20160167 Permit Pkg 03162016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROSEMARY WHITT
Address: 14856 91 ST AVE SE
YELM WA 98597
Property Information:
Site Address: 14856 91ST AVE SE
Assessor Parcel No.: 33680001400
Contractor Information:
Name: MICHAEL'S ROOF SERVICE
Address: MICHAEL JOHNSTON
PO BOX 352
EAST OLYMPIA WA 98540
Contractor License No.:
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Subdivision
Permit No.: 20160167
Issue Date: 3/16/2016
(Work must be completed within 180 days)
Phone: 425 - 822 -2863
Owner: ROSEMARY WHITT
BELLA HOUSA VILLAGE
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
MICHAEL'S ROOF SERVICE
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 restric ions r cord. If plying as a contractor, I further certify that I am currently
registered in the a a rjgton.
Signature 1 Date Ida L,
Firm (/ 1`i ,%�1 r S (`)r-) n .�C_ r l a/ 4
Lot: 14
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00225787 3/16/2016 8:58 AM
OPER: CO TERM: 001
REF #: 1518
PAID BY:
TRAN: 30.0000 BUSINESS LICENSE
2016 -11120 MICHAEL'S ROOF
BUSINESS LICENSES & 25.00CR
TRAN: 33.0000 BUILDING PERMITS
20160167 25,OOCR
WHITT, ROSEMARY
14856 91ST AVE SE
ROOF 25.000R
TENDERED: 50.00 CHECK
APPLIED: 50.00-
CHANGE: 0.00
�� o �u
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: I (.1 A S- ( 9 / S7 `fit 5-e Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction i VRe -M
Plumbing Mechanical
Project Description/Scope of Work:_
Project Value: 42 �7 i) I)
Building Area (sq. ft) 1St Floor
Basement_
# Bedrooms_ # Bathrooms.
odel / Re -Roof / Addition Home Occupation Sign
Mobile / Manufactured Home Placement Other
2nd Floor Garage Deck
Carport Patio
Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: / •
ADDRESS I L4 9, S S 7 EMAIL
CITY Sj r� vv,, STAT � i! ZIP TELEPHONE-20-
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR ' YLL PHONE 9– 3 G
ADDRESS 0 -0, c,� 3s;--J EMAIL
CITY ) STATE _IAI•4_ZIP N FAX
CONT CTO 5 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 a cordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
A,// 6
Ap c Date
Ow 'er / ontractor I O ne '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
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us