20140275 Permit and Payment Receipt 11072014 �o'� t�'�o� City of Yelm Permit No.: 20140275
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� �� Community Development Department Issue Date: 11/07/2014
o. e++ (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
LM
°'""'""°" Fax: (360)458-3144
Applicant:
Name: EASTHAVEN VILLA Phone: 503-357-3793
Address: c/o BEEHIVE MANAGEMENT
FOREST GROVE OR 97116
Property Information:
Site,4ddress: 111 KILLION RD NW Owner: EASTHAVEN VILLA
Assessor Parcel No.: 21724140600 Subdivision: Lot:
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Contractor Information:
Name: EASTHAVEN VILLA Phone:
Address:
c/o BEEHIVE MANAGEMENT
FOREST GROVE OR 97116
Contractor License No.: Expires: 0/00l0000
Project Information:
Project: LAND SITE PLAN REVIEW
Description of Work:
Sq. Ft. per floor: First Heat Type (Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BOUNDARY LINE ADJUSTMENT EASTHAVEN VILLA $ 100.00
LAND CUP EASTHAVEN VILLA $ 250.00
ENVIRONMENTAL EASTHAVEN VILLA $ 150.00
SITE EASTHAVEN VILLA $ 1,500.00
TOTAL FEES: $ 2,000.00
Appli nYs Affidavit: OFFICIAL USE ONLY
I certi that I have read and examined the information contained within the application and know the same
to be rue a corr I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm regul t� s includi g those governing zoning and land subdivision,and in addition,all covenants,
ease ent a d restri ' ns of record. If applying as a contractor,I further certify that I am currently Final Inspection:
regis red n St of Washing n.
Date:
Signat e ` Date �
By:
Firm
Ci� of��lmo�
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V�EC#� OQ177296 .11�a�17/LO�� 2:45 PM
OPER: CO TERM
REF#. 1153
TRAN: 33.�00� BU�2 OpO.GOCRIjS
ZU140275
EASTNAVEN VILLA
111 KI�LION R� N�
��A 100.QOCR
CUP 250.OQCft
ENV 15t).00CR
SITE 1 ,500.00CR
TENDEkED: 1 ,9U0.00 CHECK
1p0.00 CHEC,K
APPLIED: 2,�00�00-
CHANG�:: �� 0 �0