20130299 Permit Pkg 09162013 'f''�oF TH�A,A'� City of Yelm Permit No.: 20130299
�
� � Community Development Department Issue Date: 9/16/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELM
Fax: (360)458-3144
Applicant:
Name: JOHN BICHLER Phone: 360-789-9085
Address: 13003 RAINIER ACRES RD
RAINIER WA 98576
Property Information:
Site Address: 109 93RD AVE SW Owner: .lohn Bichler
Assessor Parcel No.: 21724210401 Subdivision: Lot:
Contractor Information:
Name: RAINIER GENERAL DEVELOPMENT Phone: 360-400-0740
Address: DOUG BLOOM
P.O. BOX 627
RAINIER WA 98576
Contractor License No.: RAINIGD115QL Expires: 1/01/2011
Project Information:
Project: UTILITY
Description of Work: SEWER CONNECTION
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SEWER RAINIER GENERA�DEVELOPMENT $6,538.54
TOTAL FEES: $ 6,538.54
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 th�e f Washington;
Signature � ��•� ��n � Date Q — � '!� Date:
Firm By�
�pF TNFp� City of Yelm Permit No.: 20130299
O �
� � Community Development Department Fee Calculation Worksheet
Building Division
Phone: (360)458-8407
L
"'.`"'"`_°" Fax: (360)458-3144
Applicant:
Name: JOHN BICHLER Phone: } (Ca`��9 %C��',��
Address: 13003 RAINIER ACRES RD
RAINIER WA 98576
Property Information:
site Address: 109 93RD AVE SW Owner: ryy��`� -��, ,�,G�
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: S 0.00
BALANCE DUE: S 6,538.54
Cit� of Yelm
(36 } 458-8402
REC#: 00138994 9/16/2013 12:01 PM
�PER: CO TERM: 001
REF#: 5005
TRAN: 33.0000 BUILDING PERMITS
20130299 6,53B.54CR
BICHLER, JOHN
109 93RD AVE SW
SEWER 6,53B.54CR
TENDERED: 6,538.54 CHECK
APPLIED: 6,538.54-
CHANGE: 0,00
OWl�V��
�,�� T�p Ci ty o f Ye Zrri D e Received
By
� File No.
°' Community�Development
Department
NEW WATER/SEWER
EL„M TON APPLICATION
Ali permits are non-transferable and wi11 expire if work autho�ized by such permit is not begun
within 180 days of issuance, or if work 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.
NEW SEWER AND/OR WATER CONNECTION APPLICATION FORM
Project Address: 1 C� �I `� 3 �� A v� S E Parcel#: 2 i �7 Z �(z i�K o L
Subdivision: �V �/� Lot#: N� � Zoning; G - 1
❑ Water Connection '� Sewer Connection
Are there any environmentally sensitive areas located on the parcel? ,�O
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: �'���' �{ ��N tit Y �i c i-+G�CL
ADDRESS i 3 ��: � 'R f!r�v ��� f}�ce �+> EMAIL
,� CITY ���.�v��� STATE�A- ZIP 9�S�C.G TELEPHONE - -
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ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
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 INSTALLER/CONTRACTOR 1Z G r� t� c�, TELEPHONE_!.��c� -r� `74 O
ADDRESS �G ��;�.� �t � z-7 EMAIL ���,��n c d- s��/'te ✓e, w�vt
CITY ��x t�1�e� STATEw•�- ZIP 9'�'s� FAX �l c�o - c� g'z �
CONTRACTOR'S LICENSE#R��...�Ue,us 4�- EXP DATE� t - ITY LICENSE# (�- 6t� Z� �3��
1 hereby certify that the above information 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
City o,Yelm.
��`��������� .s� � �-� �3�`� ��,� �- -�y�- - ,�
; �.,� pplicant's Signature Printed Date
EIVED
; AUG1 � 2013
I
�:�':
105 Yelm Aue W {360)45&3835
Yelm,WA 98597 (360)45&3144 FAX
wwm.ci.y¢Im.wa.us
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