20100025 Permit Pkg 040510City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
Name: BARB WOOD
Address: 16135 RAILWAY RD
YELM WA 98597
Property Information:
site Address: 16135 RAILWAY RD SE
Assessor Parcel No.: 64303601204 Subdivision:
Contractor Information:
Name: BARB WOOD
Address:
16135 RAILWAY RD
YELM WA 98597
Contractor License No.:
Project Information:
Project: ROOF
Description of Work: REROOF BARN
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item Contractor
ROOF BARB WOOD
Permit No.: 20100025
Issue Date: 4/05/2010
(Work must be started within 180 days)
Phone:
Owner: TYPE CURRENT OWNER
NAME
Phone:
Expires: 0/00/0000
Heat Type (Electric, Gas, Other):
Lot:
TOTAL FEES:
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 wrrect. I also certify that the proposed structure is in conformity with all applicable City of
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 further certify th{at,Jl am curr/ent/~ly~/~~
registered in the State~W~'ashin on. f t tr ~` / Date / /~ / V V / O
Signature Il/t\J1 1(^'1/
Finn
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Y~l~
c3h0> 458-8402
REC#: 04425534 4,'9512414 1:33 FM
OVER: r_.G TERFi: 40i
REFq: 215f~
TRRN: 3'~.444D BJILDi~lG F'ER~fITS
24144025 25.44CR
WGGD, BRRB
161J5 f'RILWA'd RD SE
r",OGF 25.44CR
TENDERED: 23.04 CHECK
RF'PLIED: 25.49-
GRANGE: C.44
CITY OF YELM
I - RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: j lJ (_JI Parcel #: Q
J!
Subdivision:~~C~,~L Lot #: ~ _ Plan #: / Zoning: I~ ~'i
^ New Construction ~. Re-Model / Re-Roof /Addition ^ Home Occupation Sign
^ Plumbing ^ Mechanical y~ /1^ Mobile Manufactured ome Placement ^ Other
Project Description¢/fScope of W`o\rk: i~ - ~~ b ~ ~ ~ ~~
Project Value: Vll ~j~QU, ~
Building Area (sq. ft) 1~ Floor ~ 2n° Floor ~ Garage ~ Deck ~
Basement / Carport ~ Patio ~
# Bedrooms! # Bathrooms ~ Heating: GAS/OTHER or CECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? N
Ryes, a completed environmental checklist must accompany permit application.
BUILDING OWNER M 1 ~
ADDRES W EMAIL ( ~ ~1
CITY STATE ZIP TELEPH NE ~
'ARCHITECT/ENGINEER ~ _ LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
~GENERALCONTRACTOR W TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX i
CONTRACTOR'S LICENSE # EX DATE_CtTY LICENSE #
CITY
LICENSE
Copy of mitigation agreement with Yelm Community Schools, if applicable-
I hereby cerlkiy that the above lydormation is correct and that the construction on, arM fhe occupanry and lire use of fhe
above described property will be in accordance with fhe lays, rotes and regulations of the State of yYashington and fhe
City of Yelm.
e Date `T
Owner's Agent! Contractor's Agertt (Please circle one.}
All~ermits are nontransferable and will expire if work authoraed by such permit'is not begun
within 180 days of issuance, or "rf work is suspended or abandoned for a period of 180 days
~~~-~B~g
FFR n i 7nin
JOS Yelm Aaenae Wert (360) 45&3835
Yelm, WA 98597 B Y. - (360) 458-3144 FA%
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