BLD-05-0072
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0072-YL
Issue Date 03/11/2005
(Work must be started within 180 days)
Receipt No
35868
Applicant:
Name' Alfred Wallace
Phone,
458-9671
Address, 15921 Quail Meadows Ct.
City' Yelm
State, WA Zip 98597
Property Information.
Site Address 15921 Quail Meadows Ct.
Assessor Parcel No, 57630101400
Subdivision,
Lot:
Contractor Information:
Name, Applicant
Address,
Contact:
Phone,
City'
State:
Zip,
Contractor License No,
Expires.
Business License,
project Inforlllation.
Project: Wallace Addition
Description of Work: 648 sf. Addition
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 565 98 0,00 000 0.0000 o 0000 $1,000
Building Plan Review 367 88 000 000 o 0000 o 0000
Plumbing Permit 48,00 2000 28,00 7 0000 4 0000 Fixture
State Building Fee 4,50 450 0.00 o 0000 0.0000
TOTAL FEES $986.36
Applicant's Affadavit:
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 c' t the proposed structure is in conformity with all applicable City of
Yelm regulations including th e gover 'ng zoning and land subdivision, and in addition all covenants,
ease restric . record. I applying as a contractor, I futher certify that I am currently
regis red in the a of Wa ington.
OFFICIAL USE ONLY
# Sets of Prints:
Dat
-oS'
Firm
RECEIPT No 35 8 6 8
RECEIVED
****NINE HUNDRED EIGHTY SIX DOLLARS & 36 CENTS
RECEIVED FROM
WALLACE
15921 QUAIL MEADOWS CT
YELM WA 98597
BLD-05-0072-YL
SITE 15921 QUAIL MEADOWS CT
DATE REC NO
03/11/05 35868
AMOUNT
986.36 CHECK
FIEF I'JO
3172
MISCELLANEOUS RECEIPT
HI CHELLE
WALLACE BLD PMT 565 98. PLAN REV 367 88. PLUM PMT 48 00. BUlL FEE 4 50
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No BLD-05-0072- YL
Applicant:
Name. Alfred Wallace
Phone.
458-9671
Address. 15921 Quail Meadows Ct.
City' Yelm
State. WA Zip 98597
Project Information:
Project: Wallace Addition
Description of Work: 648 sf. Addition
TOTAL FEES
Assessor Parcel No. 57630101400
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
565.98 000 000 0.0000 o 0000 $1,000
367.88 000 0.00 o 0000 o 0000
48.00 2000 28.00 7 0000 4 0000 Fixture
4.50 4.50 000 0.0000 o 0000
$986.36
Site Address. 15921 Quail Meadows Ct.
Fees.
Item Acct Code
Building Permit - Other
032001-322-10-00
Building Plan Review
100001-345-83-00
Plumbing Permit
032001-322-10-00
State Building Fee
160001-386-00-00
PAID
MAR 1 1 2005
CITY OF YELM
.
c
o
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Project Address:
CITY OF YELM
ILDING PERMIT APPLICATION FORM
5'1!?? 0 I 0/'-11)[;
Received
MAR 0 8 2005
Subdivision. Lot #. Zoning;
U New Construction ARe-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile I Manufactured Home Placement U Other
Project Description/Scope of work:--ADtL.nM 1M r ,Y...;$( WE '5rt0J ') 1tKLJcrlJ~
Project Value. :s =~;~ (\ \:: C) 0 I-I L. ~ (..:'J C
II I, ()
Building Area (sq ft) 1st Floor 2nd Floor Garage
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heatin~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? -& If yes, a
completed environmental checklist must accompany permit application
Deck
BUILDING OWNER NAME.
ADD S
CITY
tJ::;:t-1.
LICENSE #
EMAIL
TELEPHONE
ARCHITECT/ENr,INFER
ADDRESS
CITY STATE
ZIP
GENERAL CONTRACTOR M "E. L..L.6 TELEPHONE(Z-5~) i.J:".l- t
ADD~SS .A - - 1C1 KJ$:?L ({-?9I~'7 EMAIL
CITY~N~ STATE~ZIl:lC::;f~:?B11 FAX .
CONTRACTOR'S LICENSE # MSa.oL-L..cp'1 EXP DA T ITY LICENSE #
. I
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S 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 d cribed p rty will be in accordance with the laws, rules and regulations of the State of Washington and the
City of e m.
~ c3~~--o5'
pplicant's Signat re Date
Owner I Contractor I 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.U8
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