20160277 Permit Pkg 07012016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: BILL & BECKY HAUSS
Address: P.O. BOX 25
MCKENNA WA 98580
Property Information:
Site Address: 1 J;7AA 41 ST WAY SE
Assessor Parcel No.: 43380000100
Contractor Information:
Name: BILL & BECKY HAUSS
Address:
P.O. BOX 25
MCKENNA WA 98580
Contractor License No.:
Project Information:
Project: ROOF
Description of Work:
Sq. Ft. per floor:
Fees:
Item
ROOF
REROOF
First
Second
Third
Garage
Basement
Permit No.: 20160277
Issue Date: 7/01/2016
(Work must be completed within 180 days)
Phone: 360- 458 -7068
Owner: BILL AND BECKY HAUSS
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
BILL & BECKY HAUSS
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 State of Washington.
Signature 1 tit_ -�� u �� —� Date
I L
Firm
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(36 0 458 -3244
RECA': 00235776 7/01/2016 11:11 AM
OPER: CO TERM: 001
REFA': 1096
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160277 25.00CR
HAUSS, BILL & BECKY
15746 91ST WAY SE
ROOF 25.00CR
TENDERED: 25.00 (HECK
APPLIED: 25.00-
CHANGE: 0.00
C� V (0 09 _1�
CITY OF YELM
RESIDENTIA/� BUILDING j))PERMIT APPLICATION FORM
Project Address: / -72A b `�� S L } LtJCvlt `1 Parcel #:
Subdivision: Lot #: Plan #: Zoning: _
New Construction ✓Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical �� Mobile /- Manufactured Home Placement r- Other
Project Description /Scope of Work: i�-
Project Value: 1
Building Area (sq. ft) 1" Floor 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: -�
ADD SS S c) 2 __EMAIL .-(.c) —4
CITY STATE ZIP Cr L? TELEPHONE
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR 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.
6
Applicant's Signature ate
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.ei.yelm.w¢.us