20160201 Permit Pkg 04222016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: BRADLEY & NAOMI SHOEMAKER
Address: 14927 PRAIRIE VISTA LP
YELM WA 98597
Property Information:
Site Address: lAQ97 PRAIRIE VICTA I P CF
Assessor Parcel No.:
Contractor Information:
Name: HOME DEPOT AT HOME SERVICES
Address:
140 COUNTY LINE ROAD #140
PACIFIC WA 98047
Contractor License No.:
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor:
Fees:
Item
ROOF
Subdivision:
Permit No.: 20160201
Issue Date: 4/22/2016
(Work must be completed within 180 days)
Phone:
Owner: BRADLEY SHOEMAKER
Phone:
Expires: 0 /00 /0000
REMOVE AND REPLACE 22.3 SQ COMP ROOF. NO PLYWOOD FORESEEN
F t Heat Type (Electric, Gas, Other):
i rs
Second
Third
Garage
Basement
Contractor
HOME DEPOT AT HOME SERVICES
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 applying as a contractor, I further certify that I am currently
registered in the State of Washington.
Signature C� Date —a� 6
Firm
Lot:
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00229332 4/22/2016 10 :07 AM
OPER: CO TERM: 001
REF #: 10258
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160201 25.06CR
SHOEMAKER, BRADLEY & NAOMI
14927 PRAIRIE VISTA LP SE
ROOF 25.000R
TENDERED: 25.00 CHECK
APPLIED: 25.00 -
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM zQ ae o 20 1 /
Project Address: 14927 Prairie Vista Loop
Subdivision: Lot #:
Parcel #: 81860000900
Zoning;
New Construction rG Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
Plumbing ❑Mechanical ❑Mobile /Manufactured Home Placement ❑ Other
Project Description /Scope of Work: Remove /replace 22.3 sq. comp. roofing; no plywood foreseen
Project Value: 11,619.87
Building Area (sq. ft) 1st Floor 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? _
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Bradley Shoemaker
ADDRESS 14927 Prairie vista Loop EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE 253- 677 -3710
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
If yes, a
GENERAL CONTRACTOR Home Depot At Home Svc.IHomeCompliance TELEPHONE 800- 381 -5699
ADDRESS C -11 2455 Paces Ferry Road EMAIL
CITY Atlanta STATE GA Zip 30339 FAX
CONTRACTOR'S LICENSE # HOMED "972RQ EXP DATE 2115 CITY LICENSE # 001419.0
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.
Ficant's Signature i.
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 (360) 458 -3835
PO Box 479 (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us