20140222 Permit Pkg 08212014 �pF THEA�~"� City of Yelm Permit ►vo.: 20140222
� � Community Development Department Issue Date: 8/21/2014
d sn (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
"»'"y`°" Fax: (360)458-3144
Applicant:
Name: NORTHWEST FAMILY HOMES Phone: 360-791-5644
Address: PO BOX 39
EAST OLYMPIA WA 98540
Property Information:
Site Address: 14715 91ST AVE SE Owner: NORTHWEST FAMILY HOMES
Assessor Parcel No.: 33860005000 Subdivision: BELLA HOUSA Lot: 50
Contractor Information:
Name: NORTHWEST FAMILY HOMES Phone:
Address:
PO BOX 39
EAST OLYMPIA WA 98540
Contractor License No.: NORTHFH9546E Expires: 1/05/2013
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: LOT 50, PLAN 2590
Sq. Ft. per floor: First 1251 Heat Type(Electric, Gas, Other): GAS
Second 1539
Third
Garage 429
Basement
Fees:
Item Contractor Fees
NEW RESIDENTIAL BUILDING NORTHWEST FAMILY HOMES $17,511.91
MECHANICAL SUNSET AIR INC $ �8.25
P�UMBING ACME PLUMBING $ 132.00
TOTAL FEES: $17,722.16
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 S e of ashington.
t� ����j Date:
Signature Date Gi /
Firm i/�(/1��.(/`�Q/�` �l�G`/"���' BY.
_ .
REP�INT
YELM COMMUNITY SCHOOLS
PO BOX 476
YELM WA 98597
R�ceipt #: 26�033 Clerk: Croy 1���� �� ��I�
Manual #. Terminal: 1 (36 } 458-fl402
8/21/201A 10:1� AM REC#: 00170021 fl/21%2014 10:20 AM
UpER: CO TE.RM: C10�
NN4V FAMILY NGMES REF#: 8Z2
NNW FAMILY HOMES
NQRTMWEST, FAMILY HQMES J�qN; 3:�.OUC�O BtJII.UING F'ERMITS
74�6 MANZANITA DR NW 2014Q22'"L 17,�2?.1nCR
OLYMPIA, WA 98502 NORTHWE�7i FAMILY HOMES
14715 91ST AVE $�
Pr�ice BLD-RE51 1T,511 .�1C;�
q_�_ Item _ — -- -- _ ME�H 78.25CR
1 CRF MITIGATION 3015.00 P� 13��OOCR
MTTTGATION
07-016/LOT 8/14808 91ST AVE SE;YELM TRAN: 33.UOOG BUTLQING PE�tMITS
20140223 17,722.16CR
1 CPF MIT�GATION 3G15.00 NOR�HW�S�T FAMILY I�OMES
MITIGATION 14808 91S"T AVE S�
BLL�-RES1 17,511 .y1CR
07-U16/LOT 50/14715 91ST AVE SE/YELM pLCH 78'25CR
13L O�CR
Subtotal 6Q30.OQ
Tax 0.00 TENDEf�ED: 35�,4��.32- CHECK
Total 6030�00 pPPLIEq:
Debit/Credit 6030,00 CHANGE. V.r p,a0
Change Due O.OU
THANK YOU
��� z���
CiTY OF YELM
RESIDEI�fT1AL Bt11LDING PERMIT APPLtCA710N FORM
Project Address: '�'I��� ����� f e Parcel#: 3 3�� OOD�� �a
Subdivision:Q���� �k�ti Lot�: �� Plan#: ��� (� Zoning:
.,y�i'�fVew Constructian i� Re-Model/Re-Roof/Addltion �; Home Occupation Sign
� i Piumbing ._� Mechanicaf �:i Mobile!Manufactured Home Placement �� Other
Project Description/Scope of Wo k: l-i}b•t l��! t�ca v'�" f�+� �1.� �F��
Projecf Value: ��1��
Buiiding Area(sq. ft} 15�Floor �Z�� 2"d Floor IS� I Garage�� Deck
Basement Carport Pa#io� r' �y
#Bedrooms ��" . #Bathrooms��Z Heating: AS THER or ELECTRIC{Circle One)
Are there any environmentally sensitive areas located on the parce!?
lf yes,a comp)eted environmental checkiist must accompany permit appiication_
BUILDtIVG O}�NER NAME: (1,�;;?r'�-G��,.�.''3��- �s•i�i , -� t �"� �' �
ADDRESS f -4� �G�r� ��i EMAIL �'f�i�it�t.'Pr'� r� � �i✓t��c:i;s'�. tY1�
CIN�ts r'��' tl! ;�v� �`°�STATE Lv+rfi ZIP C��,�3 TELEPHONE ��0�] 11-SZ�i�
ARCHITECT/ENG(NEER %�'t+:�t`Yti��s'L'�,- E''`j 1�r r''�'i�.1'CENSE#
ADDRESS (I'31'"�� L��� l��yft' U�- ��-' EMAIL
CiTY�i�p�a w�f�° STATE i.�.�.� ZfP�j�.s i 1. TELEPHONE
� GENERAL CONTRACTOR/�%r�°1��+�✓�'!1- l'r:ebr�i'J� I�ii�iTELEPHONE '3��'`��l f- S�' ��!
ADDRESS ��.i?. 1��'� 3�f EMAIL i^3��G�C�ri`•rrf: �'GV��G'�:.f`f.f��`�
C1TY�i:�t�' ��I�ix���niE� 57ATE �1.�.%:� ZIP��S`I��' FAX
CONTRACTOR'S LICENSE#sAiy(!n�1=HtiSNl�c EXP DATE CITY LfCENSE#
l-S-i�
PLUMBING CONTRACTOR J���'�L !l�'bf�il3il� �'" TELEPHONE 3LC �'`f�f f- �:3��L!
ADDRESS��,i� F i y�;`T G+�;• r EMAfL
CtTY r,�I��u��;'�. STATE w,�� Z!P 9��s"i3 FAX
CONTRACTOR'S LICENSE#R�i�aEPL��iti 3��' EXP DATE CITY LICENSE#
3 --�- �
MECHANtCAL CONTRACTOR J%��.�sl'�C:�� TELEPHONE Lf�?� °-LI�i.3(�
IADDRESS �.'-+�.� Lt}���i f�'1��Gt EMAIL
CITY ),.r,;� �c� STATE L�-�� ZIP 1���?3 FAX
' CONTRACTOR'S LICENSE#lr,�N.i��r�t'LtrlGrw EXP DATE CITY LICENSE#
2 -?--( ..
Copy of mitigativn agreement with Yelm Community Schools,ifi appliCable.
(hereby certify that the above information is correct aad thai the construction o�,and the occupancy and the use of the
above described property wilf be in accordance with the laws,rules and regulations af the State of Washington and the
City of Yelm.
9
�.�-� � �� 7� �� '/�9
Applicant's Signature Date
Owner/Contractor/Owner's Agent!Contractor's Agent{Please circle one.}
All permits are non-transferabte and will expire if work authorized by such permit is not begun
within 4 SO days of issuance,or if work is suspended or abandoned for a period af 180 days
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