20070095 Demo Permit 03122007 04 T� Clty Of Yelm Permit►vo: DEMO-07-0095-YL
� Community Development Department Issue Date: Not Issued
Building Division (Work must be started within 180 days)
Phone:(360)458-8407 Receipt No: 47653
EL Fax:(360)458-3144
Applicant:
Name: Dept of Corrections Phone: 704-3261
Address: P.O.Box 47440 City: Olympia State: WA Zip 98504
Property Information:
Site Address: 1410 Crystal Springs Rd
Assessor Parcel No. 22718310800 Subdivision: Lot:
Contractor Information:
Name: Department of Corrections Contact: Phone: 586-0030
Address: P.O.Box 41115 City: Olympia State: WA Zip: 98504
Contractor License No: CIENV*972CG Expires: 03/12I1071 Business License:
Project Information:
Project: Corrections
Description of Work: Demolition of 1410 Crystal Springs Rd
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: 550.00
Applicant's Affadavit:
OFFICIAL USE ONLY
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 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 tate of Wash� gton. Final inspection:
f � Date:
Signature ,` �' Date � �z-,�' 7
� By:
Firm �I� (L-r�c;lc�✓�� liJ D�< S i�"t i i_S � /.�O G
��pFTNFp�� City of Yelm Permit Fees Schedule
� � Commu�ity Development Department Permit No: DEMO-07-0095-YL
Building Division
Phone:(360)458-8407
YELM Fax:(360)458-3144
Applicant:
Name: Dept of Corrections Phone: 704-3261
Address: P.O.Box 47440 City: Olympia State: WA Zip 98504
Project Information:
Project:Corrections
Description of Work: Demolition of 1410 Crystal Springs Rd
Site Address: 1410 Crystal Springs Rd Assessor Parcel No. 22718310800
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: $50.00
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****FIFTY DOLLARS & 00 CENTS
��G=IV�D rRO.r,;i CATE REi..NO. AI410iJNT Rt�NC '.
DEPARTMENT OF CORRECTION 03/12/07 47653 50. 00 CHECK 1669
, PO BOX 41116 �
� OLYMPIA WA 98504 BUDGETARY ;
DE1�I0-07-0095-YL I
�
' MICHELLE �'
PERMIT DEP40-07-0095-YL
.••••, �� -���r ui:�1 Yelm CDD 360 458 3144 P.02
CITY OF YELM
R�SIbENTIAL BUILDING PERMIT APpLICA'f10N �ORM
Project Address;1�//c� C�'�S TR S�'f���JC-.-S Parcel#: L z 7 i y.� ,� z�c���
Subdivision: Lof#; Zorting;
:i New Canstruction =" Re-Model/Re�Roof/Addition ': Home Occupatio Sign
;.: Plumbing ': Mechanical :' Mobile/Manufactured Home Placement �Other �� ��,
Project Description/Scope ot Work_�r'�u��. , ,iv,.�r �;= 5 r�,�
Projecf Value: �/�G. ��c� ""
Building Area(sq. ft) 1s1 Floor 2"d Ffoor Garage Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: GASlOTf1ER or RiC (Circle One)
Are there any environmentally sensitive 2reaS located on the parcel? If yes,a
completed environment2l checklist must accompany permif application.
BUILDING OWNER NAME; [.�.4 S';- ��.=�i e� r= ��lz�}� ��S,�y.-����
ADDRESS_ r'�c� ��,�;� L-f l yy c, EMAIL
GTY ��-�t�, ��,, STATE >,.�.z ZIP `� �:� T�LEPHONE � :,�5 �� - 36� c �
ARCHIT�CT/ENGINEER L.ICENSE#
ADDRESS EMAIL
��� S7ATE ZIP TELEPHONE
._._ GENERAL CaNTRACTOR �:.,�� ,-��il.; TELEPHONE� =SEC�)_ S'�' "
ADDRESS pu i3 c„c y�+�� E'�-<�""S e.
3 EMAlL
CITY_ �iv,�,�>�- STATE w/a- ZIP �j'�5�:•�j FAX C3C ��) ���6 - c;�3�
CONTRACTOR'S LIC�NSE#e�c,���s�q��z� EXP DATE' �ITY LIC
PLUMBING CONTRACTOR TELEPHONE
ADDf�ESS EMAIL
C�N STATE__�tP FAX
COtVTt�ACTOR'S LICENSE# EXP DATE_CITY LICEf�lSE#
MECHANICAL CONTRACTOR � TEL�PHONE
ADDRESS EMAIL
C��' STATE ZlP F,qX
CONTRACTOR'S LICENSE# EXP DATE CI'IY LICEIVSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that tho above info�malion is correct and that the const►uction on,and tha occupancy a�d the uba oFthe
abdVe dA ribad propaRy will be in accordance with tha lawa,rul@s and regulations of iha 3tata oE Washingfon end tho
city of Y m.
.e'� ..3 /2- O -
Appllcant's " nature Date
Owne�/Contractor/Owner's Agent/Contractor's Agent (Please circle one.)
' All permits are non-transferable and wifl expire if work authorlied by such permit is not begun
within 980 days of issuance, or(f work is suspended Ot'abandoned for a period o'f 180 ddys
105 Yelm Auenue Weat (860)4b8-8855
PO Soz 479
Yelm, WA 98597 (360)958-8144 FAX
wu�m.ci.yelm.wa.us