20160159 Permit Pkg 04252016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: MOOSE LODGE
Address: P.O. BOX 757
YELM WA 98597
Property Information:
Site Address: 1117 YELM AVE W
Assessor Parcel No.: 21744120301
Contractor Information:
Name: MOOSE LODGE
Address:
P.O. BOX 757
YELM WA 98597
Contractor License No.: ISLANRL92ONM
Project Information:
Project: ROOF
Description of Work: REROOF
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Subdivision
N/A
Permit No.: 20160159
Issue Date: 4/25/2016
(Work must be completed within 180 days)
Phone: 360- 458 -3381
Owner: MOOSE LODGE
Phone:
Expires: 08/14/2016
Heat Type (Electric, Gas, Other):
Contractor
MOOSELODGE
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read nd examined the information contained within the application and know the same
to be true and correct!I qso certify that the proposed structur is in conformity with all applicable City of
Yelm regulations irud g those governing ng and land .bdivision, and in addition, all covenants,
easements and restrictions of record. If appl ing s a con tr ctor, I further certify that I am currently
registered in the;State of Washington.
S i g n I re Date
Firm
Lot: N/A
Fees
$ 195.25
$ 195.25
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mi
(36 ) 458 -3244
REC #: 00229374 4/25/2016 8:24 AM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 082413
TRAN #: 000000000802
TRAN: 30.0000 BUSINESS LICENSE
ISLANDER ROOFING LLC
BUSINESS LICENSES & 35.00CR
TRAN: 33.0000 BUILDING PERMITS
20160159 195.25CR
MOOSE LODGE
1117 YELM AVE W
ROOF 195.25CR
TENDERED: 230.25 CREDIT CARD
APPLIED: 230.25-
CHANGE: 0.00
CITY OF YELM
/ COMMERCIAL Bila—W ILDING PERMIT APPLICATION FORM
Project Address: / I117 � /n? Parcel #:
Zoning;
Current Use:
roposed Use:
❑ New Construction Re -Model / Re- of / Tenant Improvement
E, Plumbing n Mechanical ❑ Fire Prevent/Suppress /Alarm ❑ Other
Project Description /Scope of Work: �f)'11� -� 4 r� /0_�
Project Value:_ ZZ16
Building Area (sq. ft) Parking Garage
Building Height
1St Floor 2nd Floor 3rd Floor
Are there any environmentally sensitive areas located on the parcel? _
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME:
ADDRESS EMAIL
CITY STATE -7 ZIP TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACT '� TELEPHONE
ADDRESS -I EMAIL
CITYI STATE G✓ ZIP FAX
CONTRACTOR'S LICENSE # 5— -7F .XP, 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 City Mitigation documentation (TFC).
If yes, a
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above des ibed property will be in accordance with the laws, rules and regulations of the State of Washington and the
city-pt-Ye at
L
Applicant's Signatu Date /
Owner / Contractor / 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
(360) 458 -3835
105 Yelm Ave W (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us