BLD-05-0217
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0217 -YL
Issue Date 07/15/2005
(Work must be started within 180 days)
Receipt No
37340
Applicant:
Name: Halverson, Barry
Phone:
458-0783
Address. 10648 Mill Rd. SE
City' Yelm
State. WA Zip 98597
Property Information:
Site Address. 10648 Mill Rd. SE
Assessor Parcel No. 22730230501
Subdivision.
Lot:
Contractor Information:
Name. Applicant
Contact:
Phone:
Address.
City'
State.
Zip
Contractor License No
Expires.
Business License:
Project Information:
Project: RV & Garden Shed
Description of Work: Pole Barn
Sq. Ft. per floor (1 st) 1368
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas, Other). OTHER
Fees.
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
--------------------------- -------------
Building Permit - Other 111.25 0.00 000 o 0000 o 0000 $1,000
Building Plan Review 72.31 000 000 o 0000 o 0000
TOTAL FEES. $183.56
Applicallt's Affadavit:
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
registered in e State of Wa hi n.
OFFICIAL USE ONLY
# Sets of Prints.
Date
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CITY O'f
YELM
RECEiPT No. 31341
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_ --rrriu-n:F1ITT---n:r-"-- -n;AN- FE'! I c;lT- ncT------------- - ------- - - ----- -- -- - ---- .--- -- -
RECEIPT No.3 7 3 40
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Applicant:
Name. Halverson, Barry
o PAlO 0-
City of Yelm JUL 1\. 6 ~005
Community Development Department Of '(eLM
Building Division C\1'f I
Phone: (360) 458-8407 '"13 if 0 L
Fax: (360) 458-3144 5 J
Address. 10648 Mill Rd. SE
City' Yelm
Project Information
Project: RV & Garden Shed
Description of Work: Pole Barn
Permit Fees Schedule
Permit No BLD-05-0217-YL
73'-/ )
Phone.
State: WA Zip 98597
458-0783
Assessor Parcel No. 22730230501
Site Address 10648 Mill Rd. SE
Fees.
Item
Building Permit - Other
Building Plan Review
032001-322-10-00
000
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
Acct Code
111.25
100 001-345-83-00
000
000
o 0000
o 0000 $1,000
o 0000
72.31
TOTAL FEES.
$183.56
000
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Main Identity
From'
To,
Sent:
Attach'
Subject:
Barry ,
"Gary Carlson" <garyC@ci yelm.wa.us>
<BarryLoma@ywave.com>
Friday, July 15, 2005 g.oo AM
07-15-2005 pdf
07-15-2005 pdf
Page 1 of 1
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Here is your mark up If you do not have any questions I willlhave the permit ready after 3'00 this afternoon
Gary
7/15/2005
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address \0<04.8 m.dt eo\. S'cr'. :
, '
Subdivision: S $- I {gZQ Lot #. :2 Zoning,
o New Construction ~ Re-Model / Re-Roof ~ 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile / Manufactured Home Placement 0 Other
Parcel #' ~.J.1- 3 rp:23~S~ {
,. ,
Project Description/Scope of Work' ~ Gh. f?.\J rA)\o\ ~O)~"^- ~\...J-o e",,\j-j-1o &..tr~
Project Value, $S,ooo
Building Area (sq ft) 1st Floor
Basement
2nd Floor
Carport
Garage /l{Lfo
Patio
Deck
# Bedrooms_
# Bathrooms_
Heating. GAS/OTHER or ELECTRIC (Circle One)
1'/0
If yes, a
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
BUILDING OWNER NAME.
ADDRESS to(.,lt8 rni\l P-e.l J' c-
CITY W\- STATE I.JA-
BIl't"-- !-e1Y1~ '-J'w N~
~
ZIP t\8~c:;"
TELEPHONE S'(,o 4-Q (/>1-,~J
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
LICENSE #
ZIP
TELEPHONE
GENERAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
__TELEPHONE
ZIP
FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
ZIP
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
ZIP
FAX
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.
.. . dka II ~,;x;os;
Applicant's Si a ure Datetf
Owner / Cont ctor / 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
c.,.t.ommunlt\ Dc\clllprncnt'l-"urms & Proccdurcs\lluildin); I'crmits.RcsBldgl'crmitApp,doc
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