20150175 Permit Pkg 05072015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: TWISTER DONUT II
Address: 4524 RUDDELL RD
LACY WA 98503
Property Information:
Site Address: 305 YELM AVE E
Assessor Parcel No.: 22719341000
Contractor Information:
Name: TWISTER DONUT II
Address:
4524 RUDDELL RD
LACY WA 98503
Contractor License No.:
Project Information:
Project: SIGN
Description of Work: WALL SIGN
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
SIGN
Subdivision:
Permit No.: 20150175
Issue Date: May 7, 2015
(Work must be completed within 180 days)
Phone: 360- 561 -2669
Owner: TWISTER DONUT II
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
TWISTER DONUT II
TOTAL FEES:
Applicant's Affidavit:
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 f,p(gton. rd. If applying as a contractor, I further certify that I am currently
registered in the St a
Signature Date .- U i —/S
Firm
Lot:
Fees
$ 20.00
$ 20.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
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IRAN:
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TENDERED, 20.00cR
AppLIED. 20.00
CHANGE: °'�-, 2p•00_ CASH
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CITY OF YELM
SIGN PERMIT APPLICATION FORM
Project Address: _&, /k PLIe Parcel #:
Zoning;
Current Use:
Proposed Use:
Type /Number of Sign(s) (wall, monument, lighted, etc.): / 1,A11
Value of each Sign: I ,
Dimensions of Sign(s): /2,1e " f'/ Y 1 - 2 -L 0
Building Gross Floor Area (sq. ft): zs"XSz-
Building Height:
Existing Signage (if any) and dimensions:
ao15o 1`1 S
APPLICANT_ a
Last Name First Name
ADDRESS 3 C hi EMAIL
CITY STATE ✓! ZIP TELEPHONE '�f�Z� S~� / Zel 6
BUILDING OWNER
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
BUILDING TENANT
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
SIGN CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
I hereby certify that the, bove infor tion is correct and that the construction of the above described sign will be in
accordance wit he law rules an gulations of the State of Washington and the City of Yelm.
Applicant's Signatu a Date
Owner / Contractor / Owner's Agent / Contractor's Agent / Tenant (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
APR 2 4 2015
105 Yelm Ave W (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
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