20160275 Permit Pkg 07012016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JIFFY LUBE
Address: 1002 YELM AVE E
YELM WA 98597
Property Information:
Site Address: 1002 YELM AVE E
Assessor Parcel No.:
Contractor Information:
Name: JIFFY LUBE
Address:
1002 YELM AVE E
YELM WA 98597
Contractor License No.:
Subdivision:
Permit No.: 20160275
Issue Date: 7/01/2016
(Work must be completed within 180 days)
Phone:
Owner:
Phone:
Expires: 0 /00 /0000
Lot:
Project Information:
Project: OTHER SPECIAL EVENT
Description of Work: MR. WIGGLES. BALLOONS AND BALLOON GUY. JULY 1 THRU 14, 2016
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor
SE JIFFY LUBE Fees $ 0.00
TOTAL FEES: $ 0.00
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 includin ose governing zoning and land subdivision, and in addition, all covenants,
easements, and restrictions record. If ap lyin as a contractor, I further certify that I am currently
registered in the Slat ashington.
r
Signature Date '
Firm /1 M 1 0 QO
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
-VA t�� City of Yelm kN)
4
Community Development Department
SPECIAL EVENT I TEMPORARY USE
WS APPLICATION
Special Event Sign Permit (limited to 14 days, 4 times per calendar year)
Temporary Use (property owner permission letter required)
(see REVERSE for regulations)
NAME OF PROJECT��
APPLICANT /BUSINESS NAME
Mailing Address
City, State and Zip
Telephone MAIL ->`�'r JZ 0 i
City of Yelm Business License Number
SITE OWNER
Mailing Address
City, State and Zip
Telephone EMAIL
SITE ADDRESSILOCATION
SITE PARCEL NUMBER
SUMMARY OF REQUEST t2 73*-11
START DATE T ► L, END DATE
I affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am duly authorized by
the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and represent ' s of the City of Yelm and other governmental agencies to enter upon and inspect
said property as reasonabI nec sary to process this application.
Signed Date
ROUTING: SPECIAL EVENT Building Section
TEMPORARY USE Planning Section Building Section
ava zeim Avenue west (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
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