20090153 Permit w_payment 082509City of Yelm
Community Development Department
Building Division
Phane:(360)458-8407
Fax: (360)458-3144
hermit Nfl.: 20090153
Issue Date: 8!2512009
(Work must be started within 180 days)
Applicant:
Name: ANDREW 1 CINDY SMITH
Address: 15339 105TH AVE SE
YELM WA 98597
Property Information:
Site Address: ~ ~~'~A 1f1~TH ~VF GF
Phone: 573-337-0001
Owner: ANDREW & CINDY SMITH
Assessor Parcel No.: 67110001500
Contractor Information:
Name: ANDREW 1 CINDY SMITH
Address:
15339 105TH AVE SE
YELM WA 98597
Contractor License No.:
Project Information:
Project: PLAT ADMENDMENT
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Subdivision: PALISADES WEST Lot: 15
Expires:
Phone:
olaoloooo
Fees:
Item
PLAT AMENDMENT
Heat Type (Electric, Gas, Other):
Contractor l=ees
ANDREW 1 CINDY SMITH $ 350.00
T07AL FEES: $ 350.D0
Applicant's Affidavit:
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 wish all applicable City of
Yelm regulations including chose governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered sn the State of Washington.
Signature Date
Firm
OFFICIAL. USE ONLY
# Sets of Prints:
finallnspectian:
Date:
sy:
CUSHMA[~ LAW OFFICES, P.S.
City of Yelm ,~812112Q09
6201 ~ Ciient Advances and Expenses:62 2145.001 -Smith _ application fee for minor plait acne
Business Checking Ac 2145.001 -Smith -application fee for minor platt
~z~orS3
Ei' ,. _
ass
~... rp..._._,_.~
65s~
350.00
350.00