07-0129 Permit Pkg 032307~OF TAP City of Yelm
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Properly Information:
Site Address: 15408 105th Ave. SE
Assessor Parcel No. 65080007800 Subdivision: N/A
m ommunity Development Department
a
Building Division
Phone: (360) 458-8407
I, Fax: (360)458-3144
Applicant:
Name: Slack
Address: 15408 105th Ave. SE City: Yelm
Name: Contact:
Address: City:
Contractor License No: Expires:
Permit No: PL-07-0129-YL
Issue Date: Not Issued
(Work must be started within 180 days)
Receipt No: 47793
Phone: 239-7750
State: WA Zip 98597
Lot: NIA
Phone:
State: Zip:
Business License:
Project Information:
Project: Slack Stove Replacement
Description of Work: Replace electric stove with gas stove.
Gas piping permit
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other): OTHER
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
---------- ------- ----------- ----- --------- -------
Plumbing Permit 25.00 20.00 0.00 7.0000 0.0000 Fixture
TOTAL FEES: 525.00
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 ~ J-~_ ~,,,~ Date 3- Z j- G 7
Firm
of Prints:
final Inspection:
Date:
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IH;~~,,,,~yf I CITY OF
4 ~ YELM
PQ Bux 479
Yehn. W!+ 9f1597
YEL, 3(;0-A58324~1
RECEIVECi
****TWENTY FIVE DOLLARS & 00 CENTS
F;r_r..Ei~.Fn r r;~na
SLACK
15408 105TH ST SE
YELM WA 98597
Dn,~l REC. NC;.
03/23/07 47793
BUDGETARY
PLUtIBING PERIiIT
PL-07-0129-YL
MICHELLE
RECEIPT No. `i ~ I' `~
AMUUN f REF. N0.
25.00 CHECK 3010
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~_~ ~ ~!' . `~, ~i l; ~~ ~ ~~~w,, j~_ Parcel #:
Subdivision: Lot #: Zoning;
u New Construction u Re-Model / Re-Roof /Addition a Home Occupation Sign
~~ Plumbing '°~Mechanical i_~ Mobile /Manufactured Home Placement l u Other
Project Description/Scope of Work: ~~ 4Y,It1C~ `~t~nlQ ~ V ~l~'11 ~' fir' ~~ I ~ C: T~~ ~"'~5
~'P2` Fj`~
I j~~ O
Building Area (sq. ft) 1~' Floor 2nd Floor Garage Deck
Basement Carport Patio
# 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.
GENERAL CONTRACTOR ~ ~ -r? ~-(~4 -~-~~ S~ij~ r t` TELEPHONE [~ w~ ~ ~_
ADDRESS ~ ~l `- ' `~~' ~~. EMAIL
CITY ~ " w STATE w ~-~ ZIP ~- _ ~t J FAX
CONT CTOR'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 accordance wkh the laws, rules and regulations of the State of Washington and the
CRy of Yelm.
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re Date
/ 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
105 Yelm Avenue Weat (360) 45&3835
PO Bos 479 (360) 458-3744 FAX
Yelm, WA 98597 u~rum.ci.yelm.ma.ux