20130103 Permit 01112013 �oF'""�A� City of Yelm Permit No.: 20130103
'' ` � Community Development Department Issue Date: 1/11/2013
(Work must be completed within 180 days)
Building Division
� Phone: (360)458-8407
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i WaRM�NGTOw Fax: (360)458-3144
Applicant:
Name: WILD ROSE YOGA, LLC Phone: 360-951-6210
Address: 4933 CHURCHILL RD SE
TENINO WA 98589
' Property Information:
, Site Address: Owner: LINDA HOLLIS
104 YELM AVE E
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Assessor Parcel No.: 64400600800 Subdivision: Lot:
; Contractor Information:
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�I Name: WILD ROSE YOGA, LLC Phone:
I Address:
4933 CHURCHILL RD SE
� TENINO WA 98589
� Contractor License No.: Expires: 0/00/0000
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� Project Information:
Project: LAND SITE PLAN REVIEW
Description of Work: CONVERT RETAIL SPACE FOR YOGA INSTRUCTIONS AND RETAIL
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
� Third
Garage
Basement
Fees:
Item Contractor Fees
SITE WILD ROSE YOGA,LLC $ 400.00
TOTAL FEES: $ 400.00
Applicant's 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 in the State of Washington. /�
Signature Date
Date:
Firtn By
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