20120126 Permit Pkg 02132012City of Yelm
Community Development Department
Building Diwion
Phone (360) 458-0407
Fox! IJ801451
Applicant.
Name: ROBERT ISOM
Address P.O. BOX
YEtM WA 08507
Permit No.: 2012Q726
Issue Date: /Z
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Phone.
Property lnwrmanen:
site Ammer: 204 LONGMIRE ST SW Barren'. ROBEm ISDM
Assessor Par¢I No 211BN410305 SubdIN &On: W,
Contactor woodnaDan:
Name ROBERT ISOM
Addrods,
PC BO %1
YEtM WA 98591
Counsel Unwase No
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select RESIDENTAL REMODEL
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ROOF ROBERTIBOM E 35W
TOTAL FEES: a Side
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RESIDENTIAL BUILDING PERMIT APPLICATION FORM
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(l Plumbing I Macbanicel I Mobile I/ Manufactured Home Plecemerit I Other
Prolob DescdpticNScope Of Work (Pe i0
Project value: ,5�00 d
SuiMlrg Area (q.1t) Y' l 2 " Flow_ Garage Dedt
Basement Cal Patio_
#Bedrooms_ #BMrwms_ Heddlg: GdkWOTHER or ELECTRIC Cishe Chat
Are Ibere any envlmnmenlelN careful noun located an they pall
Fill a correlated theoretical cbeQllel must acwmi any permit applica0on.
BUILDING OWNER ryAME: [a s
ADDRESS Jle- lSQ�f EMAIL
CITY Jn /na TS ATE u`21P TELEPHONE
AACHRECTIENGINEER LICENSE#
ADDRESS EMAIL
CIT), STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
• ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSEp PAP DATE CITYUCENSEfy
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STAiFAX
CONTRACTOR'S LICENSER EXP GATE CITY LICENSER
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
Cf1Y STATE LP FAX
COMRACTOR S LICENSE# EXP DATE CRY LICENSE#
Copy of Irate On agreement into Yelm Community Schools, if applicable.
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Applkant'a Signature Date
Owner f Control Overall Agent I Contractors Agent (Please circle one.)
All Permits are nontransferable and will expire If woM authorized by such pent Is not begun
ovit 180 days of issuance, or ifwak is suspended or abandoned for a parlW of 180 days
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