BLD-05-0261
~~
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0261- YL
Issue Date 08/22/2005
(Work must be started within 180 days)
Receipt No
38061
Applicant:
Name' Malan, Mike & Bev
Phone.
701-9783
Address. P.O Box 747
City' Yelm
State. WA Zip 98597
Property Information:
Site Address. 1502 Yelm Ave. West, Lot 16
Assessor Parcel No 21713304040
Subdivision:
Lot:
Contractor Information .
Name:
Contact:
Phone
Address.
City'
State'
Zip'
Contractor License No
Expires.
Business License:
Project Information:
Project: Sunrise Vista
Description of Work: Set 1400 s.f Mfg. Home
Sq. Ft. per floor' (1 st) 0
Heat Type (Electric, Gas, Other)
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Fees:
Item
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
150 00 0.00 0.00 o 0000 o 0000 $1,000
40.00 4000 000 o 0000 o 0000
4.50 450 000 0.0000 0.0000
$194.50
Building Permit - Other
Water Deposit
State Building Fee
TOTAL FEES.
cfl&d 3/~ F;/06
Applicant's Affadavit: 7
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
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 futher certify that I am currently
:::~:i"~;:;;i/'"ntJ.... D,I, 8-.a'--es:
# Sets of Prints.
Final Inspection:
Date: ?&O)af'
/
By' 646'y
(..
City of Yelm
Community Development Department
Building Division
Phone: (360) 458.8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No BLD-05-0261-YL
Applicant:
Name: Malan, Mike & Bev
Phone:
701-9733
Address. P.O Box 747
City' Yelm
State. WA Zip 98597
Project Information
Project: Sunrise Vista
Description of Work: Set 1400 s.f. Mfg. Home
TOTAL FEES
Assessor Parcel No 21713304040
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
------_..-
150.00 000 000 0.0000 0.0000 $1 000
4000 4000 0.00 o 0000 o 0000
4.50 450 0.00 o 0000 o 0000
$194.50
Site Address: 1502 Yelm Ave. West, Lot 16
Fees.
Item Acct Code
Building Permit - Other
032001-322-10-00
Water Deposit
740402-389-00-00
State Building Fee
160 001-386-00-00
RECEIPT No.3 8 0 61
IVED
****ONE HUNDRED NINETY FOUR DOLtARS & 50 CENTS
RECEIVED FROM
\LAN. HIKE & BEV
) BOX 747
~LM. WA 98597
..D-05-0261-YL
:TE: 1502 YEL~ AVE WE LOT 16
DATE REC. NO.
08/22/05 38061
AMOUNT
194.50 CHECK
REF NO.
6087
'.
BUDGETARY
DIANA
..DPRMT0150, W/DEP 40, STFEE 4 50
c
c
c
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM R e .
ProjectAddress.J'50.;;t YeJ.~Ave- t.0 Lo,t lie> Parcel #. )./1 \~ 7oloY celved
Subdivision.~t,uuR.l-::e 06+1'- Lot#. fh Zoning; ~ohl (e ~~J~~
u New Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing U Mechanical ~ Mobile I Manufactured Home Placement U Other
Project Description/Scope of Work:_lfY\. 0 \) e... "1"'-. ~e.uJ mO b ( \e. (4 D H\.e...
Project Value rb-'
Building Area (sq. ft) 1st FloorJL.}oD 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms 3 # Bathrooms....r.:2. Heating: GAS/OTHER O~ECT~ircle One)
Are there any environmentally sensitive areas located on the parcel? '" 0 If yes, a
completed environmental checklist must accompany permit application
BUILDING OWNER NAME.
ADORES$, ''B 0
CITY .
ZIP 'fS5""ef7 70('- '1'1 S 3
LICENSE #
EMAIL
ZIP TELEPHONE
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
GENERAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
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
O"'Ad C' 4'/ p;/lca5
Applicant's Signature Date
Owner I Contractor I Owner's Agent I 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
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us