20130365 Permit Pkg 12162013 �'`�p� tHEp�� Clty of Yelm Permit ►vo.: 20130365
.
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a � Community Development Department Issue Date: 12/16/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELM
Fax: (360)458-3144
Applicant:
Name: YELM PROPERTY DEVELOPMENT Phone: 360-458-0544
Address: P O BOX 2950
YELM WA 98597
Property Information:
Site Address: 16669 GREENLEAF AVE SE Owner: YELM PROPERTY
DEVELOPMENT
Assessor Parcel No.: 84070010000 Subdivision: WILLOW GLENN Lot: 100
Contractor Information:
Name: YELM PROPERTY DEVELOPMENT Phone: 458-0544
Address: DENNY BALASCIO
P O BOX 2950
YELM WA 98597
Contractor License No.: YELMPDL00302000 Expires: 2/20/2011
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: LOT 100, PLAN 2565J
Sq. Ft. per floor: First 955 Heat Type(Electric, Gas, Other): GAS
Second 1241
Third
Garage 393
Basement
Fees:
Item Contractor Fees
NEW RESIDENTIAL BUILDING YELM PROPERTY DEVELOPMENT $16,754.37
MECHANICAL SUNSETAIR INC $ 71.75
PLUMBING TOP NOTCH PLUMBING INC $ 118.00
TOTAL FEES: $16,944.12
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 the State of hington.
Signature
,�� �. C Li.c� Date /��/G�2oJ3 Date:
Firm By�
_
Cit� of Y�lm
(36 } 458-8402
REC#; 00146928 12/16/2013 11 ;25 AM
OPER: CO TE�M; 001
REF#: 6466
TRAN: 33,OOQ0 BUILDING PERMITS
20130365 16,944,12CR
YELM PRUPERTY DEVEI.OPMENT "
16569 GREENLEAF AVE SE
BLD-RESt 16,754.37CR
MECH 71 .75CR
PL 118.00CR
TENQERED: 16,944.12 CHECK
APPLIED; 16,944.12-
CHANGE; 0.00
YELM CPOMBpXT4��GH00LS
YELM WA 98597
Clerk: Croy
Terminal : 1
Recei pt; 233987(Reprint)
Manual Receipt;
YELM PROPERTY
YELM PROPERTY
YELM PROPERTY, QEVEL�PMENT LLC
,
12J16/2013 11 ,13 AM
p�� Item _��_ _�.__�..___.___Price
� CPF MITIGATION ��'�.'�0
MITIGATION
07-015/LQT 1Q0/16669 GREENLEAF AVE SE;YE
Subtotal : ���p;00
Tax; 3015.00
Total;
Check 3�15.00
6465
Change que: 0�00
R�PRINT RECEIPT
TNANK YOU
CITY OF YELM ' "�� ��y'� �
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Pruject Address: ����� C��En���+���� ���. Parcel#:
Subdivision:��.lt1��j Lot#: OQ Zoning; ��l�
� New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical o Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: � �l� I !�"� ��`��su
Project Value: �ZG�, L7�� ,�,�� L� ��
Building Area(sq. ft) 1St Floor 95s 2nd Floor /Z y/ Garage 3 1,3 Deck
.,
Basement '��l���r��:-1' �.��'cn^��G �b Patio �'���' �� ��%�G �� � n_,J
# Bedrooms� � �Bathrooms�� Heating GAS/OTHE r ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? � If yes, a
completed environmental checklist must accompany permit application.
SIJI�.DING 4WNER NAME: e w� ��c +� � r':�'e ':.a'�c " �
ADDRESS o � EMAIL
CITY ��' Wt.. STATE ZIP S TELEPHONE �SS �a �
ARGy1TECT/�,NGWEER�o � �. - LICENSE#
ADDRESS U` a +'zrn r� EMAIL
CITY �it e(. STATE�ZIP ' -" TELEPHONE 3 � /Z
W7o-i
GEN�RAL CONTRAGTOR �.. TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLiJMBING C�NTRACTOR n C TELEPHONE a��.'
' ADDRES S ,."�4' �''`�� EMAIL
CITY�crtfl�Q'r" STATE�_ZIP `?.� � FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
11AECHANICAL GONTRACTOR " TELEPHONE 'S��a�" ` '%�'�
ADDRESS Z�C� AG� �V EMAIL
CITY L�L�E� STA E ZIP .��'C' FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
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 of 1'elm.
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Applicant's Signatu Date
Owner 1 Contractor/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
I —I
__ .�
� I05 Yelm Auenue West (360)458-3835
PO Box 479 (360)458-3I44 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
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