20050472Permit Pkg 030706~pF TAP City of Yelm
Community Develo
a
Building Division
Phone: (360) 458-840
EL Fax: (360) 458-3144
Applicant:
Name: Groldschmidt, Grazyna
Address: 15131 Carter Lp. SE
Property Information:
Site Address: 15131 Carter Loop SE
Assessor Parcel No. 52920002700
Contractor Information:
pment Department
7
City: Yelm
Subdivision: Hawks Landing
Permit No: BLD-05-0472-YL
Issue Date: 03/07/2006
(Work must be started within 180 days)
Receipt No: 41065
Phone: 458-5785
State: WA Zip 98597
Lot: 27
Name: Appliant Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Goldschmidt Deck
Description of Work: Deck ground floor enclosure
Sq. Ft. perfloor: (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
Building Permit -Other 23.50 _ 0.00 0.00 0.0000 0.0000 $1,000 Y
TOTAL FEES: $23.50
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Applicant's Affadavit
OFFICIAL USE ONLY
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 # Sets of Prints:
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~Was~hington. Final Inspection:
Signature G ~r~`~',J~----~~ Date ~~~/ ~.,/~ Date:
Firm -~-~ By:
a~o~,<~ City of Yelm
Project InbtmaUon:
Project: Goldschmldt Deck
Description of Work: Deck ground floor enclosure
Site Address: 15131 Carter Loop SE
Feea: .
Community Development Department
Building Division
Phone:(380-458-8407
„ Fax: (360)458-3144
AppI1CrN111t:~ ' ;~ ~ "
Name: Groldschmldt, Grazyna
Address: 15131 Carter Lp. SE City: Yelm
Permit Fees Schedule
Permit No: BLD-05-0472-YL
Phone: 458-5785
State: WA Zip 98597
Assessor Parcel No. 52920002700
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 x1,000
TOTAL FEES: 523.50
CITY OF
YELM
P.o. eox a7s
Yelm, WA 98597
360-458-8403
RECEIPT No. 410 6 5
RECEIVED . •,. *T1~ilENTY THREE DOLLARS & 50 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
GRAZYNA GROI,DSCHHIDT 03/07/06 41065 23.50 CHECK 2762
15131 CARTER LP ES
YELH. MA 98597 BUDGETARY
BLD-05-0472-YL
DIANA
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l~ ,~
C~ ty OI l e l m I Date Received
By
V/ \v Community Development
Department
Received
RESIDENTIAL B UILDING
YELM FEB 0 3 2006
r,,.,M,»°T°N PERMIT APPLICATION
APPLICATION EXPIRES 180 DAYS FROM DATE OF SUBMITTAL.
TO EXPEDITE PROCESSING, PLEASE VERIFY ALL DOCUMENTATION FOR ACCURACY.
ALL CONTRACTORS ARE REQUIRED TO PROVIDE A COPY OF THEIR CONTRACTOR'S
REGISTRATION CARD AND PROOF OF A CURRENT CITY OF YELM BUSINESS LICENSE.
IN ORDER TO PROVIDE PROMPT AND EFFICIENT SERVICE, WE NEED THE FOLLOWING
DOCUMENTS SUBMITTED WITH PERMIT APPLICATIONS:
• Identification and description of the work to be covered by the permit for which application is
being made.
• Description of the land on which the proposed work is to be done by legal description, street
address or similar description that will readily identify and definitely locate the proposed building
or work.
• Description of the use or occupancy for which the proposed work is intended.
• Two complete sets of construction plans, diagrams, computations and specifications, and site
plan including septic and/or step tank location.
• Stated valuation of any new building or structures or any addition, remodeling or alteration to an
existing building.
• Signature of the applicant, or the applicant's authorized agent.
• Energy calculations.
• Civil plans and specifications, if applicable.
• Any additional data and information as may be required by the building official.
• Copy of mitigation agreement with school district, if applicable.
THE FOLLOWING ITEMS ARE NEEDED WHEN SUBMITTING AN APPLICATION FOR A SIGN
PERMIT:
• The name, address and signature of the owner of the sign.
• The street address or location of the property on which the sign is to be located and the name
and address of the owner of that property.
• The type of sign or sign structure.
• A site plan showing the proposed location of the sign relative to the boundary lines of the property
where it will be situated, the locations and square footage areas of all existing signs on the same
premises, and the location of all abutting public rights-0f--way, building and other structures on the
premises.
• Specifications and scale drawings showing the materials, designs, dimensions, structural
supports, and electrical components of the proposed sign.
105 Yelm Avenue West (360) 458-3835
PO liox 479 (360) 458-3144 FAX
}elm, WA 98597 www.ci.velm.wa.u8
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: Parcel #:
Subdivision: Lot #: Zoning;
U New Construction ~ Re-Model / Re-Roof /Addition u Home Occupation Sign
u Plumbing u Mechanical a Mobile /Manufactured Home Placement u Other
Project Description/Scope of Work:.
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.
BUILDING OWNER NAME: ~ ;~~ ~ >~ .z~
ADDRESS ='~ `~_ T ' EMAIL n/ci.. ~' ~ ~ .
CITY Yc1.~tiv STATE~~%~ZIP yX~9~ TELEPHONE ~' -~ - ~ - ~~~
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 #
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 with the laws, rules and regulations of the State of Washington and the
City of Yelm.
Applicant's Signature ate
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
•vw gram n~enur nex[ (360) 458-3835
PO Box 479
(360) 458-3144 FAX
Yelm, WA 98597 ruruu;.ci.yelm.eua.ua