07-0371 Permit file 101907City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
Name: Kelley, Joseph or Bianca
Address:
Property Information:
Site Address: 15623 92nd Way SE
Assessor Parcel No. 55360001200
City:
Subdivision: Huntington Green
Contractor Information:
Name:
Address:
Contractor License No:
Project Information:
Project: Kelley Storage Shed
Description of Work: 12' x 16' storage shed
Sq. Ft. perfloor: (1st) 0 (2nd) 0
Heat Type (Electric, Gas, Other): OTHER
Fees
Contact:
City:
Expires:
Permit rvo: BLD-07-0371-YL
Issue Date: 10/09/2007
(Work must be started within 180 days)
Receipt No: 50568
(3rd) 0 Garage 0
Item~y--~-___ Item Fee Base Amt Unit Fee Unit Rate
Building Permit -Other 23.50 _ 0.00 0.00 0.0000
TOTAL FEES: 523.50
Phone:
State: Zip
Lot: 12
Phone:
State: Zip:
Business License:
Basement 0
No. Units Unit Desc
0.0000 $1, 000^
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same I OFFICIAL USE ONLY
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, # Sets of Prints:
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
/~ Final Inspection:
Signature( _~(~-^j ~~ Date ~(/ ~ ~ :~ ~ Date:
Firm
By:
~pF THFp~~ City of Yelm
a ~p Community Development Department
~ ~+
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Kelley, Joseph or Blanca
Address: City:
Project Information:
Project: Kelley Storage Shed
Description of Work: 12' x 16' storage shed
Site Address: 15623 92nd Way SE
Permit Fees Schedule
Permit No: BLD-07-0371-YL
~~
~s
PAID
OCT 0 9 2007
Phone:
State: C/~~ipQF ~~~~
Assessor Parcel No. 55360001200
Fees:
Item Acct Code Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit -Other 032 001-322-10-00 23.50 0.00 0.00 0.0000 0.0000 51,000
TOTAL FEES: 523.50
CITY OF
YELM
P.O. Box 479
Yelm, WA 98597
360-458-3244
RECEIVED • ~+ +- * TWENTY THREE DOLLARS & 50 CENTS
RECEIVED FROM DATE REC. NO.
JOSEPH H. OR BIANCA KELLEY 10/09/07 50568
15623 92ND MAY SE
YELH, WA 98597 BUDGETARY
400-1531
RECEIPT No. 5 0 5 6 8
AMOUNT REF. NO.
23.50 CHECK 1814
/~_ ~~
CITY OF YELM f ~ ~~ ~ ~ ~ ~
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~ ~~~ h U ~'v ``Parcel #:~ 5 ~~~~- ''' c~v l..r~
V ~ ~~, 9 ~;~ S y'7
Subdivision: Lot #: ~ Zoning;
U New Construction u Re-Model / Re-Roof /Addition u Home Occupation Sign
u Plumbing u Mechanical ~_~ Mobile /Manufactured Home Placement ~.i Other '`~
Project
Project
~~~~~\~
Building Area (sq. ft) 1~ Floor 2nd Floor Garage Deck
# Bedrooms- # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNEF~N~4ME: _? ,/ - ~ ~
ADDRESS % ~f:~ ,-~ ~ - ~ AIL /,+ C1 ~C~i~cc~tla~f
CITY ~„i ~.~„ STATE 1--,/~4_ZIP i ~ -~ ~. ~TELEPH E :~ ~~ (J- ~> iS~/
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX_
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described property will be In accordanc~vrith the laws, rules d regulations of the State of Washington and the
City of_Yglm. /
Applicant's Signature Date
Owner /Contractor /Owner's Agent /Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
]05 Yelm Avenue Weat (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597 wruu~.ci.yelm.wa.ue