07-0215 Permit Pkg 060507of T~o~ City of Yelm
a•4 Community Developm
4
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
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Applicant:
Name: Cornerstone Power and Light
Address: PO Box 2874
Property Infotmattion:
Site Address: 15331 105th Avenue SE
Assessor Parcel No. 65080007000
Contractor Information:
Name:
Address:
Contractor License No:
Project Information:
Project: Mendel Gas Piping
Description of Work' Gas piping for generator
ent Department
City: Yelm
Subdivision:
Contact:
City:
Expires:
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other)
Permit No: M-07-0215-YL
Issue Date: 06/05/2007
(Work must be started within 180 days)
Receipt No: 48819
Phone: 360.791.7886
State: WA Zip 98597
Lot:
Phone:
State: Zip:
Business License:
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Mechanical Permit 25.00 _ 0.00 0.00 0.0000
TOTAL FEES: 525.00
Applicant's Affadavit
No. Units Unit Desc
0.0000
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 ~pptyjng as a contractor, I futher certify that I am currently
registered in the State of Wastyjngton
Signature ~ Date 4 . ; . v ~
Firm
Sets of Prints:
anal Inspection:
Date:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Cornerstone Power and Light
Address: PO Box 2874
Project Information:
Project: Mendel Gas Piping
Description of Work: Gas piping for generator
Site Address: 15331 105th Avenue SE
Fees:
Item Acct Code
Mechanical Permit 032 001-322-10-00
TOTAL FEES:
CITY OF
YELM
P.o. Box a7s
Yelm, WA 98597
360-458-3244
RECEIVED
RECEIPT No. ~~ ~ ~ ~ 9
'` `* `T~~E2dTY FIVE DOLLARS & 00 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
CORNERSTONE POFIER AND LIGHT 06/05/07 48819 25.00 CHECK 405
P.O. BOR 2874
YELM WA 98597 BUDGETARY
City: Yelrn
Permit Fees Schedule
Permit No: M-07-0215-YL
Phone: 360.791.7886
State: WA Zip 98597
Assessor Parcel No. 65080007000
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
25.00 0.00 0.00 0.0000 0.0000
525.00
1fECH F~RiIIT I4-07-0215-YL
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM '
Project Address: ~/ .~ ~ f 1~~~-`~ S~ Parcel #: %, ) ~ ~~ ~ ~ ~~-' ~~
1~,~
Subdivision: Lot #: Zoning; f ,
n /v
~. ~ New Construction U Re-Model / Re-Roof /Addition ~ Home Occupation Sign ,(1 ~
u Plumbing ~ ~ Mechanical ~.1 Mobile /Manufactured Home Placement a Other ., ~ ~ v
~\
Project Description/Scope of Work: 't~ .~c,~,//~~
Project Value:
Building Area (sq. ft) 1'' Floor 2"d 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 COAT CTOR iti11 ~ TELEPHONE ,7~ j - % `/ ~ ~ _ 7 ~ ~~
ADDRESS /'G ~ ' c EMAIL ~,~~y~~^~•~~~lfll'n/c ~~ idol
CITY ~ STATE t~'~'+ ZIP FAX
CONT CTOR'S LICENSE #C®~a'~~~ 9>f'I ,f w, EXP DATE 1 CITY LICENSE # ~
PLUMBING 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 ab a information is correct and that the construction on, and the occupancy and the use of the
above described pro w II be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
.,L- 2 c--, i.
- ~-~~
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
PO Box 479
Yelm, WA 98597
WeAt
(360) 458-3835
(360) 458-.?144 FAX
www. c i.yelm.u~a. ua
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