20040123
o
o
City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
PL-04-0123-YL
Issue Date 12/29/2004
(Work must be started within 180 days)
Receipt No
34336
.Applicant:
Name Easthaven Villa
Phone
458-2800
Address. 311 Cullens Rd. NW
City' Yelm
State WA Zip 98597
Property Information'
Site Address. 311 Cullens
Assessor Parcel No 21724140502
Subdivision. N/A
Lot: N/A
Contractor Information
Name CA...) j,0~-vL---
Contact:
Phone
Address.
City'
State
Zip
Contractor License No
Expires.
Business License.
Project Information
Project: Easthaven Laundry Room Upgrade
Description of Work: Remodel Laundry Room & Kitchen
Sq. Ft. per floor' (1 st) 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
Plumbing Permit
TOTAL FEES
3400
$34.00
2000
1400
7 0000
2.0000 Fixture
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 certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including thQ.?-!:Lgoverning zO~lng and land'subdlvislon, and in addition, all covenants,
easements ~n_d,res~ti8r1sOf reco/d)lf~PPIYlng as a ~ontractor, I futher certify that I am currently
registered-Hi the ate of Washiflgtpn. / /
~ /' / .' /
~r~. . _ ,~ / J: c..< C;; G7o/
~
Firm
OFFICIAL USE ONLY
# Sets of Prints
Final Inspection;
Date:
By'
~!,
~;lllt,.."\j!\ ClrTV Off,'
\. ~"/~1" J1 )1 .
I..., . \~, Y'E .
~~ .' ,L.t\1
~/;::::/<~~' ,P 0 Box 479
~. ")~/. . n~!,~-'. \l!~ '-'H:\:)q-
,,):E:::JS:.~~ .)C,U 4b.3 B,iO']
RECE~PT No. 3 4. 336
RECEIVED
****THIRTY FOUR DOLLARS & 00 CENTS
}=lECEi\'[[" FROI\/1
DATE
F-IEC NO
P\MOU~~T
REF ~IO
EASTHAVEN VILLA
311 CULLENS ROAD
YELM. WA 98597
PL-04-0123-YL
SITE: 311 CULLENS
12/29/04 34336 34.00 CHECK
21680 !
MISCELLANEOUS RECEIPT
DIANA
- -'
-- --
PLMB PRMT 34.00
o
Applicant:
Name Easthaven Villa
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Address 311 Cullens Rd NW
City' Yelm
Project Information
Project: Easthaven Laundry Room Upgrade
Description of Work: Remodel Laundry Room & Kitchen
Site Address 311 Cullens
Fees
Item
Plumbing Permit
Acct Code
Item Fee
o
Permit Fees Schedule
Permit No PL-04-0123-YL
Phone
458-2800
State W A Zip 98597
Assessor Parcel No 21724140502
Unit Rate No Units Unit Desc
7 0000
2.0000 Fixture
032001-322-10-00
3400
Base Amt Unit Fee
2000
1400
TOTAL FEES
$34.00
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RECEIVED
JUL 22 2004
Project Address:
CITY OF YElM
COMMERCIAL BUILDING J:lERMli ~-\LICATJON FORM
e l tJCUrceI#' ).17:lt.\l ~t> ~D'L--
Zoning, Current Use, Proposed Use
o New Construction If Re~Modell Re-Roof r T anent Improvement
)( Plumbing 0 Mechanical 0 Fire Prevent/Suppress/Alarm 0 Other ,
Project Description/Scope of Work:J~~rtA.ll lA.Ja~~eK ~~fr:1' Al:l:;k,~ U,DJ
, dt ...::s~ - Rc:..~ wo.-W tiJ t<: I id.(!..~'
Project Value' ~ ~ ~
Building Area (sq. ft) Parking Garage 151 Floor 2na Floor 3rd Floor_
Building Height A/_
Are there any environmentally sensitive areas located on the parcel? ~
completed environmental ohecklist must accompany permit application.
If yes, a
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Bu;iC::b ~G:;OW'.,
, .'''''. ' J, """,___
ADDR S
CITY
~...B.lm.~Gji~~~H~!.~g." - ~ LICENSE #
ADDRESS ~7 3"1 w w~ DR.. ~~
CITY Ol - STATE (,U~ ZIP qf>.:-~'7- TELEPHONE.5{pO Ii!.Co(p ~93~
!~~~C~:AT~WNf:P_~,t- :~PH:/~ 'I 1 ~ 1~i,i~PI~O'f
! CONTRACTOR'S LICENSE #tAP<<rz. Lq{,~P DATE CITY JCENSE #
, p!-uMSiNG:,GCiNTRActqR TELEPHONE
ADDRESS.
CITY STATE ZIP FAX
Cm,ITRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICA~ CONTRAC.TOR ~l)u.)~~ __TELEPHONE
ADDRESS
CITY ST ATE:___ZIP ~FAX.
CONTRACtOR'S LICENSE # EXP DATE CITY LICENSE #
-
J
Copy of City MitigatIon documentaticn (TFC),
pplicant's Signature
Owner I Contractor I Owner's Agent /
5<-~~'
Date
(Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not
begun within 180 days 01 issuance, or If work is suspended or abandoned for a period of
180 days
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