20050131 Permit Pkg 05112005~=~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Michaelis, Connie
Address: 513 Van Trump NW
Property Information:
Site Address: 513 Van Trump NW
Assessor Parcel No. 22719231801
Contractor Information:
Name:
Address:
Contractor License No:
Project Information:
Project: Michaelis Re-Roof
Description of Work: Re-roof porch
Sq. Ft. per floor: (1st) 0 (2nd) 0
Heat Type (Electric, Gas, Other): OTHER
Fees
City: Yelm
Subdivision:
Contact:
City:
Expires:
(3rd) 0
Permit Ivo: BLD-05-0131-YL
Issue Date: 05/11/2005
(Work must be started within 180 days)
Receipt No: 36724
Garage 0
Item Item Fee Base Amt Unit Fee Unit Rate
--------------------------- ----------- ----------- ----------- -----------
Building Permit -Other 25.00 0.00 0.00 0.0000
TOTAL FEES: 525.00
Phone: 360.458.4624
State: WA Zip 98597
Phone:
State: Zip:
Business License:
Basement 0
Lot:
No. Units Unit Desc
----------- -------------
0.0000 $1,000
Applicant's Affadavlt: ~ ~ ~
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 futher certify that I am currently
registered in the State of Washington.
Signature ~ ~~~:hGl~ Date 5, "•0
~~~- -- - -
Firm
Sets of Prints:
i{ec~ 3~~ta~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Michaelis, Connie
Address: 513 Van Trump NW
Project Information:
Project: Michaelis Re-Roof
Description of Work: Re-roof porch
Site Address: 513 Van Trump NW
Fees:
Item Acct Code
--------------------------- --------------
Building Permit -Other 032 001-322-10-00
TOTAL FEES:
Permit Fees Schedule
Permit No: BLD-05-0131-YL
Phone: 360.458.4624
City: Yelm State: WA Zip 98597
Assessor Parcel No.
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
----------- ----------- ----------- ----------- ----------- -------------
25.00 0.00 0.00 0.0000 0.0000 $1,000
$25.00
PAID -=
MAY 1 1 2005
CITY OF YELM .'
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
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Project Address: , ~ I ~ ~('i:r 1 T(~i.rYl ~~ lU [,~ ~ Parcel #:~~' , `~ ~ `l ~ ~~ ~ ~~ w~ ~~
Subdivision: Lot #: Zoning;
u New Construction t~ Re-Model / Re-Roof /Addition a Home Occupation Sign
u Plumbing u Mechanical u Mobile /Manufactured Home Placement u Other
Project Description/Scope of
Project
Building Area (sq. ft) 1~ Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: ~ ~~
ADDRESS ~ ~ ~ EMAIL
CITY~.v (rn STATE~ZIP ~ "`~ TELEPHONE y5 fi - ~/ (L ~ y
~~ 6 r3 r--~c
,~
~~~ ~~~
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~DOr ~
ARrHITF(:T/FNC~INFFR I If:FNSF ft
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY 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.
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 Yelm.
~r~_~~
re Date
/ 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 Auenue Weat
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www. ci.yelm.wa. ua