20120311 Permit Pkg 11062012 �pF TH�P� City of Yelm Permit No.: 20120311
s �
,� � Community Development Department Issue Date: 11/06/2012
d �+► (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
'"'"»'""°" Fax: (360)458-3144
Applicant:
Name: MATT CAREY Phone: 360-894-0949
Address: 9225 MT VIEW RD SE
YELM WA 98597
Property Information:
site Address: 9225 MTN VIEW RD SE Owner: MATT CAREY
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: ZIELINSKI CONSTRUCTION, INC. Phone:
Address:
4615 HERMAN RD SE
OLYMPIA WA 98501
Contractor License No.: ZIELIC1957LP Expires: 6/27/2013
Project Information:
Project: RESIDENTIAL REMODEL
Description of Work: REROOF, SKIRTING, REPLACEMENT OF TWO WINDOWS
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING ZIELINSKI CONSTRUCTION, INC. $ 111.25
ROOF ZIELINSKI CONSTRUCTION, INC. $ 25.00
TOTAL FEES: $ 136.25
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certi h ve read and examined the information contained within the application and know the same
to b true an , orrect. I also certify that the proposed structure is in conformity with all applicable City of
�' , #Sets of Prints:
YelrX�regulatio s including those governing zoning and land subdivision,and in addition,all covenants,
ea�ments an restrictions of record. If applying as a contractor, I further certify that I am currently Final Inspection:
regi�stered�n t State of ingt�n. � ,i
9 I` �j .��y Date:
Si natur Date F•
Firm By�
Cl�y Of�aelmoz
(360)
REC#: 00109922 il/06/2012 1�:41 PM
OPER: CO TERM: 001
REF#: MC
TRAN: 33.Q000 BUILDj36.25CRITS
20120311
CAREY, MATT
g225 MTN VIEW RD SE
BLDG 111 .25CR
ROOF 25.(IOCR
TENaE.R�D: 136.25 OTHER
APPLIED: 136.25-
CHANGE: r� 0 OQ
�
.
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:�Z 2'�'� /r(>� 1�/��c/I�V.+� Parcei#:
Subdivision: �' Lot#: ""— Plan#: �- Zoning:
� New Construction k Re-Model/Re-Roof/Addition � � Home Occupation Sign
Plumbing Mechanical � ' Mobile/Manufactured Home Placement �" Other Z-.,������.s
Project Description/Scope of Work: ` `� ' �
��
Project Value: �1� a'�/s� t�S �
Building Area(sq. ft) 15` FI r�`"2� loor Garage Deck
Basement � Carport Patio
#Bedrooms� #Bathrooms�Z-- Heating: GAS/OTHER o ELECTRIC Circle One)
Are there any environmentally sensitive areas located on the parcel? d
!f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: �i/�°L �
ADDRESS ZZ �'�? r�.c� EMAIL .
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS � EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONT CTO L-•TELEPHONF3�o��-,�f�
I � ADDRESS EMAIL
CITIb STAT ZIP " FAX�/"�O-�S� �.�'D_�
CON C OR'S LICENSE C/ EXP DATE ! CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZI 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.
I her certify that the above information is correct and that the construction on,and the occupancy and the use of the
abov escribed property will be in accordance with the laws,rules and regulations of the State of Washington and the
City o elm.
, ' ' ' // .� Z
p ' nt's Si at e Date
O ner/Con actor Owner's Agent/Contractor's Agent(Please circle one.)
All permits ar -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 Auenue West (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us