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20150111 Permit Pkg 02122015
City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: ERLING BIRKLAND Address: PO BOX 476 YELM WA 98597 Property Information: Site Address: in1AA WEST Rfl -qF Assessor Parcel No.: 64303601702 Subdivision: Contractor Information: Name: ERLING BIRKLAND Address: PO BOX 476 YELM WA 98597 Contractor License No.: Project Information: Project: ROOF Description of Work: REROOF RESIDENTIAL Sq. Ft. per floor: First Second Third Garage Basement Fees: Item ROOF Permit No.: 20150111 Issue Date: 2/1212015 (Work must be completed within 180 days) Phone: Owner: THREE B &C LAND LLC Phone: Expires: 0 /00 /0000 Heat Type (Electric, Gas, Other): Contractor ERLING BIRKLAND 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 contractor, I further certify that I am currently registered in the State of WashiaWpxL Signature Firm Lot: Fees $ 25.00 $ 25.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City of Yolm (36 ) 458 -3244 REC #: 00186434 OPER: CO TERM: REF #: 5611 PAID BY: 2/11/2015 12:42 PM 001 TRAM: 33.0000 BUILDING PERMITS 20150111 25.00CR BIRKLAND, ERLING 10344 WEST RD SE ROOF 25.000R TENDERED: 25.00 CHECK APPLIED: 25.00 - CHANGE: 0.00 2uso t t I CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: /y431YZ Parcel Subdivision: Lot #: Plan #: Zoning: New Construction k*Re -Model / Re -Roof / Addition Home Occupation Sign Plumbing Mechanical Mobile / Manufactured Home Placement Other Project Description /Scope of Work: Z c tL,� + ' Project Value:4= Building Area (sq. ft) 1" Floor2yr� 2Id Floor Garage Deck Basement Carport Patio # Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the paretl? /f yes, a completed environmental checklistinu4 accompany permit application. I/ BUILDING OWNER NAME: 3�3; "� 6feA Z !A ADDRESS , © EMAIL tol- CITY Vda,&, STATE W ZIP 9e57,19','> TELEPHONE,-36 D ARCHITECT /ENGINEER LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE if GENERAL CONTRACTOR ILI TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # PLUMBING CONTRACTOR ,U/` -J – 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. Z o/ ApomAvs Sig e Dat Owner / Contractor I 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