20050389 Permit Package 110105~oF T'*e City of Yelm
o
Property Information:
Site Address: 15425 Mosman St. SW
Assessor Parcel No 21724440100 Subdivision.
a Community Development Department
building Division
Phone: (360) 458-8407
I, Fax: (380)458-3144
Applicant:
Name: Rainier General Development
Address: P.O. Box 827 City: Rainier
Contractor Information:
Name:
Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Tahoma Valley Golf and Country Club
Description of Work: Temporary Slyn
Permit No: SIGN-05-0389-YL
Issue Date: 11/01/2005
(Work must be started within 180 days)
Receipt No: 39035
Phone: 448-3083
State: WA Zip 98578
Lot:
Phone:
State: Zip:
Business License:
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other): OTHER
Fees:
Item
Item Fee
Base Amt Unit Fee
Unit Rate
No. Units Unit Desc
Building Pernft -Other 20.00 0.00 0.00 0.0000 0.0000 51,000
TOTAL FEES: 120.00
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 ~ Sets of Prints:
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
registered in the State of Washington. ~ FIru11 Inspection:
Date:
Signature Date
Firm By'
CITY OF
YELM
P.O. Box 479
Yelm, WA 98597
360-458-8403
RECEIVED
RECEIPT No. 3 9 0 3 5
*"*TWENTY DOLLARS & 00 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
DOUG BLOOM 11/01/05 39A35 20.00 CHECK 3186
TAHOldA TERRA LLCpo box 627
RAINIER. WA 98576 BUDGETARY
SIGN PERMIT
~ ~ 7~ y ~~ ~/ m i o~