20160171 Permit Pkg 04062016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: RAINIER CHIROPRACTIC CLINIC
Address: 503 1 ST ST S
YELM WA 98597
Property Information:
Site Address: 503 FIRST ST S
Assessor Parcel No.: 22719332400 Subdivision:
Contractor Information:
Name: DREAMTIME VISUAL COMM., INC
Address: DAVID KEENAN
PO BOX 2324
YELM WA 98597
Contractor License No.: 10988
Project Information:
Project: SIGN
Description of Work:
Sq. Ft. per floor:
Fees:
Item
SIGN
ONE NEW SIGN
First
Second
Third
Garage
Basement
Permit No.: 20160171
Issue Date: 4/06/2016
(Work must be completed within 180 days)
Phone: 360- 400 -3151
Owner: TYPE CURRENT OWNER
NAME
Phone:
Expires: 12/31/2015
Heat Type (Electric, Gas, Other):
Contractor
DREAMTIME VISUAL COMM.. INC
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 restrictions of record. If ap ing as a contractor, I further certify that I am currently
registered in the State of Washington.
Signature '" Date - , itt
Firm
Lot:
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yolm
(36 ) 458 -3244
REC #: 00227396 4/06/2016 12 :21 PM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXX,XXXXXXXXXXXXXX
AUTH #: 043377
TRAN #: 000000000594
TRAN: 33,0000 BUILDING PERMITS
20160171 125,OOCR
RAINIER CHIROPRACTIC CLINIC
503 FIRST ST S
SIGN 125,06CR
TENDERED: 125.00 CREDIT CARD
APPLIED: 125.00-
CHANGE: 0.00
CITY OF YELM
SIGN PERMIT APPLICATION FORM
Project Address: ��3 I S4 JI . s Parcel #: 1�a1 19 � ?)94 DD
Zoning; Current Use: Proposed Use:
Type /Number of Sign(s) (wall, nmonume hted , etc.):
Value of each Sign: mac, 4
/r
Dimensions of Sign(s):
Building Gross Floor Area (sq. ft):
Building Height:
Existing Signage (if any) and dimensions:
APPLICANT `. iS01VAILk, D
Last Name First Name
ADDRESS ISfi EMAIL i 6iiv�' UM
CITY lvh\ STATE IyA _ZIP ojg _ _ _ TELEPHONE (-6up -
ADDRESS 5)-,2 ht St. -5 • EMAIL _
CITY Y&IIM STATE_W_A_ZIP q KS'777 TELEPHON
TELEPHO
ADDRES
CITY � STATE PL,/ ZIPYC =FAX
CONTRACTOR'S LICENSE # EXP DATE
CITY LICENSE #
I hereby certi that the above information is correct and that the construction of the above described sign will be in
accordance th the laws, rules and regulations of the State of Washington and the City of Yelm.
O I�
Applican Tignature Date
Owner / C ntractor / Owner's Agent/ Contractor's Agent/ Tenant (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
p TC GM97TC
F _`,l 0 2"` "5
105 Yelm Ave W
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.w¢.us
Measurements
Width: 72" Alen
Hight: 48"
Sign 6Y:-------------- - - - - --
8'--------------- - - - - --
now
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