BLD-05-0229
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0229-YL
Issue Date 07/22/2005
(Work must be started within 180 days)
Receipt No
37469
Applicant:
Name Ruiz, Jim
Phone:
458-1244
Address. 14823 Prairie Vista Loop
City' Yelm
State. WA Zip 98597
Property Information:
Site Address. 14823 Prairie Vista Loop
Assessor Parcel No. 81860002800
Subdivision Vista View
Lot: 28
Contractor Information:
Name Applicant
Address.
Contact:
Phone.
City'
State:
Zip.
Contractor License No
Expires.
Business License.
Project Information:
Project: Ruiz Deck cover
Description of Work: 10x20 Deck Cover
Sq. Ft. per floor' (1 st) 0
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas Other) OTHER
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- -------------
Building Permit - Other 2350 0.00 0.00 o 0000 o 0000 $1,000
TOTAL FEES $23.50
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Applicant's Affacjavit:
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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
registered in th tate of Washington.
# Sets of Prints:
Signature
Date
7
Final Inspection:
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Firm
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CITY OF YELM $) g~OOtJ 29C!) D
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address.-.t\ g~3 PW'(I n e \/1.q~ If Parcel #. CJeeo;; r 80'S S- ~ 1><<,('
SUbdivision:%f'a. V, eW Lot #. :;#aK Zoning; ./~ ~"
u New Construction U Re-Model/ Re-Roof / Addition U Home Occupation Sign ././;} <<'<?
U Plumbing U Mechanical U Mobile / Manufactured Home Placement U Other ~
Project Description/Scope of Work:
Project Value $~ SO. -
Building Area (sq ft)
151 Floor
Basement
2nd Floor
Carport
Deck
~OS6f'-P+
Garage
Patio
# Bedrooms_
# Bathrooms_
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? II) 0
completed environmental checklist must accompany permit application.
If yes, a
EMAIL T(fJt(C!.C9t1~ thO @ cuI- (blv-
TELEPHONE 5tfJ. ";'~'-I ~ Y V'
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
LICENSE #
EMAIL
TELEPHONE
ZIP
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
City of Yelm.
II 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
POBox 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.U8
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