BLD-05-0125
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0125-YL
Issue Date 05/18/2005
(Work must be started within 180 days)
Receipt No
36781
Applicant:
Name: Woore, Tony
Phone.
458-8972
Address. 15909 Quail Meadows Ct. SE
City' Yelm
State W A Zip 98597
Property Information:
Site Address. 15909 Quail Meadows Ct. SE
Assessor Parcel No. 57630101100
Subdivision.
Lot:
ContrCictor Il1formation:
Name Applicant
Contact:
Phone.
Address.
City'
State.
Zip:
Contractor License No
Expires.
Business License.
Project Inf()l1llation"
Project: Tony Woore Addition
Description of Work: 324 Family Room Addition
Sq. Ft. per floor (1 st) 324
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas, Other). GAS
Fees:
Item
Item Fee Base Amt
Unit Fee
Unit Rate
No. Units Unit Desc
Building Permit - Other
Building Plan Review
TOTAL FEES.
181.25
117.81
$299.06
0.00
0.00
000
000
o 0000
o 0000
o 0000 $1,000
o 0000
Applicant's Affadavit:
OFFICIAL USE ONLY
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 futher certify that I am currently
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Applic;ant:
Name: Woore, Tony
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Address. 15909 Quail Meadows Ct. SE
City' Yelm
Project Information:
Project: Tony Woore Addition
Description of Work: 324 Family Room Addition
o
Permit Fees Schedule
Permit No BLD-05-0125-YL
Phone.
State. WA Zip 98597
458-8972
Site Address. 15909 Quail Meadows Ct. SE
Assessor Parcel No. 57630101100
Fees:
Item
Building Permit - Other
Building Plan Review
(~
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Acct Code
032001-322-10-00
181.25
Item Fee Base Amt Unit Fee
000
100001-345-83-00
117.81
000
000
000
o 0000
Unit Rate No Units Unit Desc
o 0000
o 0000 $1,000
o 0000
TOTAL FEES
$299.06
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Project Address:
n CITY OF YELM (\
RE,-_..JENTIAL BUILDING PERMIT APPLlCAT~,~)FORM
159 oq QU~~(I;\t\~l.\d(j'':'''s ~~r~f#. S!f6;'SDtJ{) ~ I(M)
.. "
Subdivision: Lot #. Zoning;
u New Construction ~1!I~e-Modell Re-Roof I Addition U Home Occupation Sign
u Plumbing U Mechanical' U Mobile I Manufactured Home Placement u Other
Project Description/~~~pe of Work:
Project Value: ~ '7 (.l00 ..00
Building Area (sq ft) 151 Floor 3 a 4 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ (Heating: GAS/OTHE~or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? nO If yes, a
completed environmental checklist must accompany permit application
BUILDING OWNER NAME. Teen 1.4 \..Ceo",=-
ADDRESS ISQO<i QnCi'dltYlc*.d(l~5 c.+ .se
CITY Yel VV\ STATEW~ ZIP C'.f~y::; (
EMAIL
TELEPHONE 3~P-lI5'~- ~q 1,~
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
LICENSE #
EMAIL
TELEPHONE
ZIP
GENERAL CONTRACTOR OlG \'\ ~ r
ADDRESS
CITY STAT~ ZIP
I CONTRACTOR'S LICENSE #
TELEPHONE
__EMAIL
__FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY 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 described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
';:JOJY\,U ~ '1-;J..5:'0:)-
Ap,p..!i.fant's{Signature Date
~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.us
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