20080138 Demo Permit 05012008 �.oF T� Clty Of Yelm Perrnit No: DEMO-08-0138-YL
r � Community Development Department Issue Date: 05/01/2008
4 � (Work must be started within 180 days)
Building Division
Phone:(360)458-8407 ReCeipt No:
y =, Fax:(360)458-3144
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Applicant�
Name: DOT Phone:
Address: City: State: Zip
Properly Information:
Site Address: 16947 103rd Avenue SE
Assessor Parcel No. Subdivision: Lot:
Contra�tor Infornna�on:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project#nformat�on:
Project: Demo Garage on Littleton property
Description of Work: Demo of garage on Littleton property
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 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 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 ltlspeCtion:
Signature����� � Date �— � � Date: �
Firm �y/ — �y�
r�/ !
° CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:/���� /���'������ S�- Parcel#:�U/'7�
Subdivision: � Lot#: Zoning;
❑ New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing o Mechanical ❑ Mobile/Manufactured Home Placement ��ther
Project Description/Scope of Work: ����L�-FJ ��y2s��
Project Value:
Building Area (sq.ft) 15t Floor 2"d Floor Garage C 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
compieted environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
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 EMAlL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 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,rutes and regulations of the State of Washington and the
City of Yelm.
�'i-��"
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 Avenue West (360)458-3835
PO Box 479 (360)458-3144 FAX
Yelm,WA 98597 www.ci.yelm.wa.us