20050729 Demo Permit 09282006 o�T� City Of Yelm Perrnit No: BLD-05-0729-YL
� � Community Development Department Issue Date: 09/28/2006
�' � (Work must be started within 180 days)
Building Division
Phone: (360)458-8407 Receipt No: 43897
w,,.��.o,o.
Fax:(360)458-3144
Applicant:
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Property Information:
Site Address: 15913 90th Avenue SE
Assessor Parcel No. Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Wells Demo
Description of Work: Move home from city lot out of the City-to tribal land
Sq.Ft.perfloor:(1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type(Electric,Gas,Other):
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- ----------- ----------- ----------- ---------- ----------- -------------
Building Permit-Other 50.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $50.00
Applicant's Affadavit:
I certify that I have read and examined the information 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' ding those governing ing and land subdivision,and in addition,all covenants,
easements and estr tions of record. If ply' g as a contractor, I futher certify that I am currently
registered in the t f Washington. Final Inspection:
Signature ( Date �
' Date:
Firm By'
• �• � � � � - '�■ •• �•
��T"� CITY OF
� � YELM .
YePm,WA 98597 RECEIPT No.4 3 8 9 5
360-458-8403
RECEIVED
****FIFTY DOLLARS & 00 CENTS
RECEIVED FROM DATE REC.NO. AMOUNT FiEF.NO.
SARA WLLLS 09/28/06 43895 50.00 CHECK 5571
8210 EAGLE RIDGE LANE SE
OLHPIA NA 98513 BUDGETARY
JANINE
BLD-05-0731-YL
SITE 15907 90TH AVE SE
- . .. . -. . . -. .
��f 7'� CITY OF
a° � YELM
�
YePm'wA sass� RECEIPT IVo.
36a458-�� �4 3 8 9 6
RECEIVED
****FIFTY DOLLARS & 00 CENTS
RECEIVED FROM • DATE REC.NO. AMOUNT REF.NO.
SARA NSLLS 09/28/06 43896 50.00 CHECK 5571
8210 EAGLE RIDGS LANE SE
OLYMPIA NA 98513 BUDGET�lAY
JANIHE
BLD-05-0730-YL
SITE 15911 90TH AVE SE
. .. . : -. . . -. .
��oFT� CI'TY OF ,-._-.
d � YELM
YePm,WA 98597 RECEIP No.
360-458-8403 4 3 8 9 7
l
RECEIVED
*"**FIFTY DOLLARS & 00 CENTS
RECEIVED FROM DATE REC.NO. AMOUNT REF.NO.
SAAA KELLS 09/28/06 43897 . 50.00 CHECR 5571
8218 EAGLE RIDGE LANE SE
OLYHPIA NA 98513 BUDGETARY
JAHINS
BLD 05-0729-YL
SITE 15913 90TH AVE SE
pF T�p City of Yelm ���� Permit Fees Schedule
�� � Community Development Department ti��J � � ��tj,l Permit No: BLD-05-0729-YL
Building Division
Phone:(360�458-8407 ����]��/ �i�- �Y6����
EL Fax:(360)458-3144
�� ���
Applicant:
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Project Information:
Projed:Wells Demo
Description of Work: Move home from city lot out of the City-to tribal land
Site Address: 15913 90th Avenue SE Assessor Parcel No.
Fees:
Item Acct Code Item Fee Base Amt Unit Fee Unit Rate No.Units Unit Desc
Building Permit-Other 032 001-322-10-00 50.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: 350.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM � � ..�q., y
r C� C �-�n f � '.1 _ _�L�,�r ��- 4 '�������� c
Project Address:� ) ���_"�� N'�� . �, Parcel#: �
Subdivision: Lot#: Zoning; � 2 � 2006 ��
( `; I
u New Construction u R�Model/Re-Roof/Addition u Home Occupation Sign f � �
u Plumbing u Mechanical u Mobile/Ma ufactured Home Placement u Other
Project Description/Scope of Work: � v
Project Value: `
Building Area (sq. ft) 1�Floor�� 2"a 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? If yes, a
completed environmental checklist must accompany permit application.
BUILDING E.
ADD SS G EM
CITY ST TELEPHON —
ARCHITE /ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP ' TELEPHONE
GENERAL CONTRACTOR TELEPHONE
i ADDRESS EMAIL
r \ � 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 Communiry Schools, if applicable.
1 hereby that the above ir�f ation is correct and that the construction on,and the occupancy and ffie use of the
above scri d property will in a cordance wkh the Iaws,rulea and regulaUons of the Stete of Washington and the
City of Y Im � ,
l, '� F�i' �
i
App icant'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 Aoenue Weat (360)45&3835
PO Box 4�9 (360)458-3144 FAX
Yelm,WA 98597 mww.ci.yelm.wa.us