07-0018 Permit Pkg012907'~pF THEp~~ City of Yelm
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~ ~ Community Development Department
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Building Division
Phone: (360) 458-8407
YELM Fax: (360) 458-3144
Applicant:
Name: Brazils Roofing
Address City:
Property Information:
Site Address: 16516 Creek St. Ln
Assessor Parcel No. Subdivision
Contractor Information
Name: Brazils Roffing Contact.
Address: P.O. Box 5315 City: Lacey
Contractor License No: BRAZIRI173NK Expires:
Project Information:
Project: Yelm Creek Apts
Description of Work: Wind damage roof repair
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other):
Permit rvo: BLD-07-0018-YL
Issue Date: 01/2912007
(Work must be started within 180 days)
Receipt No: 45851
Phone:
State: Zip
Lot:
Phone: 459-3366
State: WA Zip: 98507
Business License: 07000460.0
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit -Other 522.55 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $522.55
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 restricti of record. If applying as a contractor, I futher certify that I am currently
registered in the State f ashirxgton. Final Inspection:
Date:
Signature ~ - Date ~ - Z q- d
Firm ~ a ~ t' S l~-~ ~ Q" i By~
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e`,,,, ,,,~,4 CITY OF _ _ ~
ac~~~t YELM
,~~~,,. ~,~~ <~~~,~~ RECEIPT No. 4 5 ~ 51
.j. ~~,il i ~~
****FIVE HUNDRED TWENTY TWO DOLLARS & 55 CENTS
i:~ ~ ,~
BRAZILS ROOFING INC 01/29/07 45851 522.55 CHECK 24413
PO BOX 5315
LACEY WA 98509-5315 BUDGETARY
16516 CREEK ST LN
HICHELLE
PERI[IT BLD-07-0018-YL
CITY OF YELM
YELM BUILDDINGGDEPARTMENTP(360)I458-8407 Receive d
No .permits will be issued after 4 p.m. JAN 2 ~ 2007
Project
Type Commercial Residential ~ ~
Permits
Requested
Building
~ Mechanical
Plumbing Sewer
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Add
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Zoning Lot# Block
Project
Description _V r BUJ C}',(°GC;L/ /~-~
Building
Area csq. ac. ~ Floor
Sign: New
Replace Reface
Parcel# w~1~E ¢ S~f(~~ L~"~
Subdivision
Est . Value~.3 $d;7~Z. `~=
1st 2nd ~ 3rd
Basement Garage Carport
Deck Patio Sign Face
Heating Gas Electric
Number of Buildings Units Bedrooms Bathrooms
Owner ,~,,,~fs Cldt.;a 6Y~tgn f ~y Phone
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Addre
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Address - !,. ,~ ,~ city ~~
a zip~~,S~
Contractor's Lic # ~k,~ Z~ Z~ .l /~~~~ Yelm B
us. Lic # 07Un~~~O- 6
Architect Phone
Address city st zip
Engineer Phone
Address city st zip
Plumbin
t
Contrac
or Phone
Address city st zip
Mechanical
Contractor Phone
Address city st zip
Copy of City mitigation documentation. (TIA),
Copy of mitigation agreement with Yelm Community Schools, if
applicable to your project.
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.
~ _ ~'~ `~
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1 cant Si atu e Date
Please see additional information on the reverse side.