20140258 Permit Pkg 10102014 '�'/o� �H�o,p, City of Yelm Permit No.: 20140258
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� � Community Development Department Issue Date: 10/10/2014
� ns (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
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""'"`_°" Fax: (360)458-3144
Applicant:
Name: FLOYD W JR CUMMINGS Phone:
Address: PO BOX 24
YELM WA 98597
Property Information:
Site Address: 614 CRYSTAL SPR RD SE Owner: FLOYD CUMMINGS
Assessor Parcel No.: 22719240200 Subdivision: Lot:
Contractor Information:
Name: FLOYD W JR CUMMINGS Phone:
Address:
PO BOX 24
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 FLOYD W JR CUMMINGS $ 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 zo ing and land subdivision, and in addition, all covenants,
easements and restrictions of ord. If app ng as a contrador, I further certify that I am currently Final Inspection:
registered in t I ta .of ington.
Signature
Date � � Date:
By:
Firm
Cit� of Y�lm
(36 ) 458-8402
REC#: 001744�1 10/10/2014 2:26 PM
OPER: CO tE�M. Q01
REF#;
TRAN; 33.0000 Bl1ILDT�� QOCRTTS
20140258
CUMMINGS, f=LOYD W JR
614 CRYSTAL SPR�5apOCR
ROOF
TENDERE�: 25.00 CASH
APPLIED: 25,00-
CHANGE: �Y���00
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
� Project Address: �/ J ��/��� s�'��� ST Parcel#:
Subdivision: Lot#: Plan#: Zoning:
i� New Construction ��-Model/Re-Roof/Addition u Home Occupation Sign
1 Plumbing � Mechanical � Mobile/Manufactured Home Placement !' Other
Project Description/ cope of Work: s � �D F ��0� l��''�'�
,�/ �
Project Value: � LCL''��
Building Area(sq.ft) 15` Floor 2"d Floor Gara �z S�� Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: GAS/OTHER or ELECTRIC(Circie One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: LO -�/�� � � �3`
ADDRESS �� T/PC ,,ei "—EMAIL
CITY �G� STATE ZIP 9���7 TELEPH NE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S �ICENSE# EXP DATE CITY LICENSE#
MECHANICA�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 prop y will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
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Applicant nature Dat
Owner/Contractor 1 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 �
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105 Yelm Avenue West �3 ��—'-------__.._
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us