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20050665 Permit Package 080206o~ T~ City of Yelm `~ Community Development Department ~ l~ Building Division Phone: (360) 458-8407 y Fax: (360)458-3144 Applicant: Name: Brock Chiropractic Address: 211 Yelm Avs.W. City: Yelm Property Information: Site Address: 211 Yelm Ave.W. Assessor Parcel No 85800300400 Subdivision Contractor tnformatton: Name: Contact: Address: City: ontractor License No: f Expires: o Project Information: Project: Brock Chiropractic t~ Description of Work: Sign for Chiropractic Office Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Heat Type (Electric, Gas, Other): Permit fVo: SIGN-05-0665-YL Issue Date: 08/02/2006 (Work must be started within 180 days) Receipt No: Phone: 360-259-5036 State: wa Zip 98597 lot: Phone: State: Zip: Business License: Garage 0 Basement 0 Fees: Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc Building Permit -Other 20.00 0.00 0.00 0.0000 0.0000 31,000 TOTAL FEES: 120.00 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. l also certify chat the proposed structure is in conformity with all applicable City of 4r 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 currentty registered in the State of Washington. Final Inspection: Signature Date Date: Firm ~' JERI BROOK MICHELLE SIGN PERMIT 20.00 al r ~ ', c l ~ I I ~~ r,^ f?AT~ RFC N~~, AMC)IJN f RF F N(l, BROOK CHIROPRATIC 08/11/06 43414 20.00 CHECK 1049 211 YELM AVE W YELM WA 98597 BUDGETARY CITY OF YELM SIGN PERMIT APPLICATION FORM • Project Address: 2L ~ ~e.lw. F-t~ (~ Parcel #: SS S U~ 3 0~7 ~ p tJ Zoning ~ ~ Caw~etc•~urrent Use: ~ Proposed Use: ~ ~c pr~~. ~ ©'~c ~„~ r~ R Type/Number of Sign(s) (wall, monument, lighted, etc.): ~ 1;~i4-(.-L ~.~ ~~t s ~dw~ Dimensions of Sign(s): y X ~ ^~" Building Gross Floor Area (sq. ft): ~ 3 ~~ Sys ...~~ Building Height: ~~~ Existing Signage (if any) and dimensions: `~' APPLICANT [%('_k ~ Q .4- Last Name First Name ADDRESS x.11 `le lr~. ~ t~ EMAIL broc.~c.'1'17 -~ ~~~~o~p a' Cak CITY `I~l ~h STATE ,,.; .~ ZIP `Z4 5 `'1) TELEPHONE 3~~ 2 > `r ~~'.~ !~~ • BUILDING OWNER S1`~~ ADDRESS EMAIL CITY STATE ZIP TELEPHONE SIGN CONTRACTOR ~ TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #_ `~ I hereby certify that the above information is correct and that the construction of the above described sign will be in accordance with th les and regulation the State of Washington and the City of Yelm. A plica s Slgnatur Date Contractor /flyvrrel~ Contractor's Agent / Tertant (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 APPROVED ~~~~~~ ~-- 105 )"elm Avenue ~f'est (360) 458-3835 PO Box 479 (360) -J58-31aa FAA' Tel m, WA 98597 u~u~u~.ci.velm.eoa.us C'g9~t~ , ~%o ' ~ T- s 21~~~f~ _ .~4' •s BROCK CN~Rap~~,1~C ~ 458 - 7533 ~~ l.I'~N ~ W ~L~- ~ . ' CNIROPiZRCTIC 3 ~ ~, MASsAG~ ~~~~ I TH~2r~f~Y a ~~ _ J Ate! ~ S ~ ~T t-( „ ~U`~tt~1~S~ -` ~._ _ _~_ . 5' -~ N ~ ~-- -- vrwvv~ ~3Rcx,K s~G+~ zt t ~~~ f~V E ~1 ~/g ~ ~ ~ ~ S5q y ~, _ ~ „~~ .~ D X O m~ ~~~~~~` O O O 0 ~ ...•• •: " o ,~~ . . 7~ -7~~ ~~015 ~8 5 a •. ~` - : '. .: •.. a'i' : ; ~._. ,• 4 ~. - •• . _. . • = •. .s~« .z•z~ ~~ ~~~ ~~ ~~~ ~~~ ~~~ r QED S ~ ~~ ,~~- o ~-4' 11 ~ . XdW GZ ~ 1 ,s~s~ ,~~ ~R _ X36 0~ s~s8- 7s33 a