20080161 Demo Permit 05192008 �T� Clty of Yelm Pe�mit No: DEMO-08-0161-YL
�' Community Development Department issue Date: 05/19/2008
`
Building Division (Work must be started within 180 days)
Phone:(360)458-8407 Receipt No: 54485
w.,�,.a,o.
Fax:(360)458-3144
Applicant:
Name: Ronald Baughn Phone: 253-846-1489
Address: 1416 Crystal Springs Road City: Yelm State: WA Zip 98572
Property Information:
Site Address: 1416 Crystal Springs Rd.SE
Assessor Parcel No. Subdivision: Lot:
Contractor Information:
Name: Contact: Phone:
Address: City: State: Zip:
Contractor License No: Expires: Business License:
Project Information:
Project: 1416 Crystal Springs Rd SE
Description of Work: Demo
1416 Crystal Springs Rd SE
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: 350.00
Appiicant's Affadavit:
OFFICIAL USE�NLY
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 inspection:
� Date:
Signature �� �%.��,,�.� Date j�—f �� G"��
� By:
Firm
��pf THFp�� City of Yelm � � Permit Fees Schedule
� 9� Community Development Department
Permit No: DEMO-0�`-0161-YL
Building Division MAY 19 2008 (/�
Phone:(360)458-8407 — )
���� �� ����� ^ ���
YELM Fax:(360)458-3144 �
_ _ _
Applicant:
Name: Ronald Baughn Phone: 253-846-1489
Address: 1416 Crystal Springs Road City: Yelm State: WA Zip 98572
Project lnformation: '
Project:1416 Crystal Springs Rd SE
Description of Work: Demo
1416 Crystal Springs Rd SE
Site Address: 1416 Crystal Springs Rd.SE 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: $50.00
• •• . : -• . • -• .
o�oF THFP� CITY OF��
a � YELM
P.o. Bax a�s RECEIPT No. 5�4 8 5
Yelm,WA 98597'
ELM 360-458-3244
RECEIVED *��*FIFTY BOLLARS & 00 C�NTS
RECEIVED'FROM DATE REC.Nd. AMOUNT REF.NO.
RONALD <$AUGHN 05/1gl08 544$5 50 .0@ 'CHECK 4654
2�.717 64TH AVE E
SPANA6VAY. WA �8387 BUDGETARY
LORI
DEM0-08-0161-YL
aITE 1416 CR5YSTAL SPRINGS RD
► CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: lKl�G Cpy9/r�l S�Jr�ti�, ��• Parcel#:
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: ��Ce�'� U
Project Value: �
T c�
Building Area (sq.ft) 1St Floor �� , 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms Z- # 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 OWNER NAME: ort � a ►?
ADDRESS 5E14+ C�" -�•,f ,-,' , �, EMAIL
CITY STATE� IP � 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 E!l�lA!!
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.
� D � -�- l� -��
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
I05 Yelm Avenue West (360)458-3835
PO Box 479 (360)458-3144 FAX
Yelm, WA 98597 www.ci.yelm..wa.us