20160253 Permit Pkg 06212016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: GREGORY MARTIN
Address: 5 BRUNSWICK LN
PINEHURST NC 28374
Property Information:
Site Address: 11 n WA CW1KJr_TrIA1 r•T c►AI
Assessor Parcel No.:
Contractor Information:
Name: BB & K CONTRACTORS, INC.
Address: ROBERT BARNES
PO BOX 8
ROY WA 98580
Contractor License No.: 10904
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor:
Fees:
Item
ROOF
STRIP AND REROOF
First
Second
Third
Garage
Basement
Subdivision:
Permit No.: 20160253
Issue Date: 6/2112016
(Work must be completed within 180 days)
Phone:
Owner: GREGORY MARTIN
Phone.
Expires: 12/31/2016
Heat Type (Electric, Gas, Other):
Contractor
BB & K CONTRACTORS, 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 restboa5 -of record. If applying as a contractor, I further certify that I am currently
registered,i he tate of Washin teP.
Signat ° e Date
Firm
Lot:
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
C� ys' 1 �458-3244
3610'
6
REC #: 00235308
6/21/2016 8:48 AM
OPER: CO TERM.. 001
REFS`:
PAID BY:
ACCT #,. 05295E XXXXXXXXXXXX
AUTH
TRAM #: 000000001480
TRAM: 33.0000 BUILDING 0(CRITS
20160253
MARTIN, GREGORY
110 WASHINGTON T v!
ROOF
TENDERED: 25.00 CREDIT CARD
APPLIED: 25.00-
-_`_"_ 0 00
CHANGE:
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: l' 1/' 4b ',-� - Parcel #:
Subdivision: Lot #: Plan #: Zoning: _
New Construction e -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: f-2 t V vL -J
Project Value:_ 10 Zoo
Building Area (sq. ft) 1s` Floor 33 -OD 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?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE 3(90-,7_359
ADDRESS EMAIL
CITY STATE bf,4 ZIP FAX
CONTRAC R'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 ove information is correct and that the construction on, and the occupancy and the use of the
above de ed property will in accordance with the laws, rules and regulations of the State of Washington and the
Cit elm.
App (cant'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