20050682 Permit Pkg 081806of THE p ~ City of Yelm
/~
9 Community Development Department
d
Building Division
Phone: (360) 458-8407
~I, Fax: (360) 458-3144
Applicant:
Name: Butler, Dennis
Address: 19220 Cook Rd. City: Yelm
Property Information:
Site Address: 104 Van Trump
Assessor Parcel No. 64421600700 Subdivision:
Contractor Information:
Name: Applicant Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Butler Re-roof
Description of Work: Residential Re-roof
Sq. Ft. perfloor. (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other):
Permit rvo: BLD-05-0682-YL
Issue Date: 08N8/2006
(Work must t>e started within 180 days)
Receipt No: 43476
Phone: 458-3203
State: WA Zip 98597
Lot:
Phone:
State: Zip:
Business License:
Garage 0 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: 525.00
Applicant's Affadavit:
OFFICIAL
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 Prin
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 Final Inspect
registered in the State of Washington.
Date:
g K~ ~G Date ~_ l 8 . b(o y~
Si nature yam,, Q ~_ B
Firm ~
"~ ~~"-=~A" C[TY OF'
~~"~ -.~~~f 'ELM
~~~~~~ ~~~,f,,,r,-~, 43476
,,,,,,, tNn ,,,,,,.,; RECEIPT No.
YF.LM ~,t~fi $5F1-ft~lll._
'HEGEIVE`' +++*TWENTY FIVE DOLLARS & 00 CENTS
r i,n~f- rr c. N~ ~ nti9nuN, nF i ia~,
i,r~-rr.;,: -~~~-~,~~
DENNIS BUTLER 08/18/06 43476 25.00 CASH
104 VAN TRUf1P
YELIi WA 98597 BUDGETARY
RESIDENTIAL RE-ROOF
GRETCHEN
BLD-05-0682-YL BUTLER
CITY OF YELM Received
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 10~ ~A N T2UMP AvE• NE. Parcel #: L 4 y ~ ~ ~~ ~ o6PU G 1 8 2006
Subdivision: Lot #: Zoning;
New Construction p4 Re-Model a-Roof Addition _~ Home Occupation Sign
._ ~_' Plumbing I:~ Mechanical '-~ Mo I e /Manufactured Home Placement ~ Other
Project Description/Scope of Work: REP~~,Ce Gvrnno5i-(-t'~~ fOC1~
Project Value: ~ -1 DO °-~
Building Area (sq. ft) 1't Floor q90 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.
CITY
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certfty 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.
8 /~ o .,
Applicant' Signature Date
Owner /Contractor 1 er's Age /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 West (360) 458-3835 '
PO Box 479 (360) 458-3144 FAX
Ye/m, WA 98597 u,~tu.ci.yelm.toa.ue