20150176 Permit Pkg 04242015City 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: %nr vm M A\ 11= Ir
Assessor Parcel No.: 22719341000 Subdivision:
Contractor Information:
Name: TWISTER DONUT II
Address:
4524 RUDDELL RD
LACY WA 98503
Contractor License No.:
Permit No.: 20150176
Issue Date: 4/24/2015
(Work must be completed within 180 days)
Phone: 360- 561 -2669
Owner:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: OTHER SPECIAL EVENT
Description of Work: GRAND OPENING APRIL 22 THRU MAY 6, 2015
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
SE
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 of record. If applying as a contractor, I further certify that I am currently
registered in the State of Washington.
Signature Date
Firm
Lot:
Fees
$ 0.00
$ 0.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
RU 5017;
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�bv Tip City of Yelm
Community Development Department
SPECIAL EVENT I TEMPORARY USE
APPLICATION
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WASHINGTON
Special Event Sign Permit (limited to 14 days, 4 times per calendar year)
Temporary Use (property owner permission letter required)
(see REVERSE for regulations)
NAME OF PROJECT
KIV
APPLICANT /BUSINESS NAME z 4t/� �E 1
Mailing Address 6
I`'lc5'P
City, S# to and Zip
Telephone a �j] ' 2 ,g' EMAIL e
City of Yelm Business License Number
SITE OWNER__
Mailing Address
City, State and Zip
Telephone EMAIL
SITE ADDRESS /LOCATION
SITE PARCEL NUMBER
SUMMARY OF REQUEST
START DATE 0 -j— 2 Z —1_�- END DATE
I affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property as bly ecessary to process this application.
Signed Date
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5
ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning Section Building Section
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us