20140102 Permit Pkg 01072014 'f'�o� TH�p,� City of Yelm Permit ►vo.: 20140102
�
� �� Community Development Department Issue Date: 1/07/2014
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
"".""'"°'�" Fax: (360)458-3144
Applicant:
Name: BEV& EDWARD LARKINS Phone: 360-894-7202
Address: 18324 152ND CT SE
YELM WA 98597
Property Information:
Site Address: 15315 107TH LP SE Owner: BEVERLY LARKINS
Assessor Parcel No.: 62310001000 Subdivision: Lot:
Contractor Information:
Name: BEV&EDWARD LARKINS Phone:
Address:
18324 152ND CT SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF BEV&EDWARD LARKINS $ 25.00
TOTAL FEES: $ 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 trictions of record. If applyi �'as a contractor, I further certify that I am currently Final Inspection:
registered in t tate ofVyashin n. �
� Date:
Signature � f Date � ` ��
Firm By:
Cit� �f .Y�lm
(36 ) 458-8402
RFC#: U(1�48251 1/01/�014 1 :03 �'M
OPER; �0 TERM: �O1
RFF#: LAM
1'RAN: 33,U0(lC� BUILDING PERMiTS
20140102 25.CJOCft
LRRKINS, BEU & EDWARD
15315 1077N LP SE
RUOF 25.00CR
TkfJDERED: 25.OU OTHER
APPLI�D: 'L5.00-
CNANGE: ` ~ O.OQ
�_
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
J � n
Project Address:l���l� ��/� �� 5������'y�- Parcel#:
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction �i7 Re-Model Re-Roof Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ o i e/ Manufactured Home Placement ❑ Other
> > ,/ -�- , ��
Project Description/Scope of Work: �s����7� U��ti ��2e' � �� ��S- _
��i�,
Project Value:�k� ��� — ,
Building Area (sq. ft) 1S' Floor� 2"d Floor iti� � 3�d Floor��,� Garage-2 car�3 car��
Covered Patio�� Covered Porch _,"71,r Patio �h� Deck `7'l�i'
# Bedrooms� # Bathrooms� Heating� GASd/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; � ��7- ���- �
ADDRESS � � � � EMAIL _''
CITY .' v– STATE L� �L ZIP � � TELEPHONE � �^ - ' l�
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#
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 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 ofX$Im.
�// ,�' �I ' _ �_ ��
� ,�• � /
plic nt's S'�nature Date
Owner/Co ractor/Owner's Agent/Contractor's Agent(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
�rr`
105 Yelm Avenue West (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us