20160368 Permit Pkg 11172016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20160368
Issue Date: 11/17/2016
(Work must be completed within 180 days)
Applicant:
Name: STEVE DEMICH Phone: 360- 789 -5082
Address: P.O. BOX 796
YELM WA 98597
Property Information:
Site Address: 503 VAN TRUMP ST NW Owner: STEVE DEMICH
Assessor Parcel No.: Subdivision:
Contractor Information:
Name: THE ROOF DOCTOR Phone: 352 -1294
Address:
P.O. BOX 2257
OLYMPIA WA 98507
Contractor License No.: ROOFDI "168N8 Expires: 5/07/2018
Project Information:
Project: ROOF
Description of Work: TEAR OFF AND REROOF. INSTALL EDGE METAL
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
ROOF
Contractor
THE ROOF DOCTOR
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 Washington.
Signature Date H-0 I
Firm )T) c t-m- i v r
Lot:
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By_
Cite i of Y
(36 ) 458 -3elm 244
RECD': 00250685 11/17/2016
OPER: CO TERM: 001
REFS`: 86893
PAID BY:
TRAM: 33.0000
20160368
DEMICH,
503 VAN
ROOF
2 :47 PM
BUILDING PERMI13
25.0(CR
STEVE
TRUMP ST NW
25.0(CR
1E.NDERED: 25.00 CHECK.
APPLIED: 25.00 -
CHANGE: 0.00
UCITY OF YELM j
ILDI G PERMIT APPLICATIO FORM
Project Address: C ` �`Parc #: a 7 I C1 3 30 J
Zoning; Current Use: Proposed Use:
New Construction -�:Re -Model / Re -Roof / Tenant Improvement
Plumbing Mechanical - Fire Prevent/Suppress /Alarm - Other
Project Description /Scope of Work: +tg, ok�R_ 1-1- � root- "t Y�Q rU6
Project Value: I a , ---) - () L-)
Building Area (sq. ft) l3 Parking Garage 1St Floor 2nd Floor 3`d Floor
Building Height S \1�� S Y� ' 2)
Are there any environmentally sensitive areas located on the parcel ?_ If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: ct
ADDRESS Yn EMAIL
CITY STATE us c IP 5 TELEPHONE 1vc -7 9 Scff�
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ADDRESS V U r n `i, a- a 51
CITY STATE w� ZIP
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
J_ I 1 -1 JtmV ✓ J L ' 1 w I J
EXP DATE— CITY LICENSE # I �loL�
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 City Mitigation documentation (TFC).
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.
Applicant's Signature Da e
Owner / Contractor / 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
(360) 458 -3835
105 Yelm Ave W (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us