20140204 Permit Pkg 07102014 �f�`tios rH�o�, City of Yelm Permit No.: 20140204
�
� �� Community Development Department Issue Date: 7/10/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
'"'""'"G=°" Fax: (360)458-3144
Applicant:
Name: ROBERT CECIL Phone:
Address: P.O. BOX 377
YELM WA 98597
Property Information:
Site,4ddress: $05 CRYSTAL SPR RD NW Owner: ROBERTCECIL
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: ROBERT CECIL Phone:
Address:
P.O. BOX 377
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: RE-ROOF
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF ROBERT CECIL $ 25.00
TOTAL FEES: $ 25.00
Applicant's 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. I�ap�ilying as a contra or,I further certify that I am currently Final Inspection:
registered in the St_ e f Wa�hington;/
/ �� /�
Signature ' � rt�fif Date � /� Date:
Firm By�
Cit� of Y�lm
(36 ) 458-8402
REC#: 00165556 7/10/2014 1 :45 PM
OPER: CO TERM: 001
REF#: 6425
TRAN: 33.0000 BUIL.DING PERMITS
20140204 25.00CR
CECIL, ROBERT
805 CRYSTAL SPR RD NW
R�OF 25.00CR
TENDEREQ: 25.00 CHECK
APPLIED: 25.00-
CHANGE: 0.00
����� ���
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:dC��Cf�}�Si7I� Si3Q.N/6 ST Parcei#:
Subdivision: Lot#: Plan#: Zoning:
i 7 New Construction �e-Mod /Re-R /Addition �_; Home Occupation Sign
t� Piumbing -� Mechanical obile/ anufactured Home Placement �� Other
Project Description/Scope of Work: �;�,�'�.+��'-'�
ProjectValue: ��O��d
Building Area(sq. ft) 15i Floor 2nd Floor Garage Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: GAS/OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
/fyes, a completed environmental checklist must accompany permit application.
BUILDING O NER AME: fJ�s� '� _ �'�
ADDRE S • O- d k EMAIL £ r � %
CITY L STAT ZIP S� TELEPHONE 31�1� S S� 83��-/
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
� ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRAC:TOR'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.
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 Yelm.
v�� �• �Lf �
ApplicanYs Signa Date
Owner/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
k
105 Yelm Avenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us