20050689 Permit Pkg 082406~OF THFA City of Yelm
9
Property Information:
Site Address: 302 Edwards?
Assessor Parcel No. ~ S .3 0 13 GO I O Q Subdivision:
Contractor Information:
Name: Contact:
Address: City:
Contractor License No: Expires:
r Community Development Department
a
Building Division
Phone: (360) 458-8407
_, Fax: (360)458-3144
Applicant:
Name: Simpson, Rocky
Address: PO Box 2092 City: Yelm
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other):
Permit No: BLD-05-0689-YL
Issue Date: 08/24/2006
(Wor k must be started within 180 days)
Receipt No: 43541
Phone: 360.458.2580
State: WA Zip 98597
Lot:
Phone:
State: Zip:
Business License:
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Building Permit -Other 25.00 0.00 ~ 0.00 0.0000
TOTAL FEES: E25.00
No. Units Unit Desc
0.0000 $1,000
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same
OFFICIAL USE ONLY
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, # Sets of Prints:
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of ashi Final Inspection:
Signature ~~~~ Date ~ZY Date:
Firm BY~
----rr ---•- •• • : -. -.
~O Of TNf p~~I CITY OF ---- ---------- - -- --- ---
_~~``iiAA~` YELM
P.O.Box 479
Yelm, wA sass7 ~ RECEIPT No. 4 3 5 41
L 360-458-8403
RECEIVED
****TWENTY FIVE DOLLARS & 00 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
ROCKY SIHPSON 08/24/06 43541 25.00 CHECK 223.9
PO BO% 2092
YELM WA 98597 BUDGETARY
SITE 302 EDWARDS ST SW
A
SIMPSON REROOF
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~ L~~.:_c4~S ~t Sc_cJ Parcel #:_ ~ ~ .3 G I ~ O ~ - d G
Subdivision: Lot #: Zoning;
^ New Construction ~. Re-Model / Re-Roof /Addition ~ Home Occupation Sign
^ Plumbing ^ Mecharfical ^ Mobile /Manufactured Home Placement ^ Other
Project DescriptiAn/Scope of Work:_ )~~~-[~tao~' I /~~~d~;~ -k~~v -~~ C'~xrnt'~t~
Building Area (sq. ft) 1~ Floor K 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms ~~ # Bathrooms Heati~~ GAS~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
0^ ~ CITY STATE 71D rnv`~~
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 Yet ~
y, ~ /
~` `-- ~ ~~/l ~
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
!OS )'e!m Auenue West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597
wu~m.ci.;yelm.u~~.us