20050764 Demo Permit 10252006 p�T�p Clty Of Yelm Permit►vo: DEMO-05-0764-YL
� � Community Development Department Issue Date: 10/25/2006
4 (Work must be started within 180 days)
Building Division
Phone: (360)458-8407 Receipt No: 44320
LM Fax:(360)458-3144
Applicant:
Name: Kempinski,Mike Phone: 3(,�C�. �.5�- /���
Address: �� �U� ��p) 1 City: \/,e J � State: ��ip ���5 J �
�
Property Information:
Site Address: 1412 Crystal Springs Road
Assessor Parcel No. 22718310100 Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Kempinski Demo
Description of Work: Remove garage in bypass right of way out of the City
Sq. Ft. perfloor:(1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type(Electric,Gas,Other): 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
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same QFFICIAL USE ONLY
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of'Prints:
Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington. __.�---�___. Final Inspection:
.�.. .
_.
Si nature'� '%� —� t — Date:
9 �� I L � ZS�(:,t„
Firm By'
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� YELM
YePm,WAX98597 RECEIPT No.4 4 3 2 0
360-458-8403
RECEIVED ***+►FIFTY DOLLARS & 00 CENTS
RECEIVED FROM DATE REC.NO. AMOUNT REF.NO.
MIKE KEMPINSKI 10/25/06 44320 50.�0 CHECK 3406
P.O. BO% 1496
YELM wA 98597 BUDGETARY �
360-507-0868
MICHELLE
DEMO PERMIT 50.00
DEMO-05-0764-YL
CITY OF YELM
RESIDENTIAL BUILDING PERA�IIT APPLICATION FORI�R`', � • /
vr1 ��S�� ` �, ,
Project Address:�_ �t ��'��1.�, ��i)?��'Y"���z�Parcel#: �7 , �� � � f `� �
—� �.J.� ��<� i,�tl�' �� -U �
Subdivision: Lot#: Zoning;
u New Construction u R�Model/Re-Roof/Addition u Home Occupation Sign �
U Plumbing u Mechanical u Mobile/Manufactured Home Placement U Other
Project DescriptioNScope of Work: �. % r " l �--r"4,c_C t c' � -�G�.S.S l(��' t
�� �� I
Project Value:
�`a� 1
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 checklist must accompany permit application.
BUILDING O ER AME:,�Y�,� _��h ���'�c�=�k��
ADDRESS � G� . � EMAIL
CITY r, . TATE �.:i� ZIP � "� TELEPHONE .i t,-L� �'S� f 5 C� Z
ARCHITECT/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.
I hereby certffy that the above informatlon is correct and that the construction on,and the cecupancy and ffie use of the
above desc�ibed property will be in accordance wkh the laws,rules and regulatlons of the State of Washington and the
City of Yelm. _..,
��:,.....
-�---��`��-C� ---� 2 � G �-.
Applicant's Signature a
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
I05 Yelm Auenue Weat (360)45&3835
PO Box 479 (360)458-3144 FAX
Yelm, WA 98597 ruwm.ci.yelm.iva.ua