20150105 Permit Pkg 01292015City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: DALE WOOD
Address: 15708 123RD AVE SE
YELM WA 98597
Property Information:
Site Address: 16351 BIRKLAND ST SE
Assessor Parcel No.:
Contractor Information:
Name: PERKINS CONST. & ROOFING
Address:
P.O. BOX 1085
SPANAWAY WA 98387
Contractor License No.: PERKICR995LN
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Subdivision:
Expires
Permit No.: 20150105
Issue Date: 1/29/2015
(Work must be completed within 180 days)
Phone:
Owner: DALE WOOD
Lot:
Phone: 360.458.5329
12/28/2015
Heat Type (Electric, Gas, Other):
Contractor
PERKINS CONST. & ROOFING
TOTAL FEES:
Applicant's Affidavit:
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
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a co tractor, I further certify that I am currently
registered in the St of Washington.
Signature Date 0
Firm
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Nm
(36 ) 458 -3244
REC #: 00184859 1/29/2015 2:58 PM
OPER: CO TERM: 001
REF #: 6927
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150105 25.000R
WOOD, DALE
16351 BIRKLAND ST SE
ROOF 25.000R
TENDERED: 25.00 CHECK
APPLIED: 25.00 -
CHANGE: 0.00
a1601VCJ-
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 16 _351— 10x3 Rt- hi Parcel
C-5 ,
Subdivision: Lot #: Plan #: Zoning:
[I New Construction )C Re -Model / Re -Roof / Addition Home Occupation Sign
] Plumbing Mechanical Mobile / Manufactured Home Placement _! Other
Project Description /Scope of Work: LO lie fCOT ►^v Y- 1 v
t /
Project Value: W l *it 7 ,
Building Area (sq. ft) 1s` Floor -100 2 "d Floor 6 Garage Deck
Basement Carport Patio -6taI
#
Bedrooms-_J # Bathrooms3 Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
,Xovs.,
BUILDING OWNER NAME: C" p
ADDRESS r i1 .A rxtj EMAIL r :n5-4,r4
CITY STATE c` ZIP TELEPHONE 4G
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR y va(. tc• ELEPHONE --.).
ADDRESS f D.,t)X JD EMAIL r ?� n5 -11 L ,
CITY ilrti;�X.��f STATE J,A J,( ZIP_ K7 FAX . �j II �; Z{ ��,� (� L-) I .
CONTRACTOR'S L ENSE # EXP DATE CITY LICENSE # i ►het
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL 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 property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
Applicant's Signature Date
Owner / Contractor / 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 of 180 days
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
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