20120284 Permit Pkg 09252012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: YELM SENIOR CENTER
Address:
Property Information:
Site Address: 1R5'tn 1nnPirl OvF SF
Assessor Parcel No.: 64303600302 Subdivision:
Contractor Information:
Name: YELM SENIOR CENTER
Address:
Contractor License No.:
Project Information:
Project: SIGN
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
SIGN
N/A
Permit No.: 20120284
Issue Date: 9125/2012
(Work must be completed within 180 days)
Phone: 458-
Owner: YELM SENIOR CENTER
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
YELM SENIOR CENTER
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
registered in the State of Washington. /I
Signature 4jo"- z4 J r(,— Date
Finn
Lot: N/A
Fees
$ 20.00
$ 20.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City u4 le8sD2
(36 1) 10;16 AM
REC#: 00/06253 912512012
OPER: CO TERM: 001
REF #: V4
IRAN: 33.0000 BUILD120 00CRIIS
20120284
16530 103RD AVE SE
2p,00CR
SIGN
20,00 CHECK
TENDERED: _ 20,00 -
APPLIED: _
CHANGE:
CITY OF YELM 20lZo WL4
SIGN PERMIT APPLICATION FORM
Project Address: . &S ?0 %) ",4L X- S-' Parcel #: C 7 30 J?6 De 30L
Zoning; Current Use: Proposed Use:
Type /Number of Sign(s) (wall, monument, lighted, etc.): lNQ // 1'1-4 6, 7
Dimensions of Sign(s): �� 1n'r Co-7 -tr 5/� 1 l {
t � �e
/ 6,7A- NW61 r6ild'- Cc7((t-
Building Gross Floor Area (sq. ft): J" GmO SG t/'
Building Height: /0 -4
Existing Signage (if any) and dimensions:
Forge" d14
Last Name First Name
330 /n ? ld4aL FMAII v
CITY
BU1l0IN a`O. WNER
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
Bt
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
OWOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
/o "X
f
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33
1 hereby certify that the above information Is correct and that the construction of the above described sign will be in
accordance with the laws, rules and regulations of the State of Washington and the City of Yarn.
Applicant's Signature Date
Owner/ Contractor/ Owner's Agent/ Contractor's Agent/ Tenant (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
APPROVED
105 Yelm Avenue West (360) 458 -3835
PO Box 479 (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
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