20120293 Permit Pkg 01162014 ��o� TH�p,�' City of Yelm Permit ►vo.: 20120293
� 7� Community Development Department Issue Date: 1/16/2014
� t+� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELM
""""'"°'°" Fax: (360)458-3144
Applicant:
Name: LIVING WELL CHIROPRACTOR Phone: 360-458-7533
Address: 1412 YELM AVE E
YELM WA 98597
Property Information:
Site Address: 1412 YELM AVE E Owner: LIVING WELL
CHIROPRACTOR
Assessor Parcel No.: 22730140202 Subdivision: Lot:
Contractor Information:
Name: LIVING WELL CHIROPRACTOR Phone:
Address:
1412 YELM AVE E
YELM WA 98597
Contractor License No.: Expires: 0/00l0000
Project Information:
Project: SIGN
Description of Work: BACK WALL SIGN
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SIGN LIVING WELL CHIROPRACTOR $ 20.00
TOTAL FEES: $ 20.00
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 restrictions of record. If applying as a contractor,I further certify that I am currently Final Inspection:
registered in he State of n.
, i l /� � � Date:
Signa Date � V�
By:
Firm
C�ty o��e$m��
(360) 10:23 AM
00149�n3 1/1�/2014
REG#: �ERM; Oa1
ppER; CO
�E�#; MC
33.00�0 BUI�DING PERMITS
TRAN: �O.00CR
2012�Z9�
�IVINU��M �V� �Op�AC�f�
1412 y 20.00CR
gIGN
20.Q0 O�CNER
TENOERED: 2Q.00-.
APPLIED.
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CHANGE:
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CITY OF YElM
SIGN PERMIT APPLICATI�N FORM
Project Address: /'�I I Z Y�rv►? ��.� Paresl#: Lt /O !
Zoning; m°`�� ��'� Current Use: ���''�n?�''�'•w� Proposed Use: °T�"""e
Type/Number of Sign(s}(wall,monument,lighted,etc.):_T_l �, ����
t t� r� /
Dimensions af Sign(s):_ f�� � �C 'T a� ��c��
Building Gross Floor Area(sq.ft):��.�'�i ��1�
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Bui(ding Height: ��
Existing Signage(if any)and dimensians: yPo�(,Q, w! Jo�..� r ann.-avu.�
�
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Last ame First Nam
ADDRESS '� Cio 1 EMAIL r ' �� �:-,,p�1rv ��-, c�orv�
CfTY STATE ZiP TELEPFEONE -
� '
ADbRESS EMAIL
CITY STATE ZIP TELEPHONE��3- 3�'� `//7
i ' W l
ADDRESS C- !o EMAIL
CITY STATE�ZIP �'g5�97 TELEPHONE S
wi/f �at, i� '
r' TELEPNONE ' Z•�-'�y '_SGyy
ADORESS EMAIL
CI7Y STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY UCENSE# -G��/ �f, �
f hereby certlfy that the above information is corract and that the constnictfon of ths above described sign will be In
acco�dance s,rules And regulatlons oi the State of Wash[ngton and the Clty of Yeim.
�. C,,,�_�' C�--� '
ApplicanYs Sign ure D�
Owner 1 Contrac or/Owner's Agent/Contractor's Agent/Tenant (Please circfe one.)
AI!permits are non transferable and will explre if work authorized by such permit is not begun
within 180 days af Issuance,or if work is suspended or abandaned for a period of 180 days
l05 Yelm Aaenue Weat (360)468-3835
PO Box��9 (860)458-3I44 FAX
Yelm,WA 98597 wrvr�.ci.yelm.wa.us
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