20100010 Permit Pkg 012210
City of Yelm
Community Development Department
Bmldmg Division
Phone (360)458-8407
Fax (360)458-3144
Applicant
Name PENTECOSTAL CHURCH
Address c/o YELM JESUS NAME
YELM WA 98597
Property Informatton
Slte Address 204 JEFFERSON AVE E
Assessor Parcel No 75301400900 Subdivision
Contractor Informatton
Name PENTECOSTAL CHURCH
Address
c/o YELM JESUS NAME
YELM WA 98597
Contractor License No
Protect Information
Protect PLUMBING
Permlt No 20100010
Issue Date 1 /2 212 01 0
(Work must be started within 180 days)
Phone 360-400-1588
Owner JESUS NAME PENTICOSTAL
CHURCH
Phone
Expires 0/00/0000
Description of Work CONVERT UPSTAIRS ROOM TO A 4 PIECE BATH
Sq Ft per floor First Heat Type (Electric, Gas, Other)
Second
Thud
Garage
Basement
Fees
Lot
Item Contractor Fees
PLUMBING PENTECOSTAL CHURCH $ 4800
TOTAL FEES $ 48 00
AMOUNT PAID $ 0 00
BALANCE DUE $ 48 00
Appbcant's Affidavit
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 cer6iy that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdmsion, and m addition, all covenants,
easements and restrictions of record If applying as a co actor, I further certify that I am currently
registered in t State of Wash g~~t~~n,,~~ //~~-
Su7nature ~////~~!/!i( ~ „DaFe-/////Jri. ~, add
OFFICIAL USE ONLY
# Sets of Prints
Final Inspection
By
Date
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TkAN: 33.0007 EUILr,;;{; FEkfiITB
:'.0'_00010 48.OOC~'
FENTEGOSTAL CHUkCH
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TEP{DEkED: t,,9.t~D CtrE~h
Af'F'I_iFD: 48.n0.
CHANr,E: 0.00
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