07-0007 Permit PkgCITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 408 Mosman Ave SE Parcel #: 21 72441 1 800
Lot #: Zoning;
New Construction ~/ Re-Model / Re-Roof /Addition Home Occupation Sign
Plumbing ~/ Mechanical Mobile /Manufactured Home Placement Other
Project Description/Scope of Work: f3ep~lCe 50 Cia~~011 gaS t0 gaS Watet' he8tel'
Prniort\/ol~~c• 950.00
Building Area (sq. ft) 1S` Floor 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.
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
City of Yelm.
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
105 Yel~n Avenue West (360) 958-3835
YO Box 479 (36t1) •t58-3144 FAX
Yelne, WA 98597 u~u~u~.ei;yelm.wa.ua