20100030 Permit Pkg 033010City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (380)456-3144
Applicant:
Name: YELM PROPERTY DEVELOPMENT
Address: P O BOX 2950
YELM WA 98597
Property Information:
Site Address: OQ'td R1111RR11N f'RT Rd
Assessor Parcel No.: 84070008400
Contractor Information:
Name: YELM PROPERTY DEVELOPMENT
Address:
P O BOX 2950
YELM WA 98597
Contractor License No.:
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: Plan No. 1621
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
NEW RESIDENTIAL BUILDING
MECHANICAL
PLUMBING
Phone:
Expires: 0/00/0000
1015 Heat Type (Electric, Gas, Other): GAS
VVV
362
Contractor
YELM PROPERTY DEVELOPMENT
YELM PROPERTY DEVELOPMENT
YELM PROPERTY DEVELOPMENT
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 correct. I also certify that the proposed structure is in conformity with all applicable Ciry 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 that I am currently
registered in/^'t~he State of hington.
Signature V~lYI.. Q.QAd-~ Date 3~30~/O
Firm
Permit No.: 20100030
Issue Date: 3/30/2010
(Work must be started within 180 days)
Phone: 360-458-0544
Owner: WILLOW GLENN III
Subdivision: WILLOW GLENN III Lot: 84
Fees
$1z,o1s.1s
$ 78.25
$ 104.00
$ 12,198.44
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yalm
c360) 4`.8-84QR
RECD: 000251ji
QF'ER: CC TERM:
REEq: 635
j7.1D~l~DID 11:5j A~^~
001
TRAN: 33.0000 DUILDING 'r'ER?~ITS
0100030 12.198.44CR
YELN PRO`r'EkTY DEUELOPPiEPIT
9934 BOLRDON CRT 84
BLD-RE81 1.016.1"CF.
NECH 78.?5CR
F'L 10v.000fi'
TENDERED: 191')8.44 CHECK
RE'P'LIED: 1~,1'8.44-
CHANGE: 0.00
YELM COMMUNITY SCHO~~O 5 0 8 0 6
LOCAL RECEIPT DATE ~ 20~
Received from
$.
ALCOUMCWE RMOUNT CPSH CNELR ^
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MMUNITY SCHOOLS
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a-01/6-~
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 9 9e3'71/ ~CYAt^boY1 C ( Parcel #: ~y ~77 (OOlJ6 ~'t"O~
Subdivision:l~lll~~Du) G/?:~// .3 Lot #:~ Zoning; n
New Construction ^ Re-Model / Re-Roof /Addition ^ Home Occupation Sign
^ Plumbing ^ Mechanical ^ Mobile /Manufactured Home Placement ^ Other
Project Description/Scope of Work: SFiP
Project Value:
Building Area (sq. ft) 1~' Floor /O/S 2ntl Floor r~0~1 Garage ,3 ~ z Deck
Basement Carport Patio
# Bedrooms, # Bathrooms~j Heatin :GAS/OTHE r ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? c~ If yes, a
completed environmental checklist must accompany permit application.
BUILDING'OWNER_NAME: ~ ,ELM R t c `~ LC
ADDRESS $tJJC ,2`TS7s EMAIL
CITY t%EL+q STATEWs} ZIP r•~ TELEPHONE yS8-O549
ARCHITECT/ENGINEER F1niE LiN'F LICENSE#
ADDRESS ~1lF E t('f~ EMAIL
CITY G/ymd; Wit- STATE w'r9 ZIP'aiy;iGl TELEPHONE ~]S6 -E3 J~e'i
GENERAL CONTRACTOR ) LLC TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING~CONTRP;CTQR ~ 1JLt i CH TELEPHONE ~'fh- ~AO,i
ADDRESS Fi~K 497 EMAIL
CITY iP1ttN]€.2 STATE Lt.'h ZIP ~T ~~~I+ FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICQL~CONTRACTOR Suw~rT,ta TELEPHONE -lSE-ti4S6
ADDRESS $:,2/O L,4c~Y /ur ~ EMAIL
CITY L,,{CS STAT t,L r4 ZIP YSSO~ FAX
CONTRACTO S LICENSE # EXP DATE CITY LICENSE #
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 [he occupancy and the use of the
above described property will be in accordance with the laws, rules antl regulations of the State of Washington and the
City of Yelm. ~
Applicant's Si n lure Date
Owner /Contractor /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 D ~SQ,~jys~ ~~~ D
~ o Zo,o D
FEB 5
105 Yelm Aoenae West (360) 3835_..._._._._.
PO Box 979 (360) 458-3194 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
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