20170207 Permit Pkg 06202017CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: l.% Parcel
Subdivision: -4,,0 ille-iC.c_ Lot #:_ Plan #: _ 1�� y. {' Zoning:
)<' New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing C Mechanical _I Mobile / Manufactured Home Placement Other
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Project Description /Scope of Work: : x
Project Valuer
Building Area (sq. ft) 1St Floor WY 2nd Floor, 3rd Floor Garage -2 car_ 7/3 car
Covered Patio Covered Porch () I Patio 1.0 16 Deck
# Bedrooms # Bathroom 1 Heating -9 /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? 4 1" �
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: , e-,4 e,—
ADDRESS EMAIL
CITY e'' C c STATE ZIP ' S' TELEPHONE G
ARCHITECT/: GI ER r -, ,,� I s; LICENSE #
ADDRES S
/�' EMAIL
CITY STATE y ZIP 5 -? Y_ TELEPHONE
GENI:RAL,OONTRACTOR TELEPHONE
ADDRESS Z 5 °ti / i�? 11,f ~ a'- 'S* EMAIL
CITY STATE2 d ZIP FAX-YXI,
CONTRACTOR'S LICENSE # 3 1 �' EXP DAT ITY LICENSE #
PLUMBING'CC,NTRACTOR sue• u . •,, 2ZC TELEPHONE 1 C
ADDRESS EMAIL
CITY � rk-) ST E j ZIP ° FAX
CONTRACTOR'S LICENSE # ,WhiSt`V !&�, EXP DATE ITY LICENSE #
MECHANICAL CONTRACTOR :,�� TELEPHONE
ADDRESS, 115- S Lam' EMAIL
CITY �, t r'i7 J,,'1, STATEZJZZ ZIP 5,_i—.0_2FAX
CONTRA O S LICENSE 0 EXP DATE` /s�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 pToperty will be in accordance with the laws, rules and regulations of the State of Washington and the
City = f Yelm. M
Applicant's Nignature Date
Owner / Cot>I 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
STOCK
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 TAX
www.ci.yelm.wa.us
APPROVED
By Randy at 3:52 pm, Jun 08, 2017
WITH CORRECTIONS
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2' min. setback between
sidewalks, driveways,
easements, & STEP tanks w /5'
min. from property lines, house &
porch foundation & 2' min. from
utility easements.
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DEUTSCHER MARIJI
LEGAL DESCRIPTION
LOT %, VAN TRUMP SUBDIVISION
CITY OF YELM , THURSTON
COUNTY, WASHINGTON
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N.W. LONGMIRE 5T.
SCALE : I' a 20'-0'
NHD assumes no Ifabilitg
for any inaccuracies in the site Inrormation
(lot dimensions, easements; set backs, etcJ
All site Inrormation has been supplied by the client,
and shall be their res onsfbility to check and verfry
all Information prior to construction.
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