20100238 Permit Pkg 01032011
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: JOHN CRANTON
Address: 202 MOSMAN AVENUE
YELM WA 98597
Property Information:
Site Address: 7n~ M[~SM~N eVF SW
Assessor Parcel No.:
Contractor Information:
Name: LANE FRENCH
Address:
PO BOX 1555
YELM WA 98597
Permit No.: 20100238
Issue Date: 1/03!2011
(Work must be completed within 180 days)
Phone: 360-458-1061
Subdivision:
Owner: JOHN CRANTON
Phone:
Contractor License No.: 601-385-342
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor:
Fees:
Item
ROOF
RE-ROOF
First
Second
Third
Garage
Basement
Expires: 12/31 /2010
Heat Type (Electric, Gas, Other):
Lot:
Contractor Fees
LANE FRENCH $ 25.00
TOTAL FEES: $ 25.00
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 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 that I am currently
registered in t~Stati o~lashingtpn.
Firm
# Sets of Prints:
Final Inspection:
Date:
By:
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ZOZ ~'QSYV1Gv/\ 5V`I Parcel #:
Subdivision: Lot #: Plan #: Zoning:
i ] New Construction i i Re-N
~ l Plumbing i Mechanical
Project Descriptio Sco of Work:_
Project Value:
Building Area (sq. ft) 1S Floor
Basement-
# Bedrooms- # Bathrooms,
odel / Re-Roof !Addition a Home Occupation Sign
~_~ Mobile /Manufactured Home Placement ~ Other
(~ r~o~
_ 2"d Floor Garage Deck
Carport Patio
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: fL
ADDRESS ~ Z 1(1/~~6'Y11G-.~ EMAIL
CITY STATE ZIP TELEPHONE ~(. I --
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL ONT~CTOR TELEPHONE
ADDRESS O rJ0 EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE ~C'k ` `t P DATE1 ZCITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
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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 Yel
~1~~~~
pplicant's Signature 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 of 180 days
105 Yelm Avenue West (360)458-3835
Yelm, WA 98597 (360) 458-3144 FAX
www.ci.yelm.wa.us