20160211 Permit Pkg 05062016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: RONALD BAUGHN
Address: P.O. BOX 1951
YELM WA 98597
Property Information:
Site Address: 1A1R [.RY-RTAI SPR RD RE
Assessor Parcel No.: 22718310102
Contractor Information:
Name: RONALD BAUGHN
Address:
P.O. BOX 1951
YELM WA 98597
Contractor License No.:
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work:
Sq. Ft. per floor: First 1224
Second
Third
Garage
Basement
Fees:
Item
NEW RESIDENTIAL BUILDING
MECHANICAL
PLUMBING
Permit No.: 20160211
Issue Date: 5/06/2016
(Work must be completed within 180 days)
Phone: 253 - 846 -1489
Owner:
Subdivision: CRYSTAL SPRINGS Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor Fees
RONALD BAUGHN $15,161.02
RONALD BAUGHN $ 55.75
RONALD BAUGHN $ 55.00
TOTAL FEES: $ 15,271.77
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 restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the State of Washington.
Signature (Q z� Date — V
Firm
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
alt Of 58e� 44
(36�)
5/06/2016 2:42 PM
OPER. CO
REC #: 002304T�RM: 001
REF #: 26869399
PAID BY:
TRAW 33.0000 BUILDING PERMITS
20160211 15,271.77CR
BAUGHN, RONALD
1416 CRYSTA15 P 61R S E
BLD -RES1 55.7`.CR
MECH 55.001CR
PL
TENDERED: 15,271.77 (HECK
APPLIED: 15,271.77 -
__-- ------ 0.00
CHANGE:
M
�(( ()3AI
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 4` �/6 0 /�.5'1ar�Z D y/ ys � �.�t Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing 1�P Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: 6n� 1512,-Y�4 x 6a m
Project Valu �? S' .0 L oo
}
Building Area (sq. ft) 1St Floor 2 I Floor Garage _122—f( Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? AJO-
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS °j!G r i MAIL
CITY —ye y/ STATE(►ZIP
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR L TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR " tJ6y54,, TELEPHONE
ADDRESS I 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 / 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
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.w¢.us
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(360) 454 -?835
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