20170166 Permit Pkg 04072017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458-3144
Applicant:
Name: THOMAS WINKLEBLECK
Address: 11123 SHAW RD
YELM WA 98597
Property Information:
Site Address: 310 RAILROAD
Assessor Parcel No.:
Contractor Information:
Subdivision:
Name: SHINE SPECIALTIES & PROMOTIONS
Address: JIM & LORI SHINE
1201 E YELM AVE STE 400
YELM WA 98597
Contractor License No.:
Permit No.: 20170166
Issue Date: 4/07/2017
(Work must be completed within 180 days)
Phone:
Owner: TYPE CURRENT OWNER
NAME
Phone:
Expires: 0 /00 /0000
Project Information:
Project: SIGN
Description of Work: WALL SIGN
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor
SIGN SHINE SPECIALTIES & PROMOTIONS
TOTAL FEES:
Applicant's Affidavit:
I certify that I Pave read and examined the information contained within the application and know the same
to be true an correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regula ons inc ose governing zoning and land subdivision, and in addition, all covenants,
11 easements nd re trictions o record. If applying as a contractor, I further certify that I am currently
registered i the tate of W hingt.
Signature I&Ik44eq- Date q-7-171
Firm 'l n 1 L1 D lA I IF
Lot:
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: THOMAS WINKLEBLECK
Address: 11123 SHAW RD
YELM WA 98597
Property Information:
Site Address: 310 RAILROAD
Assessor Parcel No.:
Project Information:
Project: SIGN
Description of Work:
Sq. Ft. per floor:
Fees:
Item
SIGN PERMIT PER SIGN
First
Second
Third
Garage
Basement
i
I
r ,�
Subdivision:
Permit No.: 201 70166
Fee Calculation Worksheet
Phone:
Owner: TYPE CURRENT OWNER
NAME
Heat Type (Electric, Gas, Other):
Units
Lot:
Fees
0 $ 125.00
TOTAL FEES: $ 125.00
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 125.00
City► of Yelm
(361) 458 -3244
RECV 00264625 4/07/2017 1:52 PM
PIPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 043209
TRAM #: 000000004871
TYPE:: PURCHASE
TRAM: 33.0000 BUILDING PERMITS
20170166 125.0(CR
WINKLEBLECK, THOMAS
310 RAILROAD
SIGN 125.O(CR
TENDERED: 125.00 (REDIT CARD
APPLIED: 125.00-
CHANGE: U.UU
'..
U
No17oiZ4(o
CITY OF YELM
SIGN PERMIT APPLICATION FORM
Project Address: d `h _tm d sT N W Parcel* 2 Z r' vl 3 ) r `-/ 0,�
Zoning; (�,- Current Use: f P_ �Q. LJ_ Proposed Use: Yt km� L
Type /Number of Sign(s) (wall, monument, lighted, etc.):
Value of each Sign: ,
Dimensions of Sign(s): 73-60
Building Gross Floor Area (sq. ft):
Building Height: l�,, } t e,t
Existing Signage (if any) and dimensions: //01
APPLICANT _V i n K 1 h\ e 6.- Th C'i I "0.S
Last Name First Name
ADDRESS —1 11 2 5Vv,-,D R-A SF_ EMAIL e'C° QLhGb•CC7m
CITY yplum STATE \A_1 I� ZIP 85ci -7 TELEPHONE 3L-,Q- 1orJ-134�
BUILDING OWNER
ADDRESS wz3 SL EMAIL
CITY —gfi!n STATEN- ZIP S7 TEL EP ONE �G L17D 7
BUILDING TENANT
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
SIGN CONTRACTOR r�tl'e-s TELEPHONE 3( D-gCQ--(dtk
ADDRESS st EMAIL
CITY STATE — ZIP '' FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
I hereby certify that the above information is correct and that the construction of the above described sign will be in
accordance wi9) the laws, rules and regulations of the State of Washington and the City of Yelm.
::z 4 414 / -7 Me -7
Appfcant' §'Signature Date
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
105 Yelm Ave W (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa. us