20050057 Permit Pkg 02232005City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
Name: Perkins Roofing
Address: P.O. Box 1085
Property Information:
Site Address: 15307 104th Avenue SE
Assessor Parcel No. 21725110702
Contractor Information:
Name:
Address:
Contractor License No:
Project Information:
Project: Struse Re-roof
Description of Work: Tearoff and reroof residential
Sq. Ft. per floor: (1st) 0
Heat Type (Electric, Gas, Other):
Fees:
Item
---------------------------
Building Permit -Other
TOTAL FEES
Applicant's Affadavit:
City: Yelm
Subdivision:
Contact:
City:
Expires:
Permit No: BLD-05-0057-YL
Issue Date: 02/23/2005
(Work must be started within 180 days)
Receipt No: 35698
Phone: 360.458.5329
State: WA Zip 98597
Lot:
Phone:
State: Zip:
Business License:
(2nd) 0 (3rd) 0 Garage 0 Basement 0
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
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 `~ ` ~~ Date ~ a~ O S
~~ ~ -
Firm l lL ._ _ ~..~ .w _ ~ ~ ~ j 7 ~ ~i
# Sets of Prints:
Final Inspection:
` i
Date: ~^, a „~,~', , fir,
:.~ .,
By: ~" .~.-r .
~o~cFT~,E~~,=y CITY OF ,
i '. YELM
P.O.Bcx479 X5698
Y~im, wa. ss~s7 RECEIPT Na.
YELM 360-458-8?C3
RECEIVED
****TPdENTY FIVE DOLLARS & 00 CENTS
I
RECEIVED FROfv1 DATE REC. NO. A',1CL1NT Rcr. idC
PERKINS CONSTRUCTION AND ROOF 02/23/05 35698 25.00 CHECK 18121
P.O. BOX 1085
SPANAWAY, WA 98387
458-5329
MISCELLANEOUS RECEIPT
GRETCHEN
SITE - 15307 1@4TH AVE SE
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Perkins Roofing
Address: P.O. Box 1085
Project Information:
Project: Struse Re-roof
Description of Work: Tearoff and reroof residential
Site Address: 15307 104th Avenue SE
Assessor Parcel No. 21725110702
Fees:
Item Acct Code Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- -------------- ----------- ----------- ----------- ----------- ----------- -------------
Building Permit -Other 032 001-322-10-00 25.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $25.00
PAID
DEB 2 3 2~p5
GIN CF YE~M
Permit Fees Schedule
Permit No: BLD-05-0057-YL
Phone: 360.458.5329
State: WA Zip 98597
City: Yelm
,~j~ ,~ ~ ~> ~3r~ ~
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPL1CATtON FORM] ) /^~
Project Address ~ 5 3 0 7 I O Y,` A~It s c=, Parcel Y: ~~ I ~~ I l y ~ ~ ~i
Zoning; Current Use: F~esccQ.wc.~ Proposed Use:~~
^ New Construction ~ Re-Model e-Roo Tenant Improvement
^ Plumbing ^ Mechanical ^ Firs Prevent/Suppress/Alarm ^ Other
Project Description/Scope of Work: tZewwv~ ~~s-r;~.. ~ ~~~7~' Z~s-y.~.~( ~yew l~
Project Value: 3 , (fl ~y , ~
Building Area (sq. ft) Parking Garage 1~` Floor 2nd Floor 3`d Floor
Building Height 8 ~(o~
Are there any environmentally sensitive areas located on the parcel? Ny tf yes, a
completed environmental checklist must accompany permit application.
BCJILDII~IG-OUilNERjTENA ;NAM.E: NNE ST 2v
ADDRESS ~ ~ ~~ 2•
CITY Srt iZ flrs-va STATE ,4Z- ^ZIP X565 f) TELEPHONE So~,y - &03 - 1~GZ
ARGHiTECT/ENGINEER LICENSE #
ADDRESS
CITY STATE Z1P TELEPHONE
< TELEPHONE Sf tk -S_~z ~(
CITY $ STATE 1~~/ ZIP~.~#-] FaX 5~ 5~5
CONT ACTOR' LICENSE #I~~~~Lr L~~I~$LNEXP DATq~ iTY LICENSE # OS-
PLUMBING,_COI9TRACTOR TELEPHONE
ADDRESS
CITY STATE ZIP 'FAX
CONTRACTOR'S LICENSE # EXP DATE Ci ~ Y ~iCENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS
CITY STATE ZlP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
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 lays, rules and regulations of the State of
Washington and the City of Yelm.
Applir~nt's Signature Date
Owner /Contractor /Owner's Agent /Contractor's Agent /Tenant (Please circle one.)
All permits are non-transferable and v~iill expire if work authorized by such permit is not
begun within 1 SO days of issuance, or if ~rrork is suspended or abandoned for a period of
180 days