20120263 Permit Pkg 08302012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: LACEY ROOFING LLC
Address: PO BOX 5550
LACEY WA 98509
Property Information:
Site Address: 10416 BRIGHTON ST SE
Assessor Parcel No.: 65080009600 Subdivision:
Contractor Information:
Name: LACEY ROOFING
Address:
PO BOX 5550
LACEY WA 98509
Permit No.: 20120263
Issue Date: 8130/2012
(Work must be completed within 180 days)
Phone:
Owner: TYPE CURRENT OWNER
NAME
Phone:
Contractor License No.: LACEYRL928MJ Expires: 8/302012
Project Information:
Project: ROOF
Description of Work:
Sq. Ft per floor: First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Heat Type (Electric, Gas, Other):
Contractor
LACEY ROOFING LLC
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 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
Lot:
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yell
(36 ) 458 -6402
REC #: 00103786 8/30/2012 4:22 PM
OPER: CO TERM: 001
REF #: 13895
TRAN: 33.0000 BUILDING PERMITS
20120263
LACEY ROOFING LLC
10416 BRIGHTON ST SE
ROOF
TENDERED: 25.00 CHECK
APPLIED: 25.00 -
CHANGE: 0.00