20150316 Permit Pkg 10202015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: INTEGRITY CONSTRUCTION
Address: 120 STATE AVE NE #1408
OLYMPIA WA 98504
Property Information:
Site Address: 916 CRYSTAL SPR RD NW
Assessor Parcel No.: Subdivision:
Contractor Information:
Name: INTEGRITY CONSTRUCTION
Address:
120 STATE AVE NE #1408
OLYMPIA WA 98504
Contractor License No.:
Permit No.: 20150316
Issue Date: 10/20/2015
(Work must be completed within 180 days)
Phone: 360- 628 -8112
Owner: SYNNEX LLC
Lot:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: ROOF
Description of Work: NEW ROOF, REPAIR SHEETING AS NEEDED. INSPECTOR TO BE CALLED IF SHEETING
IS TO BE REPLACED.
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Heat Type (Electric, Gas, Other):
Contractor
INTEGRITY CONSTRUCTION
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 res ictions of record. If applying as a contractor, I further certify that I am currently
registered in the a of Washi ton
Signature Date j
t
Firm �PCt V I �\l r , v1 �� 1r I A (4 1 C � V \
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cat 04 Bel%
(36�)
REC #: 00210912 10/'20/2015 11:11 AM
OPER: CO TERM.1
001
REF #: 125148
PAID BY:
TRAN: 30.0000 BUSINESS LICENSE
BUSINESS CONST &EW 35.000R
TRAN: 33.0000 BUILDING ITS
PERM
20150316
INTEGRITY CONSTRUCTION
916 CRYSTAL SPR25 OOCR
ROOF
TENDERED: 60.00 CHECK
APPLIED: 60.00 -
CHANGE: Q.00
CITY OF YELM
RESIDENTIAL BUILDINGnnP��ERMIT APPLICATION FORM
Project Address: gito r t c Qd Parcel #: Iq
,
Subdivision: Lot #: Plan #: Zoning:
New Construction � Re -Model / Re -Roof / Addition I I Home Occupation Sign
Plumbing Ll Mechanical a Mobile / Manufactured Home Placement F1 Other r�
Project Description /Scope of Work:_ it o ` epa t r SbztYt S �fi V
Project Value: CD
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car.
Covered Patio Covered Porch Patio Deck
# 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.
$ ILDING OWNER NAME: L
ADDRESS °S �i- MAIL
CITY IKtrtUGlhC STATE Ini ZIP Ci S��i� TELEPHONE &at0 - )A
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
!GENERAL CONTRACTOR Yr\ r% LEPHONE 4) — UIX X I I �.
ADDRESS t ,� EMAIL i . 1 y4 ear' W .0 `in
CITY STATE VQ A_ZIP CA' �bO I FAX -
CONTRACT R'S LICENSE # iKJtGGSG)iLFEXP DATEig 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 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.
Applicant's Signature Date
Owner / Contractor 1 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
OCT 2 0 2015
105 Yelm Avenue West (360) 458 -3835 _
Yelm, WA 98597 (360) 458 -3144 FAX
www.ei.yelm.wa.us