20050733 Demo Permit 09282006 o� � Clty of Yelm Permit►vo: BLD-05-0733-YL
� � Community Development Department Issue Date: 09/28/2006
`
Building Division (Work must be started within 180 days)
Phone:(360)458-8407 Receipt No: 43893
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Fax:(360)458-3144
Appi#cant:
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Property info�rnation:
Site Address: 15903 90th Avenue SE
Assessor Parcel No. 00000000000 Subdivision: Lot:
Contractor InfQrtna�on:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Welis 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
Appiicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same OFF1GIAl,USE ONLY
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #�g of Rrints:
Yelm regulations' 'ng those govemin 'ng and land subdivision,and in addition,all covenants,
easements and r strict ons of record. If pplyin as a contractor, I futher certify that I am currently
registered in th ate of Washington. Flnal lr�pectipn:
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Signature Date Date:
Firm BY'
�oF T�,.,� City of Yelm Permit Fees Schedule
� �'�,� Community Development Department �,-�A�� Permit No: BLD-05-0733-YL
Building Division
Phone:(360)458-8407 ��'� �� � �����E'
EL�,�TeM Fax:(360)458-3144 �'-�-Y �� 1l���
Applicant: /J���l/��
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: 15903 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 n
RESIDENTIAL BUILDING PERMIT APPLICATION FO�I�� c.,', ,p�, ,L `'�
, --�� � ����r `, �: l��j
Pro'ect Address� n� '��� f', � Parcel#: � ;
s � -��r�-�,
Subdivision: Lot#: Zoning; �
� �
u New Construction u Re-Model/Re-Roof/Addition u Home Occupation Sign ,}
u Plumbing u Mechanical Mobile/Manufact red Home Placement u Other `�
; �
Project Description/Scope of Work:
Project Value:
Building Area (sq. ft) 1�'Floor��� 2"� 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 pe ' application.
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BUILDING E:
ADD S AIL � ' �
C�N TE TELEPHONE
ARCHI CT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR 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.
1 hereb that the above informatfon is correct and that the consVuction on,and the cecupancy and the use of the
above sc bed property will n accordance wfth the laws,rules and regulaUons of the State of Washfngton and the
City of el ��
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A cant's ignature Da
Owner 1 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)458-3835
PO Box 479 (360)458-3144 FAX
Yelm,WA 98597 ruu�w.ci.yelm.wa.ue