20080118 Demo Permit 04112008 �pF THEp�� City of Yelm Perrnit No: DEMO-08-0118-YL
� '� Community Development Department Issue Date: 04/11/2008
4 M (Work must be started within 180 days)
Building Division
Phone:(360)458-8407 ReCeipt No:
YELM Fax: (360)458-3144
Applicant:
Name: Annette Ivey Phone:
Address: City: State: Zip
Property Information:
Site Address: 16947 103rd Avenue SE
Assessor Parcel No. Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Littleton Manufacture Home Removal
Description of Work: Move mobile home(1979)and decks to 16744 103rd Avenue SE.
Sq. Ft.per floor:(1 st) 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 0.00 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: $0.00
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 addiUon,all covenants, i �
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently II
registered in the State of Washington. Final Inspection:
If Date: �!
Signature Date ;
– –__ _____--- – – —- -__--- – --- _ __— – i
Firm . By' �
*****�********* -COMM. JOURNAL- ****��*�******��*** DATE APR-11-2008 ***** TIME 01:42 ��******
MODE = MEMORY TRANSMISSION START=APR-11 01:41 END=APR-11 01:42
FILE No.=070
STN COMM. KEY NAME STATION NAME/EMAIL ADDRESS/TELEPHONE N0. PAGES DURATION
No.
001 OK s 93604587383 001/001 00:00:44
-Yelm CDD -
***** DP-3520 **�******************* -Yelm CDD - ***** - 360 458 3144- *********
�oF Y'u'.►+ City of Yelm Permit No� DEMO-08-0118-YL
a° s'� Community�evelopment Department Issue Dete: 04/11/2008
� (Work must be starletl wiNin 180 days)
Building Division
Phone�(360)488-8407 ReCeipl No:
ELM Faz:�360)s58-3144
Appticant:
Name: Annette Ivey . Phone:
AddreSS: Ciry' State: Zip
Property Information:
Site Address: 1694710�rd Avenue SE
Assessor Parcel No. SUbdivision: Lot•
ConVactor Infom,ation:
Name: Contac[: Phone:
Address: Ciry: Scate: Zip:
Contrac[or License No: Expires: Business License:
Project Information:
Projecl: Llttleton Manufacture Home Removal
Description of Work; Move mobile home(1979)and decks to 167m 103rd Avenue SE.
Sq.FL.per Floor.(1 sq 0 (2nd) 0 (3rd) 0 Garaga 0 Basemem 0
Heat Type(Eleclnc,Gas,Other):
Fees:
I[em Item Fae Bese Amt Unit Fee Unil ftaie No.Unils Unit�esc
Building Permi�-p�her 0.00 0.00 0.00 0.0000 0.0000 S1,p00 �
TOTAI FEES: 50.00
Applicant's Affadavit:
� OFRICIAL USE ONLY������
1 certiry that I have read and examinzd the in(ormalion wntained witliin the aDPlication and know the same
ro be true and correct. I also canify Ihat[he proposeG struUUre is In conformity with all applicable City ef p Sets of Prints�
Yelm regulations Inclutling those goveming zoning and land subdivision,and in addilion,all cqvenanls,
easemeals and res[ricUOns of reCOrd, If applying as a coMreUOr,I tuthe�ceniry mat I am currenty
registered in the State of Was�ington. Final Inspeetion:
Signa[ure Date
Data:
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By �
Firm
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04/^0/1995 19:23 �E0-45S-64�9 F'�GE 61
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
�
Project Address:/�'��i i i' /��r`l��l%�': i�, Parcel#: ����d�� ��._..`�>�,��C�
Subdivision: Lot#: Zoning;
❑ New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work:�;�� ;�j����/C. f7'tG�'�J1�'' �',��'� 1�S ( I ��"1�
Project Value: !'1�D(I1�� � /°� ��`1 L
( 1 t��'�d f�� S� �
Building Area (sq. ft) 1S'Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parce�? :�i' l.� If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: L'' r'
ADDRESS ��'` C? r" � ' ' / .� � E AIL
CITY �,-"��"I �1�1 STATE ' ZIP �� - 5 ' ELEPHONE � -�Gf - ��''— J ��
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR 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'CONTRACTQR 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 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.
ApplicanYs 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