20190259 ApplicationCITY OF YELM
/
RESIDENTIALBUILDINGPERMIT APPLICATION FORM
Project Address: %d 2D �tR�rf�Gc�'/ ff .J� Parcel #:
Subdivision - Pa l i rad of 09f'�Lot #: Plan #: 2-707 Zoning: _
NNew Construction -1 Re -Model 1 Re -Roof 1 Addition C Home Occupation Sign
Plumbing F Mechanical/�� ^^ ❑ Mobile 1 Manufactured Home Placement El Other
Project Description/Scope of Work: 60m rtyb�t Gf 14 e S F R
Project Value:
Building Area (sq. ft) 1 s' Floor r V -2nd Floor �p� 3`d Floor Garage -2 car 3 car X 6 7 Y
Covered Patio ! Covered Porch tf i Patio Deck
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Bedrooms it Bathrooms e -a ing: Qa>M I FIER or (CircleOne)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
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ARCH ITECTIENG IN EER oe;, oi. Er► q1Lhee_n'kgUCENSE#
ADDRESS 6?7U :213V vf- N'� EMAIL,r ovle�t r ieeyl-�-
CITY �6 e t STATE (A)/+ ZIP C1957 & TELEPHONE_ZQ__- � ? •-__479
GENERAL CONTRACTOR H064 0ee-r-1'P1' 1'I�meiTELEPHONE 3& 0 7'11-S_b y y
ADDRESS e, n . Q 0 -� EMAIL rCjh 40 V1 -0_k e v • /n
CITYg i A STATE ZIP U FAX
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CONTRACTOR'S LICENSE #'RopaED j# g ? rti-I EXP DATE CITY LICENSE #
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PLUMBING CONTRACTOR AcrKC 101VW Vo TELEPHONE 36 0 - L(C11 - 7 3,i `(
ADDRESS 70 .4Ver !V !'E PMO 2-b-7 EMAIL
CITY STATE WA- ZIP C)O ?3 FAX
CONTRACTO 'S LICENSE #Aem pi.�Y4930 EXP DATE CITY LICENSE #
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MECHANICAL. CONTRACTOR f i' f A TELEPHONE -360 -ti.!"6 " LI ISI,
ADDRESS fX10 WVG EMAIL
CITY e%.e e.4, STATE /-I_ ZIP (?51_P3 FAX
CONTRACTO 'S LICENSE # SVAJf',CA4 72V CM EXP DATE CITY LICENSE #
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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.
Appli ant's Signature Date
Owner! Contractor 1 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 Yelm Avenue West (360) 458-3835
Min, WA 98597 (360) 458-3144 FAX
wwui.c i.yelna.wa. us