20050057
City of Yelm
Community Development Department
Building Division
Phone' (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-OS-OOS7 - YL
Issue Date. 02/23/2005
(Work must be started within 180 days)
Receipt No
35698
Applicant:
Name: Perkins Roofing
Phone
360.458.5329
Address. P O. Box 1085
City' Yelm
State: WA Zip 98597
Property Info~mation
Site Address: 15307 104th Avenue SE
Assessor Parcel No 21725110702
Subdivision.
Lot:
Contractor I nformation.
Name
Contact:
Phone:
Address:
City'
State
Zip:
Contractor License No
Expires:
Business License.
Projectlnforl11ation
Project: Struse Re-roof
Description of Work: Tearoff and reroof residential
Sq Fl. per floor' (1 st) 0
Heat Type (Electric, Gas, Other)
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Fees
Item
Item Fee
Base Amt
Unit Fee
Unit Rate
No Units Unit Desc
Building Permit - Other
TOTAL FEES
2500
$25.00
000
000
0.0000
00000 $1,000
Applicant!s Affadavit:
OFFI€lAL USE ONLY
#.Sels,bfPrints:
Date
oS
Final Inspection
Date:,;(.Lib ,,6r
,/ .,
By- d.....r;.,..
Firm
. . :l
RECEIPT No 3 5698
RECEIVED
****TWENTY FIVE DOLLARS & 00 CENTS
RECEIVED FROM
PERKINS CONSTRUCTION AND ROOF
P O. BOX 1085
SPANAWAY, WA 98387
458-5329
DATE
REC NO
AMOUNT
25.00 CHECK
REF NO
18121
02/23/05 35698
MISCELLANEOUS RECEIPT
GRETCHEN
SITE - 15307 104TH AVE SE
City of Yelm \0
Community Development Department P ~
tEB ~ ?, lf0f0~
oN Of '{E.LM
e\ \ \
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicaht:
Name. Perkins Roofing
Address. POBox 1085
Project Information
Project: Struse Re-roof
Description of Work: Tearoff and reroof residential
Site Address. 15307 104th Avenue SE
Fees
Item
Acct Code
Building Permit - Other
032 001-322-10-00
TOTAL FEES
City' Yelm
Permit Fees Schedule
Permit No BLD-05-0057 - YL
Phone'
360.458.5329
State WA Zip 98597
Assessor Parcel No 21725110702
25.00
Item Fee Base Amt Unit Fee
000
Unit Rate No Units Unit Desc
o 0000
00000 $1,000
$25.00
000
:: I J
FES 2 3 Z005
hi:!) ~05-oCJ5 7
CITY OF YELM
COMMERCIAL BUILDING pERMIT APPLICATION FORM , . ~
Project Address ( 'S .3 0 I /0 <(.." AvE.. S c=- Parcel #. cJ. I { ;;..5 I I 0 70
Zoning, Current Use. kS~c2-W(A' Proposed Use ~
o New Construction ~ Re-Modef ~Tenant Improvement
o Plumbing 0 Mechanical 0 Fire Prevent/Suppress/Alarm 0 Other
Project Description/Scope of Work: ~""'-uv-< -e)q,.r~I:V~ ,~.:>f 2N.fI4-(;( New l~
Project Value 1 , Co f{<( . oJ
Building Area (sq ft) Parking Garage
Building Height g..!(dJ
Are there any environmentally sensitive areas located on the parcel? "v<J
completed environmental checklist must accompany permit application.
1 st Floor
2nd Floor
3rd FJoor_
If yes, a
~~5~~~Q~~g~f;P!~~&fg.
CITY $1.i.1.t.A. v.~-iA STATE A7-.
~RQ8.!illg~Jir;r&~INEt;R
ADDRESS
CITY STATE
TELEPHONE 50l.0 - 803 - f';' (
ZIP
LICENSE #
TELEPHONE
'f<R -~.?~.tf
5 - /38'"5
ITY LICENSE # a~-ao 'JJ...a... L{.
TELEPHONE
-FAX
EXP DATE CITY LICENSE #
PLUMBING cbN1I~AcIOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
MECHANICAL CQNTRACTOR
ADDRESS
CITY STATE
CON I RACTOR'S LICENSE if
TELEPHONE
ZIP
FAX
EXP DATE CITY LICENSE #
Copy of City Mitigation documentation (TFC).
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 raws, rules and regulations of the State of
Washington and the City of Yeim
\~ (J----
Applicant's Signature
Owner / Contractor I Owner's Agent / Contractor's Agent I Tenant
l( ^-3( O~
Date I
(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
.,
po, 'l,l.\