BLD-05-0131
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0131-YL
Issue Date. 05/11/2005
(Work must be started within 180 days)
Receipt No
36724
Applicant:
Name: Michaelis, Connie
Phone:
360.458.4624
Address. 513 Van Trump NW
City' Yelm
State: WA Zip 98597
Property Information:
Site Address. 513 Van Trump NW
Assessor Parcel No. 22719231801
Subdivision.
Lot:
Contractor Information.
Name
Contact:
Phone.
Address.
City'
State.
Zip.
Contractor License No.
Expires.
Business License.
Project Information
Project: Michaelis Re-Roof
Description of Work: Re-roof porch
Sq. Ft. per floor (1st) 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 2500 0.00 000 o 0000 0.0000 $1,000
TOTAL FEES $25.00
~f-t-
Applicant's Affadavit:
I~$~ <<-. :J fJr;/ Of..,
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 the State of Washington.
# Sets of Prints.
Signature ~A t 1..:.0
Firm
Date
5..II-D c:-
Fil1allnsp~ction:
Date:~ ?II~ /riiJo2j
By' 1z~--
~
~
Applicant:
Name: Michaelis, Connie
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Address. 513 Van Trump NW
City' Yelm
Project Information:
Project: Michaelis Re-Roof
Description of Work: Re-roof porch
Site Address. 513 Van Trump NW
Fees:
Item
Building Permit - Other
Assessor Parcel No.
Acct Code
Item Fee Base Amt Unit Fee
0.00
'Kec::ti:
3(0 lCl ~
032001-322-10-00
2500
0.00
Permit Fees Schedule
Permit No BLD-05-0131-YL
Phone.
360.458.4624
TOTAL FEES
$25.00
State. WA Zip 98597
Unit Rate No Units Unit Desc
o 0000
o 0000 $1,000
E
~
PAID
.~~
.
~-
~
MAY 1 1 2005
J
CITY OF YELM '
,
c
c
c
CITY OF YELM -- 13 ( ::jC
RESIDENTIAL BUILDING PERMIT APPLICATION FORM ''19 L l) -O~-6-
Project Address. ,5' i 3 V{'; ,Vl/(U1YI P fV Ld Parcel #. _ J 2/ ) q J ~ I ? 0 I
Subdivision.
Lot#"
Zoning;
~~
C'
~r ~ '"
./ 0 <<'</
~
ZIP
ZIP
ZIP
u New Construction I)t Re-Modell Re-Roof I Addition u Home Occupation Sign
u Plumbing u Mechanical U Mobile I Manufactured Home Placement u Other
Project Description/Scope of Work: <1)c;Y(l ~ A..: ~ DOJ" 1\ (J - /\ {Jl~
Project Value.
Building Area (sq ft) 1st Floor
Basement
2nd Floor
Carport
Deck
Garage
Patio
# Bedrooms_
# Bathrooms_
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
BUILDING OWNER NAME. ~;~~~ ~~ ?f\tll'(7 ~",' r hr.,(? 1,'<;
ADDRESS .!;; L ~ Vtt Vl '11, ^ I EMAIL
CITY STATE INA ZIP TELEPHONE Lf5:'i:- 4~ 24
I l1Rr.I-IITI=r.T/I=I\Jr,INI=I=R
I ~~~ESS ..-- '--- ---'STATE
GENERAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
I Ir.FN~F it
EMAIL
TELEPHONE
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
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.
,~/ 1/ / (),E)
s Signature Date I I
ntractor / 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