20150231 Permit Pkg 06242015City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: AGNES BENNICK
Address: 121 MTN VIEW DR NW
YELM WA 98597
Property Information:
Site Address: 171 MTN VIEW nP NW
Assessor Parcel No.:
Contractor Information:
Name: EDWARDS EXTERIORS
Address:
2301 120TH ST E
TACOMA, WA 98445
Contractor License No.: EDWARE"906JF
Subdivision:
Expires:
Permit No.: 20150231
Issue Date: 6/24/2015
(Work must be completed within 180 days)
Phone: 360- 458 -3423
Owner: AGNES BENNICK
Lot:
Phone: 253- 475 -8883
03/19/2016
Project Information:
Project: ROOF
Description of Work: REPLACE ROOF. DRIP EDGE FLASHING REQUIRED, EAVES AND RAKE.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor
ROOF AGNES BENNICK
TOTAL FEES:
Applicant's Affidavit:
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�l State AU4-hvk4�4 shirton. Signatur Date G —Z
Firm
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yo1m
(36 ) 456 -3244
REC #: 00199100 6/24/2015 10:25 AM
OPER: CO TERM: 001
REF #: 6147
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150231 25.000R
BENNICK, AGNES
121 MTN VIEW DR NW
ROOF 25.00CR
TENDERED: 25.00 CHECK
APPLIED: 25,00 -
CHANGE: 0.00
2oisOZ3(
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address 12-1 MU(l�"4i W li 1 L:11 4rhl #lN
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof /Addition i 1 Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:
()rr je
� � XeQ� f►res
Project Value:
-
rl�avts, d
RAk-
Building Area (sq. ft) 1" Floor 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS I L I 1 EMAIL
CITY (& M STATE �ZIPg_�e TELEPHONE 5bQ '' p �I
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR P,.,ftaS Xga-.P5 TELEPHONE 25 !> 411 en K
ADDRESS 13o i2_ 7 sr E EMAIL£",%.,Ae1 x %c7re5 �'� 7-D�ic
CITY ")`ACO D ft STATEZIP Gi kL( FAX Z 5 " 4 / i s ' 6
CONTRACTOR'S LICENSE # XP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certify that the ab formation is correct and that the construction on, and the occupancy and the use of the
above described prope SAwill be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yew.
9- pplicant's Signature
Owner / Contractor I (
Date
Agent / 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
,. 1 J
Ann I� A` '2- S LO
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
JUN 2 3 2015
(360) 4# 8ii3r-_
(360) 458 -3144 FAX
AJC
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 141 &✓ Parcel #:
Subdivision: / a / Lot #: Plan #: Zoning:
New Construction �!Re-Model / e -Roo / Addition Home Occupation Sign
❑ Plumbing Mechanical ❑ Mo 1 e Manufactured Home Placement ❑Other
Project Description /Scope of Work: .,Pr � �' ho 7 A 4A
Project Value: �L %, 77 3 9V y 3
Building Area (sq. ft) 1s' Floor /07D17 2nd Floor 3rd Floor Garage -2 car car
Covered Patio Covered Porch Patio Deck :1G 6
# Bedrooms 1 # Bathrooms Heating: GAS /OTHER or CT (Circle One)
Are there any environmentally sensitive areas located on the parcel? All'
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: 1 ,u 4
ADDRESS /._� / /1% M h%t.41Al ic:w Q EMAIL d5,.b'c3,6 Cam' Y��cZi
CITY `L� STATE G /' ZIP g_' -i 7 TELEPHONE ✓e o . 4i�d�. � 3
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR �,�l�, �,s �X /t.Nivc�s TELEPHONE ,?zy, :�7y. y75" j'
ADDRESS % — EMAIL eduSt�eao «xte�rai
CITY F140o*# STATE 66'9 ZIP `gs FAX �T
CONTRACTOR'S LICENSE # CAVAk ?`y� /-: EXP DATE&,.4—CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # 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.
6�4,u )O�, r t G Ag /�
A (cant's Signature Da e
Owner / Contractor / Owner's Agent / 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 (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us