07-0179 Permit Pkg 041907City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant
Permit No: BLD-07-0179-YL
Issue Date: -Ala~asstr~d ~( /~~r ~C
(Work must be started ithin 180 ays)
Receipt No: 48104
Name: L8G Phone: 360.480.9376
Address: 10231 Kiwa Drive SE City: Olympia State: WA Zip 98513
Property Information:
Site Address: 104 Edwards St SE
Assessor Parcel No. 85800200600 Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Frey Reroof
Description of Work: Tearoff and reroof
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
Building Permit Other 25.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $25.00
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 Washington. ; Final Inspection:
~-__ ~ ... ~- ; Date:
,/,
Signature _~ ~ ~ F-~. Date 1~/ ~rl ~ - ,
- - By:
Firm
i
/ ~4 THEp.P~ City of Yelm ~~~~
~'p~ Community Development Department
~ m
Building Division A~~ a inns
Phone: (380) 458-8407
YELM Fax: (360) 458-3144 CITY OF YELM
.~ lj~i~' j
Applicant:
Name: L8G
Address: 10231 Kiwa Drive SE City: Olympia
Project Information:
Project: Frey Reroof
Description of Work: Tearoff and reroof
Site Address: 104 Edwards
Fees:
Item Acct Code
Building Permit -Other 032 001-322-10-00
TOTAL FEES:
CITY OF
YELM
P.O. Box 479
Yelm WA 98591
360-458-3244
- .ti ~ 'T
RECEIPT No. °' - ---
RECEIVED ****TWENTY FIVE DOLLARS & 00 CENTS
RECEIVED FROM DATE REC. N0. AMOUNT REF. NO.
L&G CONSTRUCTION 04/19/07 48104 25.00 CHECK 2817
10231 KIWA DR SE
OLYMPIA WA 98513 BUDGETARY
Permit Fees Schedule
Permit No: BLD-07-0179-YL
Phone: 360.480.9378
State: WA Zip 98513
Assessor Parcel No. 65800200600
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
25.00 ~ 0.00 ^ 0.00 0.0000 0.0000 S 1, 000
525.00
JANZNE
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ,'~ r; `~ ~ ~?r'w ~ r' ~~~ ~?~ ~ Parcel #: ~- ~~~-= ~~
Subdivision: Lot #: Zoning; ~\
u New Construction Re-Model / Re-Roof /Addition ~.i Home Occupation Sign
u Plumbing u Mechanical u Mobile /Manufactured Home Placement a Other
Project DescriptioNScope of Work: ~ e ~~ c^ c~ ~ S 6 ~ ct ~ ~ ~ ~u ~ ~ N,t.`~ ~~
Project Value: ~ ~~ G - -
Building Area (sq. ft) 1'' Floor 2nd Floor 7D0 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 NAyIE: ~ ,,. " e l ~ ' ~' ~.~
ADDRESS /mss -1 s r- .:^a~ - EMAIL
CITY l ~ STATE~ZIP~SS ~ -~ TELEPHONE 3 L~ - y~ S S~- 72 3 C~
CITY
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 accordance with the laws, rules and regulations of the State of Washington and the
CRy of Yelm.
i
~_ % '
App ' nt's Signature Date
Owner / Contractor I 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 Auenue Weat (360) 458-3835
PO Box 479 (360) 458-3144 FAA
Yelm, WA 98597 www.ei.yelm.ura.us