20170206 Permit Pkg 06202017CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: c >= ��i ►r�-z S. j�fi✓l Parcel #: z��aCGs ,✓%(
Subdivision: f rcw Lot #: Z Plan #: fe) 2 Zoning:
01
X New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing C: Mechanical Mobile / Manufactured Home Placement Other
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Project Descripf n /Scope of Work: ti r7 �-�� c;7"' ,,�-
Project Value% �.1(7 h 6 e"
Building Area (sq. ft) 1steFloor 2nd Floor 3rd Floor Garage -2 cara/3 car
Covered Patio Covered Porch Y6 Patio Deck
# Bedrooms # Bathrooms /-... Heating: ASS THER or ELECTRIC (Circle One)
t
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS %ilk ✓J V-V,%, Ad 112 e,2 -4:: ' ` EMAIL e2r''�i°Zi'� ��ct:�,er -.�s ,,7e7
CITY STATE , ZIP TELEPHONE - -/6,L ;7 s
ARCHfTECT /ENGINEER Ne ,,,,,r LICENSE #
ADDRESS ~ Q Re � �� /� EMAIL '° i< ',,e
CITY f�,` , e�, ,STATE ZIP _ ,� ,- F TELEPHONE 2S-,Y y_
GENERAL CONTRACTOR PVIV TELEPHONE 3' 61e,� - -i� 5 21
ADDRESS k', v!' A4/ — � 5`t' EMAIL
CITY c STATE W ZIP .5-/Z, FAX a
CONTRACTOR'S LICENSE EXP DATES CITY LICENSE #
PLUMB,ING'CONTRACTO R ,_.� TELEPHONE _.� v^
ADDRESS--& 2e J S',6 EMAIL
CITY ST E °vZI P FAX
CONTRACTOR'S LICENSE #&4j73 -P ?J6 1eQ EXP DATE / ITY LICENSE #
MECHANICAL trONTRACTt7R a „- TELEPHONE
ADDRESS 69 J J ``1' e_ S ) EMAIL
CITY / t STATE ZIP c `5'0 FAX
CONTRA T 'S LICENSE # Ht,'Wd ZC6 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 Yelm.
r / }
Applicant's ignature Date
Owner / C ractor / 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.ci.yelm.wa.us 14 -5
N
APPROVED
By Randy at 12:57 pm, Jun 14, 2017
WITH CORRECTIONS 9 IC
2' min. setback between sidewalks,
driveways, easements, & STEP tank
w/5' min. from property lines, house &
porch foundation & 2' min. from utility
easements.
Nind3blive '$oov
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N "d 36' l2!' E 'WWO
N1 LOINGMIRE 15T.
ME ELM Egg.
$CALE s V 4 20'-0
PEUTSC14ER MARIJKV NH0 assuires no liabflltk
LEGAL pear'Riell lor any Inacrur4cle$ in ft Oita fnrormatlor
LOT MI, VAN TFWMF WisolvisloN (lot 1,1.anslons, easements, act backs, etc;;
CITY OF YELM , TI-WIRSTON All site Information has been supplied by the client
and shall be their responsIbIlitg to check, and verify
CCLWY, WASHINGTON 411 it) ormation prior to construction,
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N "d 36' l2!' E 'WWO
N1 LOINGMIRE 15T.
ME ELM Egg.
$CALE s V 4 20'-0
PEUTSC14ER MARIJKV NH0 assuires no liabflltk
LEGAL pear'Riell lor any Inacrur4cle$ in ft Oita fnrormatlor
LOT MI, VAN TFWMF WisolvisloN (lot 1,1.anslons, easements, act backs, etc;;
CITY OF YELM , TI-WIRSTON All site Information has been supplied by the client
and shall be their responsIbIlitg to check, and verify
CCLWY, WASHINGTON 411 it) ormation prior to construction,
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