2020.0022 211 Jefferson Ave Duplex ApplicationProject Address:
Subdivision:
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
211 Jefferson Ave NW Yelm Parcel #: 75301500200
Lot #: Plan #: Duplex Zoning:
New Construction [I Re -Model / Re -Roof /Addition D Home Occupation Sign
11 Plumbing 11 Mechanical F1 Mobile /Manufactured Home Placement 11 Other
Project Description/Scope of Work:
Project Value: $125000
Construct MFR Duplex
St 1245 nd 1300 d 1 CAR
Building Area (sq. ft) 1 Floor 2 Floor 3 Floor Garage 315 3 car
i
r,nxf A D +; Covered Porch +; 200 n i,
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# Bedrooms 6 #Bathrooms 4 Heating: GAS/OTHER or EECTRI Circle One) Ductless Mini
79ain, 3 Upper 2 Main, 2 Upper No Split w/Cadets
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
Cynthi
a Schmeir
MINIM:
ADDRESSPO Box 1891 EMAIL Cynthiafromremax@gmaii.com
CITY Yelm STATE WA ZIP 98597 TELEPHONE 360-318-3011
TELEPHONE 701.609.4764
A %V";!���EMAIL pro.a8r1223a_gmail.corn
CITY Rochester STATE WA ZIP 98579 FAX "
CONTRACTOR'S
- LICENSE # PROAIAH849DH EXP DATES/22 CITY LICENSE # 603.586.447
I 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 0".
. 10 rl.o
Aicant's Signature Date
OVPnerkdontractolr/ 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
Yelyn, WA 98597 (360) 458-3144 FAX
www.ci.yelm.wa.us