20120310 Permit Pkg 11052012 �oE Y�a� City of Yelm Permit ►vo.: 20120310
� � Community Development Department Issue Date: 11/05/2012
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
'"""'"°'°" Fax: (360)458-3144
Applicant:
Name: JEAN JAMES Phone: 360-458-7218
Address: P.O. BOX 120
YELM WA 98597
Property Information:
Site Address: 205 LONGMIRE ST SW Owner: JEAN JAMES
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: BBK Phone:
Address:
PO BOX 8
ROY WA 98880
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF BBK $ 25.00
TOTAL FEES: $ 25.00
ApplicanYs Affidavit: OFFICIAL USE ONLY
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 #Sets of Prints:
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 Final Inspection:
registered' he St as ton.
Signature Date �� "�� f Z Date:
By:
Firm
,
Cit� of Y�lm
;�� � ��e-sao7
REC#: 00109845 11/05/2012 3:U6 FM
OPCR: CO fERM. 001
REF#;
TRAN: 33.0000 BUILDING PERMTTS
20120310 25.00CR
JAMES, JEAN
205 LONGMiRF 5T SW
ROOF 25.00CR
TENDERED: 50.00 CASH
APF'�IED; 25.00-
CHANGE: ~� � 25.00
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ?C� � L-,a'"``���"e- ��� Parcel#:
Subdivision: Lot#: ` Plan#: Zoning:
� New Construction � Re-Model/Re-Roof/Addition i , Home Occupation Sign
Plumbing Mechanical Mobile/Manufactured Home Placement �''Other
Project Description/Scope of Work: r��°��
Project Value: '/����'
Building Area(sq. ft) 1St Floor / d� 2nd Floor Garage Deck
Basement Carport Patio
#Bedrooms� #Bathrooms ( Heating: GAS/OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
/fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: e-
ADDRESS ��% . �' � EMAIL
CITY Irti r.� STA E�_ IP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE IP TELEPHONE
GENERAL ONT C OR .b �'� ` TELEPH E ` Z •
�_ ADDRE S �T� ���' EMAIL .G�S1N�,
CITY � STATE�ZIP FAX
CONTRACTOR' CENSE# EX DATE_CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
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 appficable.
1 hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
City of elm. -
/ �r ) /�
0
Applicant's Signature Date
Owner/Contractor/Owner's Agent/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 Auenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us