20140234 Permit Pkg 08212014 oF THEP,� City of Yelm Permit ►vo.: 20140234
� ,
� � Community Development Department Issue Date: 8/21/2014
d e+► (Work must be completed within 180 days)
Building Divisio�
Phone: (360)458-8407
L
""'""°" Fax: (360)458-3144
Applicant:
Name: YELM SENIOR CENTER Phone: 458-7733
Address:
Property Information:
Site Address: 16530 103RD AVE SE owner:
Assessor Parcel No.: 64303600302 Subdivision: N/A Lot: N/A
Contractor Information:
Name: YELM SENIOR CENTER Phone:
Address:
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: OTHER SPECIAL EVENT
Description of Work: SENIOR CENTER FUND RAISER,AUGUST 30, 2014
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
SE YELM SENIOR CENTER $ 0.00
TOTAL FEES: $ 0.00
Applican 's Affidavit: OFFICIAL USE ONLY
I certify t at I have read and examined the information contained within the application and know the same
to be tru and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm re ulatio ng those g erning zoning and land subdivision, and in addition, all covenants,
easeme ts a restrict ns of recor . If a plying as a contractor, further certify that I am currently Final Inspection:
register in Stat of Was i t n.
Z/ Date:
Signature Date �
By:
Firm
�,�o� T"Ep ��` City o f Yelm
� 2v1302 ��
� � �
��- Community Development Department
t SPECIAL EVENT/TEMPORA.R Y USE
APPLI CATION
YELM
WASMINCTON
Special Event Sign Permit (�imited to �4 days, 4 times per calendar year)
Temporary Use (property owner permission letter required)
(see REVERSE for regulations)
.
NAME OF PROJECT ^� �
APPL/CANT/BUS/NESS NAME ` �/.� a/� C'` ��� L�
Mailing Address ,
City, State and Zip ` i . 9 �'S9 7 � ��
Telephone - 7 EMAIL �. �
City of Yelm Business License Number c�
SITE OWNER
Mailing Address
City, State and Zip
Telephone EMAIL
SITE ADDRESS/LOCATION 1 S o "l� �
SITE PARCEL NUMBER
SUMMARY OF REQUEST
START DATE �-.�� -- /� END DATE
I affirm that all answers,statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. 1 also affirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property as reasonably necessary to process this application.
Signed �f��1.Cx�( �—,1�j 4�`-�. Date �'" �� —f 7
� ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning Section Building Section
105 Yelm Auenue West (360) 458-3835
Yelm, WA 98597 (360)458-3144 FEIX
www.c i.yelm.wa.us