20140223 Permit Pkg 08212014 �pF THEA�� City of Yelm Permit ►vo.: 20140223
� 7
� � Community Development Department Issue Date: 8/21/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
'""°» 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: 14808 91ST AVE SE Owner: NORTHWEST FAMILY HOMES
Assessor Parcel No.: 33860000800 Subdivision: BELLA HOUSA Lot: 8
Contractor Information:
Name: NORTHWEST FAMILY HOMES Phone:
Address:
PO BOX 39
EAST OLYMPIA WA 98540
Contractor License No.: NORTHFH954BE Expires: 1/05/2013
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: LOT 8, 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 SUNSETAIR INC $ 78.25
PLUMBING ACME PLUMBING $ 132.00
TOTAL FEES: $17,722.16
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants,
easements and restrictions of record. If applying as a contractor,I further certify that I am currently Final Inspection:
registered in the State of Washingt n.
Signature Date v � ���� ! Date:
By:
Firm 2�" lM� ' ?�l.
�EPRI�T
YELM CQMMUNITY SCHOOLS
PO BOX 476
YELM WA 98597
Receipt #: 262033 Clerk: Croy Cit� of V�lm
Manual #: Terminal: 1 (�6 ) 458-�402
8/21J201h 10:17 AM RE.C#: 0017G021 fl/�1%2014 10:L0 AM
UC'ER. CO TE.RM. C101
NNW FAMILY HOMES REF#: 82�
NNW FAMIL'� HOMES
NORTHWEST, FAMII.Y HQMES iRAN: 33.00C10 BUILClING f'ERMITS
7426 MANZANITA DR NW 2�14p222 17,i22.1nCR
OLYMPIA, WA �8502 NORTHWE,�r FAMiLY HOMES
14715 91ST AVE S�
Qty___It�m_ ___ _- _ _Pr�ice �LD-R�51 17,511 .91C,I�
1 CPF MITIGATTON 3015.0� MECH �$�Z���
MITTGATTON p� 132.00GR
07-016/LOT �/14$08 91ST AVE SE;Y�LM TRAN: 3�.U000 BUlLDING PERMITS
2014U�23 17,722.1bCR
1 Cf'F MITIGATIQN 3015.00 NORTHW�ST FAMILY HOMES
MITIGATIDN 14808 91ST AVE SE
BLD-RES1 17,511 ,91CR
07-01"n/LOT 50/147i5 91ST AVE SE/YELM MECH 78o25C,R
p� 134,OUCR
Subtotal 6Q30.OQ
Tax 0.00 TENQEf�tn: 35,444.32 GNECK
Total 6030000 APPI.IED. 35�����32-
Debit/Credit 6030.00 CHANGF: r� ��n�
Ghange Due 0.00
THANK YOU
I�0��,�
�
C(7"Y OF YELM
RESIDEMf1AL BUILDING PERMlT APPLICA7iO1V FORM
Project Address:_�yf�0�3 f l �� /q-trt ,re Parcei#:_ 3 3 86 oa o o �,o 0
Subdivision:��Z��� ►T11�('G, Lot#: g Plan#: Z.r � Zoning:
.�New Canstruction r: Re-Modet/Re-Roof/Addition t; Home Occupation Sign
r i Piurnbing i Mechanicai �:i Mobile/Manufaciured Home Placement �i Other
Project Description/Scope of Wor :��+b•i/'�I t��� t:�t �' �1;� s��2
Project Value:
Building Area(sq. ft) 1St Floor �2S� 2°d Fioor � 3 Garage�� Deck
Basement Carport Patio-Wrcl. Il��/
#Bedrooms� #Bathrooms?�(y Heating: AS THER vr ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
lf yes,a completed environmenfal checklist must accompany perrnit applieation.
BUILDING O NER NAME:_�!;;)d'/--���„�c'3'�- f--� "vi� t �.� r�Y+ t� ,�
ADDRESS �i:� i�L?i� ���J EMAIL ��r, �° � � r� �-c;,;,�v�,c_L;s•�, �1 r�
c c' '
CiTY t'�- sl� w `�STATE Lv�fi Z1P���"�t�3 TELEPHONE_�t�G��7 71-�Z y'�
ARCHiTECTfENGINEER__L�'��'1���!`vt,-. Ey�'��c r��Y1�1�ENSE#
ADDRESS��1� Gi;,�Gc ���;�% L)�. S�-a EMAIL
CITY�t,�;•j�i,J�_�k,- STATE ':-LJ•�} ZfP �j��i L TELEPHONE
_ _ GENERAL CON7RACTOR/�%;'i^tl�b�/�!i- F'u�v�i`�� ��L�n'iTELEPHONE '3 u�''�1/- j�• r1`LI
ADDRESS__��.i,'. I���x 3��� EMAIL _✓'}'6��c CcY�•;� �� �?Lv����;I'f,ltr�
C�� �'�! 4�1 t�ra iG� S7ATE �_ 1.�1:�} ZiP �;vS�l�' FAX °
CONTRACTOR'S ICENSE#niyt?n�FN�i5yl3c EXPDATE CITYLICENSE#
t-S-ij
PLUMBING CONTRACTOR�ei�� •d+s���i3iK% V' TELEPHONE�CC -y<f(- 73.i��f
ADDRESS �"7.�� �'i�a�;`tC�r EMAIL
CiTY_��i��uH y�;'�. STATE t,�,t} ZlP_y�s'13 FAX
CONTRACTOR'S LICENSE#At�•yEPl�=y�j'�r�� EXP DA"fE CITY LICENSE#
._3__� —
MECHANICAL CONTRACTORJc������t C;�1r TELEPHONE �>;Z� �-�/y.37,
ADDRESS_��i�� Li3 c ic� (�j�,�� EMAIL
CITY �„�;� zc,� STATE W� Z�P `i f���� FAX
' CONTRACTOR'S LlCENSE#,li�N.fC-��'La,tc.,v� EXP DATE CITY LICENSE#
Copy of mi6gation agreement with Yefm Community 5chools,if appficable.
f hereby certify that the above information is correct and that the construction o�,and the occupancy and the use of the
above described property wilf be in�ccordance with the laws,rules and regulations of the State of Washington and the
City of Ye(m.
� � '_ Z( —�
Appiicant s Signature Daie
Owner I Contractor/Owner's Agent/Contractor's Agent{Please circle one.)
A(1 permits are non-transferabfe and wiil expire if work authorized by such permit is not begun
vy'�thin 180 days of issuance,or if work is suspended or abandoned for a period vf 180 days
f�
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705 fes'n:ttuererse West --
{360)458 8
Yeirn,WA 98597 1�'Q .�j C��'+�,j'i��°
www.ci.yelm.wa.us {36Q)458- '4°h� ; .
JUL 22 2014 j
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