20050732 Demo Permit 09282006 o�T� Clty Of Yelm Perrnit No: BLD-05-0732-YL
� � Community Development Department Issue Date: 09/28/2006
` � (Work must be started within 180 days)
Building Division
Phone:(360)458-8407 Receipt No: 43894
Fax:(360)458-3144
WAiNINOTOM
Appltcan�
Name: Wells,Sare Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Property Mfortnation:
Site Address: 15909 90th Avenue SE
Assessor Parcel No. 00000000000 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: a50.00
Applicant's Affadavit: .
OFFICtAL USE 4NLY
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 o#PriMs:
Yelm regulations' luding those gover ' zoning and land subdivision,and in addition,all covenants,
easements an rest ctions of record if a lying as a contractor, I futher certify that I am currently
registered in th St e of Washingt n. Final lnspe�tion:
� Date:
Signature r Date j ��
Firm By'
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�pf THF City of Yelm ;��� � Permit Fees Schedule
� � Community Development Department
� � Permit No: BLD-OS-0732-YL
Building Division �:�-�- p C'�, j(�(��
Phone:(360)458-8407
YELMTe� Fax:(360)458-3144 ''��� �� �����
A licant: ���y
PP
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: 15909 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 APPUCATION FORM ft��. s � ;,°��w-, ,
Project Address:������� !�1'�1���f Parcel#: �� 1"�� w�,��F � ��E��, v
Subdivision: Lot#: Zoning; I
U New Construction u R�Model/Re-Roof/Addition u Home Occupation Sign (,,�
u Plumbing U Mechanical u Mobile/Ma ct red Home Placement u Other L'� �
, j v1
Project Description/Scope of Work: �
Project Value: �
Building Area (sq. ft) 1�`Floor � � 2"d 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 a� mpany permi pplication.
BUILDING E" ° �
ADDR A� �'. �
CITY ATE P TELEPHONE
ARCHI T/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 Communiry Schools, if applicable.
I hereby ce that the above informatlon is correct and that the construction oa,and the occupancy and the use of the
above de crl d property will be cordance with the laws,rules and regulations of the State of Washington and the
City of Y m� �
� �
l f� �
App nt's 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 Weat (360)458-3835
PO Box 479 (360)45&3144 FAX
Yelm,WA 98597 wrvm.ci.yelm.rua.ua