20160213 Permit Pkg 05092016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ALLEN & BETTY LITTLE
Address: 15724 95TH CT SE
YELM WA 98597
Property Information:
Site Address: 15724 95TH CT SE
Assessor Parcel No.: 43390100500
Contractor Information:
Name: ALLEN & BETTY LITTLE
Address:
15724 95TH CT SE
YELM WA 98597
Contractor License No.:
Project Information:
Project: ROOF
Description of Work: TEAR OFF AND REROOF
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
ROOF
Permit No.: 20160213
Issue Date: 5/09/2016
(Work must be completed within 180 days)
Phone: 360 - 400 -1042
Owner: BETTY LITTLE
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
ALLEN & BETTY LITTLE
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 shington.
Signature �7 -�(;Q, ; Date J�tLa
Firm
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00230762 5/09/2016 1:35 PM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 143958
TRAN #: 000000000974
IRAN: 33.0000
20160213
LITTLE,
15724 9
ROOF
BUILDING PERMITS
25.00CR
ALLEN & BEITY
5TH CT SE
25.00CR
TENDERED: 25.00 CREDIT CARD
APPLIED: 25.00-
CHANGE: -6"
0.00
,A16o03
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 151�q %5_H' C"'_ 56 Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / e -Roo Addition Home Occupation Sign
Plumbing Mechanical - o I e anufactured Home Placement Other
Project Description /Scope of Work: Gun yr
Project Value: 116-00
Building Area (sq. ft) 1St Floor 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms_J # Bathrooms Z 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 NA E: _
ADDRESS 1 ` EMAIL b 3 a
CITY STATE 1A10 ZIP 5t TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR "7 �4 - TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S 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 accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
zolr,�
Applica '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 (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us