20130230 Permit Pkg 06112013 o� � City of Yelm Permit ►vo.: 20130230
� Community Development Department Issue Date: 6/11/2013
�
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
w"'"""`°" FaX: (360)458-3144
Applicant:
Name: ST. COLUMBAN RECTORY Phone:
Address: 506 1 ST ST SO
YELM WA 98597
Property Information:
Site Address: 506 1 ST ST SO Owner: SAINT COLUMBAN CHURCH
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: PERKINS CONST. & ROOFING Phone: 360.458.5329
Address:
P.O. BOX 1085
SPANAWAY WA 98387
Contractor License No.: PERKICR995LN Expires: 12/28/2004
Project Information:
Project: ROOF
Description of Work: REMOVE ROOD AND INSTALL NEW ROOF
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF PERKINS CONST.&ROOFING $ 181.25
TOTAL FEES: $ 181.25
ApplicanYs Affidavit: 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 further certify that I am currently Final Inspection:
registered in the State of Washington.
� Date:
Signature Date '—���
Firm By'
Cit� of Yelm
(36 ) 458-840�
REC#: UQ12�979 E�/11/2013 4:07 PM
Of'Ef�; CO TERhi: 001
REF#: 24582
TRAN: 33,f1000 BU�LQING PC�MITS
2U13023(l 181 .25wR
ST. COLUM�AN RECTORY
506 1ST ST SO
�pq� 1�1 .25C�
T�Kp���p; 181 .25 CHEL'K
�1PI��IEU: 181 �?5-
CHANGE; ��y_~�U.00
�a ,3 n23c�
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: J��C� ' � VC, S• Parcel#:
Zoning; Current Use: Proposed Use:
-! New Construction �Re-Model/Re-Roof/Tenant Improvement
: Plumbing � Mechanical -_: Fire Prevent/Suppress/Alarm ❑ Other
Project DescriptioNScope of Work:��)� c�ino, � �YI��/ �/e�,✓
Project va�ue: �'� � 2..,�i o�C�
,
Building Area (sq. ft) Parking Garage 1 St Floor 2"d Floor 3`d Floor
Building Height
Are there any environmentafly sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUtLD1NG OWNERlfENANT NAME: ' C�iU
ADDRESS SOG, - 1 �VP� S, E AIL
CITY STATE ZIP�TELEPHONE –
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR 'ns TELEPHONE Z_S2- 5�'/���_
ADDRESS — EMAIL fJ rl �'�J �a � nJ��
CITY STATE_1�A ZIP�'�'n3i7 FAX �"����
CONT ACTOR'S ICENSE# XP DATE �C�L CEN�#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of City Mitigation documentation(TFC).
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.
— _.._ __ ---
G��/ �
' ant's ' ure Date
wner/ on ctor wner's Agent/Contractor's Agent/Tenant (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