20160130 Permit Pkg 03042016City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: BARRY & LOMA HALVERSON
Address: 10648 MILL RD SE
YELM WA 98597
Property Information:
Site Address: 15730 91ST WAY SE
Assessor Parcel No.: 43380000500
Contractor Information:
Name: BARRY & LOMA HALVERSON
Address:
10648 MILL RD SE
YELM WA 98597
Contractor License No.:
Project Information:
Project: ROOF
Description of Work: TEAR OFF AND REROOF
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Permit No.: 20160130
Issue Date: 3/04/2016
(Work must be completed within 180 days)
Phone: 360- 458 -0783
Owner: BARRY HALVERSON
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
BARRY & LOMA HALVERSON
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 rictions of record. I app ing as a contractor, I further certify that I am currently
registered i e Sta of Washingt n.
Signature /►� .-, -, Date
Firm (t IAA k`
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Ni
(36 ) 458 -3244
REC #: 00224277
OPER: CO TERM
REF #: 6302
PAID BY:
3/04/2016 10 :47 AM
001
TRAN: 33.0000 BUILDING PERMITS
20160130 25.00CR
HALVERSON, BARRY & IOMA
15730 91ST WAY SE
ROOF 25.000R
TENDERED: 25.30 CHECK
APPLIED: 25.00-
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: %S'7.30 g1S+-0&j 51F_ Parcel #: 13360cooSoen
Subdivision: VA*n ` i&i S� 404 Lot #: Plan #: Zoning:
New Construction ARe -Model Re -Roo Addition Home Occupation Sign
Plumbing Mechanical , Mobile / Manufactured Home Placement C Other
Project Description /Scope of Work: %ar -4 2lof A,91(6u Ak44 Mw kn S�thry4t
U
Project Value: IPS,.c (.v
Building Area (sq. ft) 1St Floor 2nd Floor Garage Deck f4 4c
Basement Carport Patio i /blZsr, f'
# BedroomsA # Bathrooms 3 Heating GA THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? N v
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Si2.rr..
ADDRESS Mo` g (Al EMAIL - c%e Wars "o: -N lvma c� l.a• -n
CITY 21n STATE W1 ZIP ab5,,7 TELEPHONE 3LvCa 45 C? !2 � >`i
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR S4eve, A-Aeolyii TELEPHONE Zs3 S'37 ! S'6
ADDRESS L2 C. 4A 1-976 EMAIL
CITY Sn •r STATE_yPt ZIP us'7& FAX
CONTRACTOR'S LICENSE # ftY-jnAW 1936CB 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.
nwner t's Signq Date
C ontractor I 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 21C"11lu
ii
A-5
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
(360) 45#4035► ...................,
(360) 458 -3144 FAX