20130316 Permit Pkg 09042013 �oF rtH�p� City of Yelm Permit No.: 20130316
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a Community Development Department Issue Date: 9/04/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
"".`"'""°" Fax: (360)458-3144
Applicant:
Name: RANDY PAIGEN Phone:
Address: PO BOX 625
YELM WA 98597
Property Information:
Site Address: 715 YELM AVE E Owner: RANDY PAIGEN
Assessor Parcel No.: 22730120102 Subdivision: Lot:
Contractor Information:
Name: RANDY PAIGEN Phone:
Address:
PO BOX 625
YELM WA 98597
Contrador License No.: Expires: 0/00/0000
Project Information:
Project: SIGN
Description of Work:
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SIGN RANDY PAIGEN $ 20.00
TOTAL FEES: � 20.00
Applicant's 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 restridions of record. If applying as a contractor,I further certify that I am currently Final Inspection:
registered in tate � gton.
Signatur
—'�"' Date � �' I 13 Date:
By:
Firm
r ,
Cit� of Yelm
(36 ) 458-8402
REC#: 00137417 9/04/2013 12:36 PM
OPER: CO TERM: 001
REF#; 4706
TRAN; 1 .0000 COUNTER PAYMENT
05-1124-00 PAIGEN, RANDY((I))
PAYMENT ON ACCOUNT 211 .66CR
*PAID IN FULL�
TRAN: 1 .0000 COUN1'ER PAYMENT
05-1126-00 PAIGEN, RANpY
PAYMENT ON ACCOUNT 229,53CR
�PAID IN FULL*
TENDEREp; 441,19 CHECK
APPLIED; 441.19-
CHANGE, 0.00
w
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CITY OF YELM
SIGN PERMIT APPLICATION FORM
Project Address: 7�.7 ���r� j�L3 E Parcel#:
Zoning; �-������C � � �' Current Use: ��'ry`�=- Proposed Use: ����
Type/Number of Sign(s) (wall,.�nonu_ ment,llighted,"etc.):� - � S i��D S ��i-� (3 tJ !�i 3�e�`�
t.<� � G� �� c r�
Value of each Sign: `
1/ ;i -
Dimensions of Sign(s): l0�: J'� x �� .�c� J� c�������� ��n��S�"����, S iy�,. „ �. „�� e���/
,S4'i,�.r�� �a�?��w �P-e►� L�'r�`c,� ('�' l l q r-�'.
Building Gross Floor Area (sq. ft): �O;c'�C�L�
Building Height: �� �
Existing Signage(if any) and dimensions: �'► t rn�t'i�i°1
APPLICANT Rt G��t Al�.�D Y
Last Name First Name
ADDRESS i�0 t�DX la 2'a EMAIL �17 (C,►=� �� � t J�-�C'.CS r"l
CITY � �M STATE�ZIP9�3�9 7 TELEPHONE � io� 7a l ?v ��
BUILDING OWNER 5 AY►'�`°..
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
BUILDING TENANT �1�m �
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
SIGN CONTRACTOR S R I'1'] E'_ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
I hereby certify that the above information is correct and that the construction of the above described sign will be in
accordance with the laws,rules and regulations of the State of Washington and the City of Yelm.
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Applican 's Signature Date
Owner I Contractor/Owner's Agent/Contractor's Agent/Tenant (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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9 �I ;,�-�..�l�l,v+C.����
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105 Yelm Aue W (360)458-3835
Yelm, WA 98597 (360) 458-3144 FAX
www.ci.yelm.wa.us
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