20070350 Demo Permit 10312007 o�T� City of Yelm Permit►vo: DEMO-07-0350-YL
a� � Community Development Department Issue Date: 10/31/2007
d (Work must be started within 180 days)
Building Division
Phone:(360)458-8407 Receipt No: 1006
w..�
Fax:(360)458-3144
Applicant:
Name: Michael C Iverson Phone:
Address: City: State: Zip
Property Information:
Site Address: 15819 90th Ave SE
Assessor Parcel No. 38330001000 Subdivision: Lot:
Contractor Information:
Name: Applicant Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project information:
Project: 15819 90th Ave.SE
Description of Work: Relocate Dwelling
Sq.Ft. per floor: (1 st) 1678 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type(Electric,Gas,Other): GAS
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 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 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. Finai inspection:
Signature�!� �,�G�/�;t�r—� Date �j�'���`� Date:
-•—�
Firm BY'
CITY OF of T� c'ty "�a
10 0 6 � Phone 458-3244
YELM � Yelm Municipal Court
PO Box 479 Phone 458-3242
Yelm, WA 98597 Police Department
Phone 458-5701
--r / —�r Sewer Department
Date: l �� "� 7 l � �+ f Phone 458-8410
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o�T� City of Yelm Permit Fees Schedule
a•� Community Development Department � f�. � Permit No: DEMO-07-0350-YL
4
Building Division `t , ��
Phone:(360)458-8407 ,�� �`� -S.
c�; �
TLM Fax:(360)458-3144 � Q
,� �
Applicant: �
Name: Michael C Iverson Phone:
Address: City: State: Zip
Project Information:
Project:15819 90th Ave.SE
Description of Work: Relocate Dwelling
Site Address: 15819 90th Ave SE Assessor Parcel No. 38330001000
Fees:
Item Acct Code Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------------------- -------------- ----------- ----------- ----------- ----------- -------- ------------
BuildingPermit-Other 032001-322-10-00 50.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $50.00
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CITY OF YELM �
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: C -h'�'r'G�c.� �L� �',l-�Parcel#: � J � � % �-
. � ��-��
Subdivision: Lot#: Zoning;
❑ New Construction ❑ Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placeme�t �(Other
Project Description/Scope of Work: ' � �'1 " � `C:�r ,>G/ '� �
� ��' �----
Project Value: n � �
Building Area (sq. ft) 1St Floor � ,G2�d Floor Garage Deck °-�
Basement •-- Carport �-- Patio —
# Bedrooms� #Bathrooms� Heating�GAS THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcei? l/� If yes, a
completed environmental checkiist must accompany permit appiication.
BU[LDING OWNER NAME: • " " ' ' •.�
ADDRESS G � ,� _ , � = EMAIL
CITY STATE 1' ZIP C " t� " TELEPHONE
ARGHITECTlENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING GONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL_CaNTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicabie.
i hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm. r
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Applicant's Signature Date �
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 West (360)458-3835
PO Box 479 (360)458-3144 FAX
Yelm,WA 98597 www.ci.yelm.wa.us