20120268 Permit Pkg 09102012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: LIFESPAN HOME
Address: 8823 MARIE ST SE
OLYMPIA WA 98501
Property Information:
Site Address: Q41R MT CI INIRIAF 12T CF
Assessor Parcel No.: 63540004200 Subdivision:
Contractor Information:
Name: LIFESPAN
Address:
8823 MARIE ST SE
OLYMPIA WA 98501
Contractor License No..
Project Information:
Project: RESIDENTIAL ADDITION
Permit No.: 20120268
Issue Date: 9/1012012
(Work must be completed within 180 days)
Phone: 360- 5843833
Owner: JOHN RIOS
Lot:
Phone:
Expires: 0 /00/0000
Description of Work: 10x16 ADDITION, SUNROOM, FENCE AND WALKWAYS
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
BUILDING
Contractor
LIFESPAN
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be In
correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm rns i u ing those governing zoning and land subdivision, and in addition, all covenants,
easem r tri ions of record. If ng as a contractor, I further certify that I am currently
ofWasWnaton
Firm
Fees
$ 335.25
$ 335.25
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Be8 ►D2
(36 1
RECD: 001041TERM:
OPER: CO
REF#: MC
911012012 3:35 PM
001
IRAN: 33.0000 BUILDING PERMITS
335,25CR
20120268 ST SE
9136 MTNSUNRISE
335,25CR
BLDG
335.25 DTHER
TENDERED: 335.25 -
APPLIED:
CHANGE:
f..
a .. ,
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 13i✓ m F. SUNrI Se 5 T Parcel #: g(xp q1
Subdivision: Lot #: Plan #: Zoning:
New Constructions Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
Plumbing I I Mechanical ❑ Mobile / Manufactured Home Placement ❑ Other
Project Description/Scope of
Project Value T 2 ) , o D
Building Area (sq. ft) 1s ` Floor 1-7 2nd Floors Garage S 7 ) Deck
Basement / Carports Pat(o i
# Bedrooms_ # Bathrooms Z Heating AS /OTHER r ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? AI n
N yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Jo RI OS
ADDRESS cfiSw vv�r. Synrf3e 45.r EMAIL
CITY s 61j,l STATE_.V &_ZIP ggta7 TELEPHONE 4en. &Aft7
ARCHITECT /ENGINEER Ska"GG &-6e* _c LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE 1143 — 698Z
C113:411I4G7_1l
CITY
LICENSE
PLUMBING CONTRACTOR E A MTELEPHONE 5b-2 - 1<1. �R
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.
,at the above information is cortect and that the construction on, and the occupancy and the use of the
property will be in accordance with the laws, rules and regulations of the State of Washington and the
u X �e q
Signature Date
Contractor/ Owner's Agent I 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
Yelm, WA 98597
www.ci yelm.wa.aa
(360) 958 -3835
(360)
L
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