20050011 Payment Recpt 07162013 �lt� 4�5a�a�o2
(36 )
REC#; OQ133�9:i 7,/16,12t)13 3:39 PM
O�ER; CO TEV�M: UQ1
REF#; 3014
TRAN: 33,00(��1 �UIL1�350.00�I i�
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�3211 WILKENSON3�nN�C)GR
PLAT AMEIJD
TENDERED. �50.Ut1 C;MEGK
�PPI.IED: 35C�.00-
G'HANGE; ___..�_._.._.____ 0 00
� City of Yelm Permit ►vo.: 20050011
� Community Development Department Issue Date: 3/15/2006
� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
"'" " Fax: (360)458-3144
Applicant:
Name: BOB BENUM Phone: 253-845-5555
Address: P.O. BOX 73130
PUYALLUP WA 98373
Property Information:
site Address: 9211 WILKENSON ROAD SE Owner: APPLICANT
Assessor Parcel No.: 22718440600 Subdivision: MOUNTAIN SHADOW Lot:
Contractor Information:
Name: BOB BENUM Phone:
Address: BOB BENUM
P.O. BOX 73130
PUYALLUP WA 98373
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MOUNTAIN SHADOW PRELIMINARY&
Description of Work: Subdivide 19.93 acres into 80 single family lots. 9211 &9045 Wilkens
July 16,2013 Application submitted for Plat Amendment.
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLAT AMENDMENT BOB BENUM (7/16/2013) $ 350.00
SUBDIVISION BOB BENUM $3,400.00
TOTAL FEES: $ 3,750.00
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 the State of Washington.
Signature Date Date:
Firm By'