BLD-05-0214
6' '.
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City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0214-YL
Issue Date 07/14/2005
(Work must be started within 180 days)
Receipt No
37311
Applicant:
Name Landshapes NW, Inc.
Phone:
253.537.6370
Address. 1151 E 112th Street
City' Tacoma
State. WA Zip 98445
Property Information:
Site Address. 16190 Birkland Street
Assessor Parcel No
Subdivision.
Lot:
Contractor Information:
Name:
Contact:
Phone:
Address.
City'
State.
Zip:
Contractor License No
Expires.
Business License.
Proj~ct Information.
Project: Landshapes Reroof
Description of Work: Tearoff and reroof
Sq. Ft. per floor (1 st) 0
(2 nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas, Other).
Fees:
Item
Item Fee
Base Amt
Unit Fee
Unit Rate
No. Units Unit Desc
Building Permit - Other
TOTAL FEES.
2500
$25.00
0.00
000
0.0000
o 0000 $1,000
Applic:~nt's Affadavit:
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 r strictions of record. If applying as a contractor, I futher certify that I am currently
registered in t te of s' on.
# Sets of Prints.
Firm
Final Inspection:
Date: <Il'f-w,
By' ~~~
a
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No BLD-05-0214-YL
Applicant:
Name. Landshapes NW
Address
Phone.
City'
State.
Zip
Project Information:
Project: Landshapes Reroof
Description of Work: Tearoff and reroof
Site Address. 16190 Birkland Street
Assessor Parcel No.
Fees.
Item
Acct Code
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
Building Permit - Other
032001-322-10-00
2500
000
000
o 0000
00000 $1 000
TOTAL FEES
$25.00
PAlO
JUl 1 4 2005
erN OF YELM
RECEIPT No.3 7 311
RECEIVED
****TWENTY rIVE DOLLARS & 00 eENTS
RECEIVED FROM
LAND SHAPES NOBTHWET INC
1151 EA3T 112TH 3T
T.I\CUHA vIA ~i24,J,5
BLD'-05-0~14-YL
DATE REC NO
07/14/05 37311
AMOUNT
::. 5 ~)~1 CHECK
REF NO
2448
PUDGETARY
HIt'HELLE
E LD PEFUIIT