M-05-0206
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
M-05-0206-YL
Issue Date. 07/06/2005
(Work must be started within 180 days)
Receipt No
37202
App.Ucant:
Name: Landshapes NW
Phone.
253-537-6370
Address. 1151 East 112th Street
City' Tacoma
State. WA Zip 98445
Property Information:
Site Address. 16190 Birkland St. SE
Assessor Parcel No
Subdivision. Autumn Hill p. II
Lot: 20
Contractor Information.
Name:
Contact:
Phone:
Address.
City'
State.
Zip
Contractor License No.
Expires.
Business License:
Projectlnformati()n:
Project: Autumn Hill, p. II
Description of Work: Gas Piping for furnace
Sq. Ft. per floor (1st) 0
(2nd) 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
Mechanical Permit
TOTAL FEES
25.00
$25.00
000
0.00
0.0000
0.0000
Applicant's Affadavit:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and re trictions of record. If applying as a contractor, I futher certify that I am currently
registered in th t te of W hingt
# Sets of Prints.
Final Inspection:
_.___~~_I___._.,-.
DatetN~ 1~5' i
By' t..:"Vt1
I
Firm
zro, - f~7' ?Iv ~
PAID
City of Yelm
Community Development Depattmant
Building Division
Phone: (380) 458-8407
Permit Fees Schedule
Permit No: 1lJl-O~206. YL
JUL te 6 ZOO
CITY OF YEC~dsllapes PAW
F2K: (360) 458-3144
Phone: 25~37-83TO
Address: 1151 East 112th Strut
City. Tacoma
Stale: \AlA Zip 98446
ProJed~n:
Proj&d: Autumn Hill, p. II
08$Crfptlon of Work: Gas Pi,ung for fumlK;D
Sil& Add"'6&: 18180 Birldand SL SE
Assessor Parcel No.
fees:
Il.em
Ac:ct Code
Item RIa Base AmI Unil Fee Unit Rale No. Units Unit Cue
Meduinical Permit
032 OOf-322-1~
25.00
0.00
0.00
0.??oo 0.0000
TOTAL FEES; $25.00
- .
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l~fTHEp~1 CITY OF
f' ~ YELM
~ PO Box 479
I Yeim WA 98597
,YE.b.,~;L,," 360-458-8403
RECEIPT No 37202
RECEIVED
k**kTWENTf FIVE DOLLAFS & 00 CENTS
RECEIVED FROM
LANDSHAPES NW INC
1151 E 112TH S1
TACOHA i~A 9:3445
SITE 15190 BIRKLAND ST SE
H-05-0206-YL
DATE REC NO
<217/06/05 3720:::
AMOUNT
25 00 CHECr:
REF NO
24()5
BUDGETARY
HICHELLE
r!r~CH PERllIT 25 c.;;)