20130374 Permit Pkg 12312013 �pF TH�p� City of Yelm Permit No.: 20130374
y
� � Community Development Department Issue Date: 12/31/2013
� �� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
"".`"'"`_°" Fax: (360)458-3144
Applicant:
Name: K. PETERSEN PROPERTIES Phone: 360-458-2404
Address: PO BOX 447
YELM WA 98597
Property Information:
Site Address: 309 JEFFERSON AVE NE Owner: LEVINCE GROUP
Assessor Parcel No.: 64420900800 Subdivision: Lot:
Contractor Information:
Name: K. PETERSEN PROPERTIES Phone:
Address:
PO BOX 447
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: BOUNDARY LINE ADJUSTMENT
Description of Work: FOURTH ST AND JEFFERSON AVE NE 309 AND 313 JEFFERSONA AVE NE PARCEL
NUMBERS 64420900500 AND 64420900700
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BOUNDARY LINE ADJUSTMENT K. PETERSEN PROPERTIES $ 100.00
TOTAL FEES: $ 100.00
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify th I have read and examined the information contained within the application and know the same
to be true nd correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm reg lati ns including those governing zoning and land subdivision,and in addition,all covenants,
easemen s res ions of record. If applyi�as a contractor,I further certify that I am currently Final Inspection:
registere in ta of W t .
Date:
Signatur Date
Firm By�
Cit� af_Y�lm
(36 l 4�8-�4Q2
REL'#: OC14714� 12/31/21�13 4:45 PM
OPER; CO TERM: �01
REF#: 1U12
TRAN: 33.00()0 BUTLDl00.DOCR�t�
20130374
�(, �'E�TERSCN PROPERTIES
309 JEFFERS(lN 1a0.00CR
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TENUF�E�: 100.00 Cf�ECK
APPL7ED: 100.0�-
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