20130356 Permit Pkg 11142013 ",Ytio� ''"�A� City of Yelm Permit No.: 20130356
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� � Community Development Department Issue Date: 11/74/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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wiFNiNGTON Fax: (360)458-3144
Applicant:
Name: REBECCA THOMAS Phone: 360-458-6544
Address: P.O. BOX 936
YELM WA 98597
Property Information:
Site Address: 404 MCKENZIE AVE SW Owner: REBECCA THOMAS
Assessor Parcel No.: 75300501500 Subdivision: Lot:
Contractor Information:
Name: REBECCA THOMAS Phone:
Address:
P.O. BOX 936
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: RESIDENTIAL REMODEL
Description of Work: FIRE SMOKE DAMAGE-NO STRUCTURAL DAMAGE
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING REBECCA THOMAS $ 748.75
ROOF REBECCA THOMAS $ 25.00
TOTAL FEES: $ 773.75
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify that I have read and examined the infortnation contained within the application and know the same
to be true and correct. 1 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 1 am currently Final Inspection:
registered in the S te of Washington.
Signature Date ' ` .. Date:
Firm BY�
�. !'�f•�/�G��� 8�J� ��
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Cit� of Y�lm
(�� ) 458-8402
REC#: �1014418Q 11/14/2013 11:17 AM
OPER: CO rERM: 001
REF#; LAM
T�AN: 33.0000 BIJYLDING PFRMITS
20130356 7�73,75CR
iNOMAS, REBECCA
4Q� MCK�NZIE AVk SW
BLDG �748.75CR
RDOF 25.00CR
TENQERED: 773.7� OTHER
APPLIED: 773.75-
CHANGE: � 0.00
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: �� � �G(G�r,�� ��� Parcel#:
Subdivision: Lot#: Plan#: Zoning:
��,
❑ New Construction ❑ Re-Model Re-Ro /Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ o ile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: ��"� S��"'"'�'K� W��'p�' ��� -�""�+�r'''�''�I �J�t*�-f+-S-c,
Project Value: ,� S, GG�
Buitding Area (sq. ft) 1St Floor I7�"' 2nd 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,�.v
/fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: � e «s
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR G�'..y.��'l•��t✓ .���'�ELEPHONE �(�'� '��� $� y/
ADDRESS yG3 7j'�C/c e��,`� �y� EMAIL
CITY e«i�t STATE�ZIP 9'$S!7 FAX
CONTR TOR'S LICENSE# EXP DATE CITY LICENSE#
cS O
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 of Yelm.
!l /,� �3
A c nt s Signature Date
ner/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
� '.-- ------_..
, _:�:CC��VED
_ NOv 13 2013
105 Yelm Auenue West (360)458-3835
Yelm, WA 98597 (360)45,8.-3144 FAX
www.ci.yelm.wa.us �.. '
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