20080159 Demo Permit 05142008 �oF rH�p,p� City of Yelm Perrnit tvo: DEMO-08-0159-YL
� '!� Community Development Department Issue Date: 05/14/2008
a M (Work must be started within 180 days)
Building Division
Phone:(360)a58-8407 Receipt No: 54444
YELM Fax:(360)458-3144
Applicant:
Name: Ron Baughn Phone:
Address: City: State: Zip
Property Information:
Site Address: 21777 64th Avenue Court East
Assessor Parcel No. Subdivision: Crystal Springs Lot:
Contractor Information:
Name: CheYs House Moving Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: Move house from 15901 90th Avenue
Description of Work: Move house to 1416 Crystal Springs Road
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: $50.00
Applicant's Affadavit: '
OFFICIAL USE ONLY. �
I certify that I have read and examined the information contained within the application and know the same I
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 Inspection:
�
Signature �G✓l� �j Date S- ��/� �'G" Date:
-- -- — — �
Firm �� BY�
��f THEp�� City of Yelm Permit Fees Schedule
� 9� Community Development Department
Permit No: DEMO-08-0159-YL
Building Division
Phone:(360)458-8407
��fi��;�
YELM Fax:(360)458-3144 ; C��� .-
Applicant: �AY �. 4 20�� ,
Name: Ron Baughn ��P;, .;� ��;"' �''�', �,
r� , � � Phone:
� i �_x..�.�;L,
� �,_.r a
Address: City: State: Zip
Projectlnformation: ' ��':
Project:Move house from 15901 90th Avenue � j �
Description of Work: Move house to 1416 Crystal Springs Road �v,
Site Address: 21717 64th Avenue Court East Assessor Parcel No.
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: $50.00
• .• . -. . • -• .
-- ��.�._ _.^._._��_.._�.��____.__.�
°�°F T�p� CYE �F
LM
PA.Box 479
veim;wa ssss� RECEIPT No. 5 4 4 4 4
•�Y L�•�• 360-458-3244:
RECEIVED ****FIFTY Dt�LLARS & 04� CENTS :
RON ���("�,HN FROM 051T�4f0$ ��444 AMOUG�. 00 CASH REF.NO.
1t�'. Od-CASH
SUDGEfiARX 50. @C� TOTAL '
LORI
21717 64TH AVE . iT. EAST
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
f�
Project Address: �s T° � �° J��� Parcel#:
Subdivision:�`G��� �S�t �{J Lot#: Zoning;
❑ New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanicai ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: f'n�U L ��m �f e �'n /�y�� ��ysfq/�'p"„'S i�.(�,
Project Value:
Building Area (sq.ft) 1S' Floor 2"d Ffoor Garage 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
completed environmental checklist must accompany permit application.
BUILDING QWNER NAME: nnl G � '�
ADDRESS 2- ��r 'i C� Gl �f, EMAIL
CI a�G� STATE ZIP TELEPHONE ZS� �22� '7(,� ��
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR (% t S sT �N���� ELEPHONE
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 EMA!!
CITY STATE Z!P 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.
�-,� � � S-���o�
App icant'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