20140244 Permit Pkg 09082014 �aF THEO�, City Of Yelm Permit No.: 20140244
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� � Community Development Department Issue Date: 9/08/2014
� en (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
"'.""'"`_°" Fax: (360)458-3144
Applicant:
Name: REX MIKLER Phone:
Address: 203 EDWARDS ST SW
YELM WA 98597
Property Information:
Site Address: 203 EDWARDS ST SW Owner: REX MIKLER
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: REX MIKLER Phone:
Address:
203 EDWARDS ST SW
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: REROOF DUPLEX
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage �
Basement
Fees:
Item Contractor Fees
ROOF REX MIKLER $ 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 restrictions of record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the ate of Washington.
. � . , Date:
Signature Date
By:
Firm
i
Git� �f Yelm
(36 ) 458-8402
REC#: 00171206 9/0$/2014 2;24 PM
OPER: CO TERM: 001
REF#;
TRAN; 33,0000 BUILDING PERMIrS
20140244
MIKLER, REx 2�•OOCR
203 EDWARDS ST SW
ROOF 25.00CR
TENDEREfl; 25.00
ANPLIEp; OtHER
25.00-
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CITY OF YELM
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RESIDENTIAL BUILDING PE�IVI�T AP�16�4TION FORM
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Project Address:Z I ( �dl��t.� S Parcel#:
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction �CRe-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/ Manufactured Home Placement ❑ Other
Project Description/Scope of Work: /^t - r v a 'f' /7✓ D/!. Y
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Project Value: �p C7v
V
Building Area (sq. ft) 15' Floor ZJU 2"d 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?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: • �'
ADDRESS �I�.� �� - /�Ir��. SG� EMAIL t�. rh. C. -�.r G~t �Is* < <-" "�
CITY t STATE w�- ZIP �yY'c� � TELEPHONE b
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 of Yelm.
, � , 5. - < <.{
pplicant's Signature Date
Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.)
All permits are non-transfe�able 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
�
105 Yelm Avenue West (360)458-3835
Yelm, WA 98597 (360) 458-3144 FAX
www.ci.yelm.wa.us