20070377 Demo Permit 10152007 ^ CITY OF YELM Zo��03�
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: '-� b a`�1 �d���5 ���� Parcel#:
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 I�4 Other
Project Description/Scope of Work: �a L�"7.��'J
Project Value:
Building Area (sq. ft) 1�'Floor $ �� 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms� #Bathrooms� Heating: GAS/OTHER o�ELECTRIC ircle One)
Are there any environmentally sensitive areas located on the parcel? w� If yes,a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: C 2 \ �4 '"�5�.._ a� �� � � o ��
ADDRESS Q� �x �3� EMAIL
CITY � M STATE � ZtP TELEPHONE S LL � ��
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 certify that the above iaformatlon is correct and that the construction on,and the occupancy and the use of the
above described property will be in accordance wkh the laws,rules and regulations of the State of Washington and the
City of Yelm.
__ \ � -r 5����
Applicant's Signature Date
Owner/Contractor/Owner's Agent/Contrac ent (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)45&3835
PO Box 479 (360)458-3144 FAX
Yelm, WA 9859� rvmm.ci.yelm.wa.ua
1U;08/2007 10:05 F�% 360 491 6a08 ORC9A f�001/001
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'�:�-����' � PERMIT�� '��
�--����F Q`' � I C�IVDITIONAC�.Y A VED�^
��'�� ` � : �. nlympic Regic�n �iean Air A ��'��a�,
• �. 2940-Ci Limited Lane NW �A���A��
' � '� Olymipia, WA 9$502 ORCAA REGtI H 1
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`"{������ � ; (3fiQ) 58f-1�44 or 1-B00-422
� � .�,,:� �''� '� Fax: (36�) 491-63�8 www.QRCAA.or��1�Z�per.��- �S�
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Notificat�on of Demalition Per�nit
1� ia unlawful ror�ely pCl'SUD t8 Cfl1LSC OT 81MW th8 dflO1QIRiq11 (Oi 01�QI TC00�9ho11�Df Yny Kfr1lCtiYrC 114IlSS AII�SbC5t05-
r,ontaieing m�Eeria#a h9ve btep rcmeval trum the area to be demo��d. Work si911 noL cvmmdace�a�a�n�►Khacetna prnjeG�
ar damqliNvo uAlesm r�o owaer or optrttur �uw ubt�eiaed written approv�l from OJ3CAA. A written applicatioa for n
damuliLiun S6a11 iublude a �ertiflCetioll thet there �9 no la�nw� I1,9bcstos-caatniuiag u�aieri�el n:mainin� in the area of the
S�ructurd. f —
�'rojec:t Site 1ldd�oss: �a� a �a,•s � r'r
� ca��: L��,rr,sT�
�'�h': �`��t..s1n � , st���: _ t,.�.� Gip:�`7
Starting Date: _ �P►S Sooa.1 � t�c�sS,ksc.G ��� IF,�a"7 Ca�pletion Date�
*(There is u !0 wurl�ug,day sdvancu nutilicalion perlcx�¢om kaceipt of perrni[appllcstion)
k'roperty ()w�er:' C +��rcQ-t � �aSP��-- Tcle:phunn:�G,3�d�3-�it��o rax:�� �.I -b $`1
N�siling ,Addre+St "� A`-� S^'�qeo=J � ,
. . $Co
C:iRy: o� .. St.ate: l.�J�t 7,ip;�p
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U�.rnc�liticm f,',onL�-acGc�r.:����-��Z, State Lia;iLU;#:
1�Iailuz,g Address� ��, �z,� �� �
C'ily: ;� ., v Stntt:
Zip: 5 t�
Cont�ct!'crson: ' �►.1,��` .,,� Q\s►x 'i'cicphon�e:�S3-$c�3� ��vo ,r.•�x:��3-�a3��X7
YLS M�
✓ _j_ Dcmoli�iun by Wr�okin� or Dismantling?($ZS,00 fee)cheek# nonrel'uodahle
i1 Traini.ng Fir� Demnlili.un'? (lfyes,attach fire department request for tr,e,i,ning�i.rc)
' �'" R.cnovaliuu.Allcr�licm,R�mod�liag,MainCenaricc,or other C'ontiLi�uctiqr�?
`f Asbestos faund or sugpc�tcd�' — jU�r�9� A��,t���, ,
*An OItCAA '-Natiae of Intent to itenove er Encapsulxte AsbesMs" form and a��npr;afe fra mu,t b� nibmittcs!prior ta any asbesk�s
�e+��uviJ work. Asbc�u6 rcmoval pmjects ii�volvinb demnlil,ia,r mn.� bc przfvr.r,ed by a �,crot",cd nsE�estas Corcuncic�r und �df frittbk ur
polcnliul]y I}ist�lc a�bcaaR mtist f�c rurii�vui t�fi» any dcmuhliun bc:gins. Rcfcr ip (�liC:11A Itegulntlon 1 Att9C1C 14 tor addidonal
�4qnircrri�ua cluir tnt�y!appty.
� Asbestos Survey Complctc�l by .
AH'�]�A Cc�t�iS�d Inspcctor. l. �C��.l�. �V►`��.r�r.'��.��v�L'� ^����
C�rtificatia�# , Lr��G �:��'q►�1� "�.,3
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Thic;.pproved peYmit must Eocbse$2$ Cp-tiliuu[ion uf I,he Ashexte�Survcy m��st
be�vailable at r�e job site Pruras+in�Fee accompany thi:�brm
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