20150314 Permit Pkg 10152015City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: JASON & STACI JARVIS
Address: 9017 LEALAN CT SE
YELM WA 98597
Property Information:
Site Address: 9017 LEALAN CT SE
Assessor Parcel No.:
Contractor Information:
Name: BBK
Address:
PO BOX 8
ROY WA 98880
Contractor License No.:
Project Information:
Project: ROOF
Description of Work: TEAR OFF AND REROOF
Sq. Ft. per floor:
Permit No.: 20150314
Issue Date: 10/15/2015
(Work must be completed within 180 days)
Phone: 253 - 312 -1160
Owner: JASON JARVIS
Subdivision:
Phone:
Expires: 0 /00 /0000
First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Lot:
Fees:
Item Contractor Fees
ROOF BBK $ 25.00
TOTAL FEES: $ 25.00
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 restrict gns -ef- record f applying as a contractor, I further certify that I am currently
registere State of Washington
Signatu Date
Firm
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Citt of Yelm
(36 } 458 -3244
REC #: 00210269 10/15/2015 1:35 PM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 0675BG
TRAN #: 000000003570
TRAN: 33.0000 BUILDING PERMITS
20150314 25.00CR
JARVIS, JASON & STACI
9017 LEALAN CT SE
ROOF 25.000R
TENDERED: 25,00 CREDIT CARD
APPLIED: 25.00-
CHANGE: 0,00
,�V( C, C) �) I q
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 90(-7 t_� C d o_n C j Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / e-Ro / Addition Home Occupation Sign
Plumbing Mechanical Mobile /Manufactured Home Placement ! Other
Project Description /Scope of Work:,
Project Value: (V 7 &0o
Building Area (sq. ft) 1St 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: JCLSUn 1 C.x' y UC
ADDRESS EMAIL
CITY STATE ZIP TELEPHON
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR -fir' ' 6r_STELEPHONE l00 23'_ SSS
ADD?�,SS �O cry, 8 EMAIL r'Ob�nc+ -ncLl FCC° �/C_tij -,m•
CITY too STATE wn ZIP ` C FAX
CONTRACTOR'S LICENSE # EXP 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.
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.
/o J
Applicant's Signature Date
Owner / Contractor / Owner's Agent / ontractor's Age (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