20110121 Permit Pkg 01142011City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: KATHIE BENNETT
Address: 16200 159TH LN SE
YELM WA 98597
Property Information:
Site Address: '~f1~ ~IRRT ST S
Assessor Parcel No.: 64420200100 Subdivision:
Contractor Information:
Name: DREAMTIME
Address:
PO BOX 2324
YELM WA 98597
Contractor License No.: A10559513
Project Information:
Project: SIGN
Permit No.: 20110121
Issue Date: 1/14!2011
(Work must be completed within 180 days)
Phone: 360-894-7295
Owner: ICATHIE BENNETT
Expires: 12/31/2013
Description of Work: ILLUMINATED PLASTIC SIGN FACE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SIGN DREAMTIME $ 20.00
TOTAL FEES: S 20.00
Phone: 360-458-7183
OFFICIAL USE ONLY
Sets of Prints:
final Inspection:
Date:
Lot:
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
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CITY OF YELM
SIGN PERMIT APPLICATION FORM
• Project Address:3U3 ~ ~~ ~ S 0 • U~ i ~ ~ Parcel #:
Zoning; ~~;;,~,fim %r ~iT(k ~ Current Use: ~ Proposed Use: ~ 1~1Q~
Type/Number of Sign(s) (wall, monument, lighted, etc.): cY ~~ (A ~-~~~ ~
~I ~~ /7 ~~
Dimensions of Sign(s):,,C. X I (2
Building Gross Floor Area (sq. ft): ~ n~
Building Height:
rr}}, l„ ~~
Existing Signage (if any) and dimensions: oC `1
Last Name
•
C,
CITY-(,( vn STATE I,Ji~ ZIP 9R S'~i 7 TELEPHONF ~c r~ -- sr ~. ~
BUILDING OWNER ~ r"o ~~ l o V~ L r-
ADDRESS. ,'~- vim, I ~-{- `•7-1- ~ t7 ~ EMAIL
CITY l STATE~C _ZIP B~~I TELEPHONE X53 ~ 3~6' l~ ' LG a~
.c
BUILDING TENANT Gik~ l -~ ~n ~1 ~-E-4-
ADDRESS Llr ~ -~.~h L_rt ~ EMAIL
CITY STATE tJ,~ ZIP ~-t~55{t-7 TELEPHONE
SIGN CONTRACTOR r ~ TELEPHONE_3bD -NS6 -- ~IH 3
ADDRESS ~ I ~_, ~-~ m l~V L ~ . EMAIL
CITY STATE W ~~ ZIP G ~S~ "1 FAX
CONT CTOR'S LICENSE # EXP DATE CITY LICENSE #
I hereby certify that the above information Is correct and that the Construction of the above described sign will be in
accordance with the laws, rules and regulations of the State of Washington and the City of Yelm.
Applicant's Signature Date
Owner !Contractor /Owner's Agent /Contractor's Agent / enan (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
l05 Yelm Avenue West
PO Box 479
Yelm, WA 98597
_ . ,. , ~;,
1- ~,/i.
www.Ci.yelm.wa.us
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