20130253 Permit Pkg 06272013 �o�TH�a� City of Yelm Permit No.: 20130253
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� � Community Development Department Issue Date: 6/27/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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"""`"'"`"°" Fax: (360)458-3744
Applicant: Ct
Name: BIRKLAND HOMESTEAD LLC Phone: 360-23�8295
Address: P.O. BOX 875
YELM WA 98597
Property Information:
Site Address: 16240 PRAIRIE HEIGHT ST SE Owner: BIRKLAND HOMESTEAD LLC
Assessor Parcel No.: 69270002300 Subdivision: Lot:
Contractor Information:
Name: BIRKLAND HOMESTEAD LLC Phone:
Address:
P.O. BOX 875
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: RESIDENTIAL REMODEL
Description of Work: ADD THIRD BEDROOM
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUII.DING BIRKLAND HOMESTEAD LLC $ 160.46
TOTAL FEES: $ 160.46
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 W ngton. °�°,.., I
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Sign ure Date�j , /..3
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�PPI.IED: __
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CNAN���
CITY OF YELM I �C�/��
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RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:/�Q��y� /�i.a�z�E f�5 .T Parcel#: Co9Z yUOO 2 3 D�
Subdivision:/�it�±��-f/zr�srs Lot#:�� Plan#: Zoning: t�-is�
❑ New Construction �,'Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/ Manufactured Home Placement ❑ Other
Project Description/Scope of Work: ��L? i,�,r,exzv i�1,,�y�ri2
Project Value:��,!c�vrs -
Building Area (sq. ft) 15t Floor /� 2"d Floor 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 OWNER NAME: / .a7ZICL�irJL� /�r�s'r��/,Z+ C G C�'
ADDRESS l?D .S EMAIL ��cm?�'3.�e�cc��PG-rl.7sZ.�i�+�-
CITY STATE .r/�ZIP 3� TELEPHONE3GD•s�azy� -M��
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ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR .t�//� 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 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.
f G��3
t's S ure Date
Owner ontractor/Owner's A ent/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
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JUN � $ 2�J13
105 Yelm Auenue West B 60)458-3835 �
� Yelm,WA 98597 _=f
www.ci.yelm.wa.us
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