07-0136 Permit Pkg362839
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM ~ ~,~, .' ~' f 7
Project Address:624 CRYSTAL SPRINGS ST Parcel #: 22719240101
Subdivision: Lot #:
_i New Construction ^ Re-Model / Re-Roof f Addition ~ Home Occupation Sign
i~ Plumbing ~ Mechanical ^ Mobile /Manufactured Home Placement ~~ Other
Project Description/Scope of Work: Remove/Replace Gas Water
Building Area (sq. ft) 15` Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heating: GAS/OTI-IER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE #
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.
,~~` l_-:r-~Ll %~ ' 3/28/07
Applicant's Signature Date
Owner (Contractor /Owner's Agent J 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 West (360) 458-3835
PO 13ox 47,9 (360) 458-3144 FAX
Yelm, WA 98697 www.ci.yelne.wa.us