07-0277 Permit Pkg 072707City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: De La Vergne, Vernon
Address: 15644 View Drive Ct. SE
Property Information:
Site Address: 15644 View Drive Court SE
Assessor Parcel No. 85820000800
Contractor Information:
Name: Applicant
Address:
Contractor License No:
Project Information:
Project: DeLaVergne Reroof
Description of Work: Tearoff and reroof
Sq. Ft. per floor: (1st) 0 (2nd) 0
Heat Type (Electric, Gas, Other):
City: Yelm
Permit No: BLD-07-0277-YL
Issue Date: 07/27/2007
(Work must be started within 180 days}
Receipt No: 49535
Subdivision: Yelm Creek Estates
Contact:
City:
Expires:
(3rd) 0 Garage 0
Phone: 458.4151
State: WA Zip 98597
Lot: 8
Phone:
State: Zip:
Business License:
Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit -Other 25.00 _ 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $25.00
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 llVashington.
. ~ )___ _
Signature ~ ~ - -~ ~ " Date ~'- ~ /- ~ C~
_ ~~ 7
~~
Firm ! ~ j~
l
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
Name: De La Vergne, Vernon
Address: 15644 View Drive Ct. SE
Project Information:
Project: DeLaVergne Reroof
Description of Work: Tearoff and reroof
Site Address: 15644 View Drive Court SE
Fees:
Item Acd Code
Building Permit -Other 032 001-322-10-00
TOTAL FEES:
roe°F T"~ ~ CITY OF
a ~ YELM
P.O. Box 479
Yelm, WA 98597
360-458-3244
City' Yelm
Permit Fees Schedule
Permit No: BLD-07-0277-YL
Phone: 458.4151
State: WA Zip 98597
Assessor Parcel No. 65820000800
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
25.00 0.00 0.00 0.0000 0.0000 51,000
525.00
RECEIPT No. 4 9 5 3 5
RECEIVED
"'""•Ti+1ENTY FIVE DOLLARS & 00 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
DE LA VERGNE, VERNON 07/27/07 49535 25.00 CASH
15644 VIEN DR CT 3E
YELH WA 98597 BUDGETARY
BLD-07-0277-YL PERHIT
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 5(oyy V - t? W ti~ . (~ S ~ Parcel #: ~ ~ ~ 2- ~~ ~ Q~
Subdivision: "IF ~ w~~ Y c~~~~. ~ ~t~Lot #: ~ Zoning; ~c S _ i
u New Construction !q( Re-Model / Re-Roof /Addition a Home Occupation Sign '~'~ ~/
u Plumbing a Mechanical U Mobile /Manufactured Home Placement I_ i Other ~ 1~L~ ~'~
O ~~
Project DescriptionlScope of Work:~~ r - K~.r`npye. ~~ Q~S~~1~ G
~~~ ~- ~ rv E D
PrniPrt ValuP• ~ ~-
Building Area (sq. ft) 1~' Floor ;~?~(., 2"d Floor 32 Garage ~~ Deck 1~~'
Basement Carport Patio
# Bedrooms, # Bathrooms ~ • ~ Heating: GAS/ THE t; ELECTR (Circle One)
Are there any environmentally sensitive areas located on the parcel? ~~ If yes, a
completed environmental checklist must accompany permit application.
GENERAL 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.
1 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.
plicant's Si ature Date
ner /Con ctor /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 Ye[m Avenue Weat
PO I3ar 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
meoro.ci.yelin.ma. ue