20050734 Demo Permit 09282006 o�T� Clty Of Yelm Perrnit No: BLD-05-0734-YL
r� � Community Development Department Issue Date: 09/28/2006
` (Work must be started within 180 days)
Building Division
Phone:(360)458-8407 Receipt No: 43892
..:��.p.o.
Fax:(360)458-3144
Applicarr�
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Properly Infonnabon:
Site Address: 15917 90th Avenue SE
Assessor Parcel No. 00000000000 Subdivision: Lot:
Contractor Infortnation:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Proje�t Infarmation:
Project: Wells Demo
Description of Work: Move home from city lot out of the City-to tribal land
Sq. Ft.per floor:(1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type(Electric,Gas,Other):
F@es:
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 Affadavi�
I certify that I have read and examined the information contained within the application and know the same
QFFICtAI.tlSE Qt+llY
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prir►ts:
Yelm regulation ' clu 'ng those govemin ning and land subdivision,and in addition,all covenants,
easements and restric ons of record. If pply ng as a contractor, I futher certify that I am currently
registered in th Sta of Washington. Finat(�peGtion:
Signature � Date � Date:
Firm $Y'
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�pF T�p City of Yelm � ���F Permit Fees Schedule
� P�' Community Development Department ��F' � � I
` � Permit No: BLD-05-0734-YL
Building Division �!�( (�� Y�Z„(�j
Phone:(360)458-8407
YEL Fax:(360)458-3144 ���v/�
Applicant:
Name: Wells,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: 15917 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
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
� �� �1�+. �� j V �<u�'�".5
Project Address: 1 1 I "I �'��� Parcel#: J� V�� � � ��� ��
Subdivision: Lot#: Zoning; ��FJ `� � `���'�� � 1
U New Construction u Re-Model/Re-Roof/Addition u Home Occupation Sign � �
u Plumbing u Mechanical u Mobile/Manufa tured Home Placement u Other �"�
�
Project Description/Scope of Work:
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 chec list must accompany permit application.
�
BUILDING E:
ADDR SS EM IL
CITY S E IP TELEPHON �
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
.;� GENERAL CONTRACTOR TELEPHONE
� ADDRESS EMAIL
�� ��,1 CITY STATE ZIP FAX
, CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CIZY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY UCENSE#
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 hereb �that the above inform s correct and that the construction on,and the occupancy and the use of the
abov descrl d property will be in ccord nce wkh the Iaws,rulea and regulations of the State of Washington and the
City o Yelm. �
pF /
A can s Signature �
Owner/Contractor/Owner's Agent/Contractor's Agent (Please circle one.)
All permits a�e 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 Weat (360)458-3835
PO Bos 479 (360)458-314�FAX
Yelm,WA 98597 cuuno.ci.yelm.wa.ua