20120336 Permit Pkg 12142012 �OF TH�A� City of Yelm Permit No.: 20120336
4 'r
� � Community Development Department Issue Date: 12/14/2012
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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""�"„�""'°" Fax: (360)458-3144
Applicant:
Name: MOUNTAIN TERRACE BUILDERS Phone: 360-458-1502
Address: 14730 STATE RT 507
YELM WA 98597
Property Information:
Site Address: 15050 LONGMIRE ST SE Owner: MOUNTAIN TERRACE
BUILDERS
Assessor Parcel No.: 21724420503 Subdivision: Lot:
Contractor Information:
Name: MOUNTAIN TERRACE BUILDERS Phone:
Address:
14730 STATE RT 507
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: DEMOLITION
Description of Work: DEMO HOUSE
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
DEMOLITION MOUNTAIN TERRACE BUILDERS $ 50.00
TOTAL FEES: $ 50.00
ApplicanYs Affidavit:
I certify that I have read and examined the inforrnation contained within the application and know the same OFFICIAL USE ONLY
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
registered in the State of Washington. Final Inspection:
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Signature -~, _�...._...__.._._...__._._._._..�_ _ ��. ''� Date jZ��(�Z Date:
Firm By:
Cit� af Yelm
(36 } 458-8402
REC#: 0071362t� 12/14/2012 2:(17 PM
ONER: CO TERM: 001
REF#: 16058
TRAN; 33.0000 BUILDING PERMTTS
2U120336 50.00CR
MOUNTAIN TERRACE BUILDERS
1505Q LfINGMIRE ST SE
DEMQ 5Q,QOCR
l�END�RED: 50,OQ CHECK
RPPLIED: 50.O�i-
f HANGE; _______._..._0.U�
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATiON FORM
Project Address:�j� �����}Mr s�S�`�L Parcel#: r�i �� ;Z�'� �01d��3
Subdivision: Lot#: Plan#: Zoning:
� '� New Construction i ' Re-Model/Re-Roof/Addition ! i Home Occupation Sign
Plumbing Mechanical Mobile/Manufactured Home Placement � Other
Project Description/Scope of Work: ��'�'�� h��3-S C
Project Value:
Building Area(sq. ft) 1St Floor 2"d 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?
lf yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: 1'Yl{."i� j,LL
ADDRESS �'-��3C� S'� F�i $"� EMAIL
CITY���,�. STATE l.vr/ ZIP �� `� TELEPHONE�L,(J NS`L! 1'�vL
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR CiZ.�+•--�.� TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP 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 applicable.
I 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 Yelm.
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.2....,.....____.....o.,_._.,,_ . /'2/��f��
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
V�
105 Yelm Avenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us
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