20130235 Permit Pkg 06192013 o� City of Yelm Permit No.: 20130235
Community Development Department Issue Date: 6/19/2013
� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
"` " " Fax: (360)458-3144
Applicant:
Name: ACHTENS QUALITY ROOFING Phone:
Address: 410 112TH ST S
TACOMA WA 98444
Property Information:
Site Address: 107 WASHINGTON AVE SW Owner: JOHN HARDING
Assessor Parcel No.: 75301600700 Subdivision: Lot:
Contractor Information:
Name: ACHTENS QUALITY ROOFING Phone:
Address:
410 112TH ST S
TACOMA WA 98444
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF ACHTENS QUALITY ROOFING $ 25.00
TOTAL FEES: $ 25.00
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 e State of Was ington.
Signature � Date �`—' ( �� � � Date:
Firm BY�
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(36 )
REC#: 00131U51 6/19/2013 1:18 PM
pp�R: CO �TERM: 001
RE.F#; TM
TRAN; 3U.0000 �USTNESS LICENSE
Achtens QuailtY Raofing 35 �OCR
@USINESS LICENSES &
TRA�l: 33.0000 BUII.DI�5.00CRIT5
20130235
ACHTENS QUALITY RUOFING
107 WASHING�ON 25E�OCR
ROdF
TENDERED: 60.00 Q�W�R
Af'PI-IEQ: 60.00-
CHANGE: � ��0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: � b� 5 W '�l�£�� � Parcel#:
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction � Re-Model Re-Roo /Addition o Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/ Manufactured Home Placement ❑ Other
Project Description/Scop�oi Work: '(�/� ��
Project Value: � i Lb�L
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?
/f yes, a compieted environmental checklist must accompany permit application.
BUILDING OWNER NAME: m1-L•J °����1�-
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR F�NIr TELEPHONE '�-S3 '-S3`� ' b6y
ADDRESS �-4,10 il2t`^ �'s�- S EMAIL �bb �'.-c�-�-t.�n �n, .Lt�
CITY '��'Gfl�M� STATE (,�. .A- ZIP�_FAX 2S�'i• ��'-1 • ?(ol�3
CONTRACTOR'S LICENSE#�-t-EQ2.�t23C.w�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.
�- ta - � 3
Ap icant's Signatur Date
O ner/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 Auenue West (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us