20050731 Demo Permit 09282006 o T� Clty Of Yelm PermitNo: BLD-05-0731-YL
r� � Community Development Department Issue Date: 09/28/2006
4 (Work must be started within 180 days)
Building Division
Phone: (360)458-8407 Receipt No: 43895
_, Fax: (360)458-3144
Appiica�:
Name: Wells,Sara Phone: 360.455.0694
Address: 8210 Eagle Ridge Lane SE City: Olympia State: WA Zip 98513
Property information:
Site Address: 15907 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 Infarmation:
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
Appiicant'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 P�ints:
Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants,
easements an est ictions of record. If ply ng as a contractor, I futher certify that I am currently
registered in t t te of Washington. F1na1 InspeCtioa:
, Date:
Signature /� i Date
By:
Firm
. .. . . . - -.. . •.
_ — —_ _ — — � --
�f t"�� CIT L OF
� YE M � � � ��
Po.sox a�s RECCIPT No. /� � �
Yelm,WA 98597 �r �{ �8��
360-458-8403 % /
_._....a. \
RECEIVED �_,_
****FIFTY DOLLARS & 00 CENTS "
RECEIVED FROM DATE REC.NO. AMOUNT REF.NO.
SARA NELL3 09/28/06 43895 50.00 CHECK 5571
8210 I�AGLE RIDGE LANE SE
OLHPIA NA 98513 BUDGETARY
JANINE
BLD-05-0731-YL
SITE 15907 90TH AVE SE
-- - - - � .. . : -. . . -. .
���T'� CITY OF
�° � YELM
d
Po.BoX a�s RECEIPT No.�4 3 8 9 6
Yelm,WA 98597
' 360-458-8403
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�RY
JANINE
BLD-05-0730-YL
5ITE 15911 90TH AVE SE
. .. . : -. . . -. .
��T� CITY OF
� � YELM
Ye m�WA 98597 RECEIPT No.4 3 8 9 7
360-458-8403
RECEIVED
****FIFTY DOLLARS & 00 CENTS
RECEIVED FROM DATE REC.NO. AMOUNT REF.NO.
SARA NELLS 09/28/06 43897 . 50.00 CHECB 5571
8210 SAGLE RIDGE LANE SE
OLYMPIA WA 98513 BUDGETARY
JANINE
BLD 05-0729-YL
SITE 15913 90TH AVE SE
�pf T�p� City of Yelm ���� Permit Fees Schedule
.� Community Development Department � 1 Permit No: BLD-05-0731-YL
` � �F� e � /()OF
Building Division
Phone:(360)458-8407 i '��� � (�� ��� �
�,,, : � i..L, f
ELM Fax:(360)458-3144 //� lI�/
,L U J
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: 15907 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 ��9°�°k ��; <; : , \
Project Address:�`1��� �������'�X Parcel#: � ������
Zonin ; �
Subdivision: Lot#: 9 �'� 1
U New Construction u Re-Model/Re-Roof/Addition u Home Occupation Sign ��
u Plumbing U Mechanical Mobile/Manu c, red Home Placement u Other (�
, �:�� ,. , v
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 environmentatly sensitive areas located on the parcel? If yes, a
completed environmental checklist must a ompany pe it application
BUILDING � M _
ADDR ' C E AIL (1
C�Ty ATE ZIP �'` TELEPHO
ARCHI CT/ENGINEER LICENSE#
ADDRESS EMAIL
C�Ty STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
�. � ADDRESS EMAIL
, CITY STATE ZIP F�
�� CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
L
' PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
C�Ty STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Communiry Schools, if applicable.
I hereby certffy that the above informatfon is correct and that the construction on,and the occupancy and the use of the
abov ribed property will,�fel�accordance wkh the laws,rules and regulations of the State of Washington and the
City Y m. � �
, �;`
:' �' i
ca t s 'gnature / 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 Y¢lm Auenue Weat (360)45&3835
PO Box 479 (360)45&3149 FAX
Yelm,WA 9859? wrvw.ci.yelm.u�a.ua