20160249 Permit Pkg 06092016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458-3144
Applicant:
Name: PAUL KEESLAR
Address: 24336 PEISSNER
YELM WA 98597
Property Information:
Site Address: 14977 101ST WAY SE
Permit No.: 20160249
Issue Date: 6/09/2016
(Work must be completed within 180 days)
Phone: 360- 894 -2666
Owner: TYPE CURRENT OWNER
NAME
Assessor Parcel No.: 81780000001 Subdivision: VINTAGE GREES Lot: TRACT A
B C D F G
Contractor Information:
Name: PAUL KEESLAR
Address:
24336 PEISSNER
YELM WA 98597
Contractor License No.:
Project Information:
Project: SIGN
Description of Work: TWO MONUMENT SIGNS
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
SIGN
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
PAUL KEESLAR
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�plying as a contractor, I further certify that I am currently
registered in tnPn WasWgto // /
Signature �(�,G(�,__ Date
Firm
Fees
$ 250.00
$ 250.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of mm
(36 ) 458 -3244
REC #: 00233858 6/09/2016 4:14 PM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 03168D
TRAN #: 000000001342
TRAN: 33.0000 BUILDING PERMITS
20160249 250.06CR
KEESLAR, PAUL
14977 101ST WAY SE
SIGN 250.0()CR
TRAN: 30.0000 BUSINESS LICENSE
PK ARTSTONE
BUSINESS LICENSES & 35.000R
TENDERED: 285.00 (:REDIT CARD
APPLIED: 285.00-
CHANGE: - 0.00
CITY OF YELM
SIGN PERMIT APPLICATION FORM
�G��- �1
1-77 SC �l
Project Address: Parc6i' #:
Zoning; / (2 Current Use: 2/d�/ur�K Proposed Use:_
Type /Number of Sign(s) (wal monument lighted, etc.): *Q k (/✓" 2 5 1�
Value of each Sign�0
L g&,
�al �w
7,�- 000 00,0 /
Dimensions of Sign(s):
Building Gross Floor Area (sq. ft):
Building Height:
Existing Signage (if any) and dimensions:
APPLICANT "4n
ADDRES st Name EMA L &6 ` `rte [ ao "Can?
CITY STATE ZIP TELEPHONE /
BUILDING: t
CITY YZ,ZH / STATE W#-' ZIP 99 �9-7 TELEPHON
BUILDING TENANT
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
SIGN CONTRACTOR Xc— TELEPHONE
ADDRESS EMAIL �Sc v c at.►.l
CITY STATE ZIP Vg' ST9 FAX
CONTRACTOR'S LICENSE #?IbJRL BEXP DATE? +CITY LICENSE #
t?
I hereby certify that the above information is correct and that the construction of the above described sign will be in
accordance with the laws, rules a 'Ad regulations of the State of Washington and the City of Yelm.
I Date
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
105 Yelm Ave W (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ciyelm.wa.us
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