20130288 Permit Pkg 08022013 �p�TH�I►� City of Yelm Permit ►vo.: 20130288
Q '�
� Community Development Department Issue Date: 8/02/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
WAiNMIGTOF Fax: (360)458-3144
Applicant:
Name: RICK/CHERYL DANCE Phone:
Address: 9521 SOLBERG CT SE
YELM WA 98597
Property Information:
site Address: g521 SOLBERG CT SE Owner: CHERYL DANCE
Assessor Parcel No.: 70190000500 Subdivision: Lot:
Contractor Information:
Name: RICK/CHERYL DANCE Phone:
Address:
9521 SOLBERG CT SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: RE-ROOF
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF RICK/CHERYL DANCE $ 25.00
TOTAL FEES: S 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 the State of Washington.
Signature Date �
Q Date:
Firm By'
�lt� Of �e��l
(36 ) 458-8402
REC#; U0134705 8/02/2013 2;11 F'M
OPER: CO TERM: 001
REF#; 9172
TRAN: 33,0000 BUILDING PEI�MITS
20130288 25.qOCR
DANCE, RICK/CHERYL
9521 SOLBERG CT SE
ROOF 25.00CR
TENDERED; 25.00 CHECK
APPLIEp: 25,00-
CHANGE: 0.00
�13 0�-�
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 9521 Solberg Ct SE Parcel#: 70190000500
Subdivision: �ot#: Zoning;
New Construction �(� Re-Model/Re-Roof/Addition 1 Home Occupation Sign
Plumbing — Mechanical — Mobile/Manufactured Home Placement - Other
Project Description/Scope of Work: Remove/replace 21 sq. comp. roofing; no plywood replacement
ProjectValue: $10,152.86
Building Area (sq. ft) 1St 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: Cheryl Dance
ADDRESS 95zt so�be�9 ct sE EMAIL
C�TY vE�M STATE WA ZIP 9es9� TELEPHONE 360-458-9719
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR Home Depot At Home Svcs. TELEPHONE 800-381-5699
ADDRESS tao counry�ine Rd#�o�, EMAIL
CITY PACIFIC STATE wA ZIP 98047 FAX
CONTRACTOR'S LICENSE# HOMED�•972RQ EXP DATE2i�5 CITY LICENSE# oo�ais.o
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 anv Yhe use of the
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
Cify of Yelm.
�
Ap icant's Signature Dat
Owner/Contractor/Owner's Agen Contractor's�yeF� (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
�'�'`"r'''�`',�V�'.�
AUG Q 2 2013
105 Yelni Auenue West (360)458-38,3,�
PO Box 479 (360)45 �X4:
Yelm, WA 98597 www.ci.yelm.wa.us