20130224 Permit Pkg 06062013 �o� '�' City of Yelm Permit No.: 20130224
Community Development Department Issue Date: 6/06/2013
~ (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
""�`"�""°" Fax: (360)458-3144
Applicant:
Name: YELM COMMUNITY SCHOOLS Phone: 360-458-1900
Address: P.O. BOX 476
YELM WA 98597
Property Information:
site Address: 14848 BERRY VALLEY R SE Owner: YELM COMMUNITY
SCHOOLS
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: WE&B LTD Phone: 360-458-5540
Address:
15708 123 AVE
YELM WA 98597
Contractor License No.: WEBL"133MG Expires: 12/19/2006
Project Information:
Project: DEMOLITION
Description of Work: DEMOLITION OF BUILDING
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Th i rd
Garage
Basement
Fees:
Item Contractor Fees
DEMOLITION WE&B LTD $ 50.00
TOTAL FEES: $ 50.00
Applicant's 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, �further certify that I am currently Final Inspection:
registered in the State of Was�i .
___ , � .
Signature ' _�._........,_...... r'� Date � � � Date:
�
Firm �� �,c , ' ` _.. � . � 9 By:
JUN/�b,%2G13i�THU 10: 51 AI� OAGAA FA� No, 3604916308 F, 001/001
.-'�Ct����y Olpm�ic�tcgion Cleazl t�ix.A.gen.cy
. °�,'�� /"�.�'�P7, 2940-B Limited Lanc�lW , .
� �r �� G'� Olpmpx�,W�A.98502 ,
; ' � (36U) 539-7f10•F.AX(3G0)491-6308 �4'�Q��1O • .
��� � ��'� Port Angcics offlcc(3G0)4�7-14C>G . � �(��'�,1'�
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� �� '�,''�. '�}��,i,�„t� �,� , Raymond Officc (3G0)942-Z137 � ' '
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;�,.: -- �'� �i�f� �o���
���'`� �
,. ,
�`� 'Dwner occu,pied residzntial dwelling—Per�it�ee; $35,�0�prior N'otice-Ndurefundable �
�:J ,Othex Stxuctwres—�'erxuuit�ee: $60.U0—10 warlung day wa�it period-Naare�undable
( )���merger�cy Fee $58.00�mnst be acco�panied by�overnment Urderec�lDecYa,ratiom(otl�er structures on�y)
PitOPERTY QWNER � .
Na:zze: ' lPhoz�e_ F360�458-6128 znail:�b['�cY_...,L�t�eKZry.�.-.�
Yelm Community School� �sd-�5$�6434 �60 239 8295
�'ax: ob9J,e:
Mazling.A.ddres&= Ciry. �"attD �58-�lK b State: .� z�p:
Pa Box 476 - � `feitn Washi�gton 88597
Site Addxess: � City: � Statc: Zip:
14848 Berry Valley Rd. SE Yelm ' Washington 9859T
DE1I�IOLITTOI�T COI�TRACT�It Check i�saraae a.s xo e o�er infa�naadon. '�•
Business Name: PhoAC: (J -
�� �' �'j ��e4) I ��-���� �,mail: .
�'o Be �eterm�ned �;,�;�--FGQ Fa�: c�,, c� �s_ �r3� � .
Orisitc Contact:1 Phoac ( ) Mobile: ( )
��-��. �N�G� k�ax: t )
Iv�� � �ddzess: � .� Czty, `Z � State:� Zip:
3 '' v �� �
D�OY.TTYON INFORMATIO�T � .
� #of scructures bezz�g dex�aol.islaed: Sta�:t Date: Com�2et�on Zlate:
2 July 1st � July 95th
.A.sbestas pr�serit? f:'� yes [� P,To Suxve�attaaxxed2 Xea �J No � Has all ideu�.Sed asb�stos been
� � [,rz tcmoved2 • 'Y'es ("'�I�io
DEMOLZ'T'ION P1tO�CT CATEGORY � �
�'f Coznplete l�emolirio� ,
(��'�'raining F'ire-Fire Agenry,Couract,Phone: � �
Rcnovari�n;Alceration,Remode' ,Mainttnance or other Construcdon
I do hBreby cerSi.fy tbat a!!adent�fied'dsbs.rro,r ba.c besn ramoued and tbs snforma�an containsd on tbir for�r and
.r,rpplc,arenta!data dascri&ed berei� r.r, ta tbe be.rt of r,ay k�o�vled�e, ac�urate dnd'Eo�ar,pleta. '
�rling Birkiand for Yelm Community$choais �' � ""�� 5/15/13
Applicaut Na�ae '�gua Date
Dat�����,�� Ra�ment Info. . �Approved : Asbcsros P t
. ( ] Cash Disappraved Y'ennit# �ASB00_���
�^� �✓l�Check: #�.$�_ ., DemolitionPermit
1
��' . MAY 2 2 �Q1� � ]Crcdit Cazd . Revicw datc:.�O/.�/� ,Fe�mit#�,�EMOO�S�O
� Rcceive date:�/�� Re�vierued by:
g en Uae Onl ett Use On en rJ're On
02/X3 ' "OVER ' �
5
x.�� (�-�v .
Cit� of Y�lm
{36 ) 45$-84Q7
REC#: U�112y?B7 6/06/2U13 3:01 PM
QPER: CQ TERM: OQ1
REF#: �1830
TRAN: 33.OUC10 BUIL�ING PFRMI7�S
20130224 50.GOGR
YELM COMMl1NITY SCHOQLS
14848 QERRY VALL�Y R SE
DEMO 5U.00CR
T�ENDEf�E�: 50,0� CWECK
APPLIED: 50,00-
L'HANG�, �__ � 0.QO
CITY OF YELM ( ����
�0 3
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:/S�f�-,�f��`3c�iiey v,��c��v�c��� Parcel#: �� �i 7 y�„_�,� 3�,�
Subdivision:_�fA Lot#: JV /f} Plan #: jzJ � Zoning: � � � / .
—7-�—
❑ New Construction 0 Re-Modei/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/ Manufactured Home Placement �Other
Project Description/Scope of Work:_��,.,d�.,.--�-���,� ��- ,3;�,� �� t�
Project Value:�et9� �
Building Area (sq. ft) 1St Floor,�� 2"d Floor�3�d Floor Garage-2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: �czm ��,rr,✓.y�-i-*.i `�,.YJ,�•vc:_�
ADDRESS_�'.U' . /3;,� �"1'S ' EMAIL �?oek —i3,�izr.Ct�f t t . �i-:iyrz-i. �'1�./
CITY e c�Z��. STATE��`�ZIP �f.9"rr'9' TELEPHONE ,�Gt�-g' 8''G/2 �
ARCHITECT/ENGINEER iJ/.�- LICENSE#
ADDRESS � EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR �r " TELEPHONE jC�•°/ ts-s�l',rtc�
ADDRESS /_S''fa�y !23 - s�►ye' SL EMAIL �u/,�
CITY i c2 i�` STATE �u� ZIP ��'S'� FAX o�G.�^ �/SfrFCG�32
CONTRA TOR'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 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.
_,.... � ,,,�r a
) � � i
A plic s Sign e Da e
Owner/Contractor/Owner's gent/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
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us