~ END DATE -1~[ - o~
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 r presentatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property a n y necessary to process this application. # u
Signed ~ Date ~ ~ * ( ~~
ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning Section Building Section
]05 Yelm Avenue West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
Community Development Depacrtment
SPECIAL EVENT / TEMPORAR Y USE