20130338 Permit Pkg 10142013 �pf TH�A�� City of Yelm Permit ►vo.: 20130338
ti 7
� 7� Community Development Department Issue Date: 10/14/2013
d �► (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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asHlM4iPM Fax: (360)458-3144
A li ant:
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Name: MATT&DIANNE CAREY Phone:
Address: 9225 MTN VIEW RD SE
YELM WA 98597
Property Information:
Site Address: g225 MTN VIEW RD SE Owner: MATT CAREY
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: MATT&DIANNE CAREY Phone:
Address:
9225 MTN VIEW RD SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
II i n:
Pro�ect Informat o
Project: ROOF
Description of Work: REROOF. DRIP EDGE FLASHING REQUIRED.
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF MATT&DIANNE CAREY $ 25.00
TOTAL FEES: $ 25.00
ApplicanYs Affidavit: OFFICIAI 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 Sta�of Washington.
�,.-y/�`=� �—� _ � �o_� _ / 3 Date:
Signature Date y
Firm � By:
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R�C#. 001 TERM: 001
QPER: CO
REF#; MC �UILDING PERMITS
TRAN: 33.0000 25,OOCR
2�13�A EY, MAT1 � DIANNE
9225 MTN VIEW Rd �E
�S,OOCR
ROOF OTHER
25.00
DEREQ: 5.00-
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
,�^-- Project Address: �r = �= `' "'' T � - � ` °` - Parcel#:
�`'"� Subdivision: Lot#: Plan#: Zoning:
❑ New Construction ��` Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: ; � ' t
,
Project Value: � �
Building Area (sq. ft) 1St Floor 2"d Floor 3�d Floor Garage-2 car�3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: ; � ` r' � '
ADDRESS ,- ,. �� ,� � ��, l�� , _- EMAIL �l r �-„���� � .,�:�-�!� � � �- .
CITY �� � ' � STATE �- � '� ZIP TELEPHONE '- -/ "
`���> _, :+,y � •
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_ ""�" � �-
MECHANICAL CONTRACTOR TELE �r ,'� ���� �
ADDRESS EMAI
CITY STATE ZIP FAX_
CONTRACTOR'S LICENSE# EXP DATE_
J� I l c' �
Copy of mitigation agreement with Yelm Community : I' J �� �/l c �\�°�v�V,e.�
I hereby certify that the above information is correct and that the constru _,�ancy and the 4��
above described property will be in accordance with the laws,rules and r _.._..�tne State of Washington and the
City of Yelm.
_ — � _ `/ / ..�
Applicant's Signature Date
Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.)
All permits are non-transferable and will expire if work authorized by such per ������ED
within 180 days of issua Ge, or if wo,�[,��s suspended or abandoned for a period of 180 ay
`�` OCT 14: 2a13
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''�' ._..y,...._..�����/��� BY:
I05 Yelm Auenue West (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.w¢.us