20140283 Permit Pkg 11202014 �'�o� TH�p�, City of Yelm Permit No.: 20140283
'
� � Community Development Department Issue Date: 11/20/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
"","�'�" Fax: (360)458-3144
Applicant:
Name: LILIA&ROJAS BAHENA Phone: 360-481-0714
Address: 413 WASHINGTON AVE SW
YELM WA 98597
Property Information:
Site Address: 413 WASHINGTON AVE SW Owner: LILIA BAHENA
Assessor Parcel No.: 75300500200 Subdivision: Lot:
Contractor Information:
Name: LILIA& ROJAS BAHENA Phone:
Address:
413 WASHINGTON AVE SW
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
ROOF LILIA&ROJAS BAHENA $ 25.00
TOTAL FEES: $ 25.00
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 restri � s of record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the State of shi�n.
Signature Date � � � Date:
Firm By�
Cit of 8�$�02
(36�) M
11/20(2014 3:56 P
R��#; QU1787TERM: 001
OPER: ��
REF#:
TRAN: 33�0000 BtJTLQI�� �OCR TS
2014��a3
BAHENA, LII.IA & RQ�AS
413 WRSHINGTON �5 p0 R
ROOF
T�NDERED: 25.00 CASH
APPLI�.D: 25.�0�
-,'_`�p,00
GHRNGE:
�
2bru o 2�3
CITY OF YELM
RESIDENTI L BUILDING PERMIT APPLICATION FORM
� Project Address: � � �� l G�� Parcel#:
—�—
Subdivision: Lot#: Plan#: Zoning:
i 7 New Construction ,,P�Re-Modei Re-Roof 'ddition �� Home Occupation Sign
� Plumbin g :! Mechanical � o i e/Manufactured Home Placement �-� Other
Project Description/Scope of Work:
Project Value:
Building Area(sq.ft) 1S` Floor 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms� #Bathrooms_ Heating: GAS/OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING O ER NAME: `� c,�
ADDRESS EMAIL /
CITY STATE � ZIP TELEPHONE — 4 � I �
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 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.
1 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 a� nce with the laws,rules and regulations of the State of Washington and the
City of Yelm. �
_.-- �� �� - �a � � y
ApplicanYs 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
I05 Yelm Avenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us