20050735 Demo Permit 09282006 o�T� Clty Of Yelm Permit No: BLD-05-0735-YL
� � Community Development Department Issue Date: 09/28/2006
�
Building Division (Work must be started within 180 days)
Phone:(360)458-8407 Receipt No: 43891
� Fax:(360)458-3144
Applicant:
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Praperty Mformation:
Site Address: 15915 90th Avenue SE
Assessor Parcel No. 00000000000 Subdivision: Lot:
Contractcr Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Proj�ct tnformation.
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):
Fe$s:
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
AppiicanYs AfFadavit:
I certify that I have read and examined the information contained within the application and know the same
4FFICIAL USE ONLY
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Pnn3s:
Yelm regulations including those gove � zoning and land subdivision,and in addition,all covenants,
easements and rictions of recor . If a plying as a contractor, I futher certify that I am currently
registered in th te of Washing n. Finai inspection;
? � Dat�:
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�pF T�p� City of Yelm pA�D Permit Fees Schedule
� g Community Development Department ��'� G R I���i Permit No: BLD-05-0735-YL
Fi
Building Division
Phone:(360)458-8407 CITY O F YELM
Y�=; Fax:(360)458-3144 ���/`}'
�, �l/
Applicant:
Name: Welis,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Project Information:
Project:Wells Demo
Description of Work: Move home from city lot out of the City-to tribal land
Site Address: 15915 90th Avenue SE Assessor Parcel No. 00000000000
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: 550.00
CITY OF YELM �
RESIDENTIAL BUILDING PERMIT APPLICATION FORM i��,
� ,
Project Address: �, �I �� I D����� Parcel#: E ?�� ��` ��
� � R �°�r���;� �
Subdivision: Lot#: Zoning; O�;
lJ
U New Construction u Re-Model/Re-Roof/Addition u Home Occupation Sign ��
u Plumbing u Mechanical u Mobile/Manufactured Home Placement u Other
Project Description/Scope of Work: 1 �(i O
Project Value:
Building Area (sq. ft) 1''Floor��� 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? If yes,a
completed environmental checklist must accompany permit application.
BUILDING ER NA E: �
ADDRES EMAIL
CITY TA E Z "— TELEPHON
ARCHITE T/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAI L
�� ��� CITY STATE ZIP FAX
��� CONTRACTOR'S UCENSE# 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.
I hereb ce that the above i�rt�tlon is correct and that the construction on,and the occupancy and the use of the
above sc bed pmperty will be�f(acjordance with the laws,rules and regulatlons of the State of Washington and ffie
City of Irr�. �
� � ? I�� �f
,
App�canYs Signature Da
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
PO Bos 479 (360)45&3144 FAX
Yelm, WA 98597 wrvm.ci.yelm.ma.ue