20130303 Permit Pkg 08262013 �oF YH�a� City of Yelm Permit No.: 20130303
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a � Community Development Department Issue Date: 8/26/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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"""","'�'°" Fax: (360)458-3144
Applicant:
Name: SOUTH PUGET SOUND HABITAT FOR Phone:
Address: 415 OLYMPIA AVE NE
OLYMPIA WA 98501
Property Information:
Site Address: 412 YELM AVE E owner:
Assessor Parcel No.: 22719340500 Subdivision: Lot:
Contractor Information:
Name: SOUTH PUGET SOUND HABITAT FOR Phone:
Address: CALEB
415 OLYMPIA AVE NE
OLYMPIA WA 98501
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: OTHER SPECIAL EVENT
Description of Work: FREE BIKE REPAIR CLINIC, SEPT 7 THRU 21,2013
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SE SOUTH PUGET SOUND HABITAT FOR $ 0.00
TOTAL FEES: $ 0.00
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 dnd 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,a{�d restrictions of record. If applying as a contra r,I further certify that I am currently Final Inspection:
registered" rthe Stat�of�'Wash'ngton. . ! .
4' I Date:
Signature �� r �;�; -` � � � GMn te � �'
' t By:
Firm ,
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���3 ��a�
'��,of T�p�` City of Yelm
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Community Development Department
SPECIAL EVENT/TEMPORAR Y USE
APPLI CATION
YELM
WASMINGTON
�Special Event Sign Permit (�imited to �4 days,4 times per calendar year)
Tempo�ary USe (property owner permission letter required)
(see REVERSE for regulations)
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NAME OF PROJECT /'r�� � � � ���.✓' � ��i �
APPLICANT/BUSINESS NAME �- �
Mailing Address
,� ,� , � - �/' ������v�
City, State and Zip
Telephone EMAIL
City of Yelm Business License Number C�(' a.t��r , �1��
SITE OWNER a�; �� �f � ,��=�� ��
Mailing Address `�� Z- el� �<�. ��.x-�;r ��- �
City, State and Zip
Telephone �(c :- �7a1�,-3�fS� �x �� EMAIL
SITE ADDRESS/LOCATION ��+�
SITE PARCEL NUMBER
SUMMARY QF REQUEST �� � �h r� �� �
�`�1a ��d�F� � �;� ��v�Ls�;o� -�-� h.�vz � F sa�- ��- :�,�
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START DATE � END DATE 'S e..y 21 . 2� ��
I affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property as reasonably necessary to process this application.
Signed Date
� ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning Section Building Section
105 Yelm Auenue Weat (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us