20130299 Permit Pkg 08222013 �OF TH�p� City of Yelm Permit ►vo.: 20130299
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a � Community Development Department Fee Calculation Worksheet
Building Division
Phone: (360)458-8407
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w�RMIMGTOti
Fax: (360)458-3144
Applicant:
Name: JOHN BICHLER Phone:
Address: 13003 RAINIER ACRES RD
RAINIER WA 98576
Property Information:
site Address: 109 93RD AVE SW owner:
Assessor Parcel No.: 21724210401 Subdivision: Lot:
Project Information:
Project: UTILITY
Description of Work: SEWER CONNECTION
Fees:
Item Units Fees
SEWER ERU 1 $6,393.54
SEWER INSPECTION FEE 1 $ 145.00
TOTAL FEES: S 6,538.54
PAYMENTS MADE: E 0.00
BALANCE DUE: S 6,538.54
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Q�,�� T�p Ci ty o f Ye Zm Date Received
By
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I Communtt 'Develo ment
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Department
NEW WATER/SEWER
�L MM T°N A.PpLICATION
All pertnits are non-transferable and will expire if work authorized by such permit is not begun
within 780 days of issuance, or if worlc is suspended or abandoned for a perlod of 180 days
AlL CONTRACTORS ARE REQUIRED TO PROVIDE A COPY OF THEIR CONTRACTOR'S
REGISTRATION CARD AND PROOF OF A CURRENT CITY OF YELM BUSINESS LICENSE.
I'�i NEW SEWER AND/OR WATER CONNECTION APPLICATION FORM
Project Address: i C� �I � 3 �� f�v� SC Parcel#: 2 I '7 Z �z i u K o L ,
Subdivision: 1✓ ��- Lot#: N� � Zoning; G - f
i o Water Connection '�f Sewer Connection
Are there any environmentally sensitive areas located on the parcel? n!C
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Sn�� � i��N nJ`/ �i e t-+�F CL
ADDRESS i 3 ��: 3 '�z�r,v �F� l��e �� EMAIL
._., CITY �t2,4�.�J1�� STATE�A- ZIP 9�S�C� TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
i 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#
SEPTIC INSTALLERICONTRACTOR IZ G c� �r.� c�;, TELEPHONE 4�c� -o `7 y O
ADDRESS �a �B C� � � z-� EMAIL �� � � ;,✓C� ✓�, �.v�
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CITY_ �a���e,� STATE W.�-- ZIP 9'�s� FAX �c�o - c� �'� �
CONTRACTOR'S LICENSE#����o,�ls q� EXP DATE� � ITY LICENSE# I'�- dC� Z 3 ���Ca
j 1 hereby certity that the above ir�formation 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
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City o,Yelm.
� , ���l���G'��� .�� /� l3�`G /,� �' -/�5�� - �---
� � EIVED
, ,�.� pplicant's Signature Printed Date
,° AUG 15 2013
�,�:
105 Yelm Aue W (360)45&3835
Yelm,WA 98597 360 458-3144
f ) FAX
www.ci.yelm.wa.us
93RD AVE SE
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