20170164 Permit Pkg 04042017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: LEE ANNE CAMPBELL
Address: P.O. BOX 1568
YELM WA 98597
Property Information:
Site Address: 1 f1R-,Af1 MII I RIB SF
Assessor Parcel No.: 22730230203
Contractor Information:
Name: LEE ANNE CAMPBELL
Address:
P.O. BOX 1568
YELM WA 98597
Contractor License No.:
Project Information:
Project: BOUNDARY LINE ADJUSTMENT
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Permit No.: 20170164
Issue Date: 4/04/2017
(Work must be completed within 180 days)
Phone:
Owner: LEE ANNE CAMPBELL
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Fees:
Item Contractor Fees
BOUNDARY LINE ADJUSTMENT LEE ANNE CAMPBELL $ 250.00
TOTAL FEES: $ 250.00
Applicant' Aff idavit:
I certify . a I have read and examined the information contained within the application and know the same
to be true orrect. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regu ations including those governing zoning and land subdivision, and in addition, all covenants,
E asement and restrictions of ecord. If applying as a contractor, I further certify that I am currently
registered in the to of shington.
Signature % Date •'-7
Firm
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
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PAID BY:
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20170164 LEE ANNE
CAMPBELL,
10630 MILL RD 250 0(CR
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TENDERED 250.00 (HECK. F,PPLIED 250,00 -
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