20090222 Permit Pkg 102709City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: DARLENE BAKER
Address: 16901 SR 507 SE
YELM WA 98597
Property Information:
Site Address: 1FA01 SR 507 SE
Assessor Parcel No.: 643031200500 Subdivision:
Contractor Information:
Name: DARLENE BAKER
Address:
16901 SR 507 SE
YELM WA 98597
Contractor License No.:
Permit No.: 20090222
Issue Date: 10/27/2009
(Work must be started within 180 days)
Phone: 360-870-1604
Owner: DARLENE BAKER
Lot:
Phone:
Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: REPLACE 50 GALLON GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
Contractor
DARLENE BAKER
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 ir~t~Sta~t9/ashington.~
Date IA7 • G t'
Firm
Fees
$ 33.25
$ 33.25
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
~.j,i!'i
1~9j'1 i~fi 'r !
~~!: ~JI I?~1(I
.,; ,;,,.
;,
::
~~,
r.'t~': _. ;,-gym ,._
.._r':t u ._ . ...
~~^_
F ."n
~-~
Project Address:
Subdivision: Lot #: Zoning;
New Construction ~ Re-Model / Re-Roof /Addition .Home Occupation Sign
Plumbing ~ Mechanical ~ Mobile /Manufactured Home Placement :Other
Project Description/scope of work: REPLACE 50 GAL. GAS WATER HEATER
Project Value:
Building Area (sq. ft) 1 sc Floor 2~d Floor Garage Deck
Basement Carport Patio
# Bedrooms # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas !orated on the parcel? If yes, a
completed environmental checklist must accompany permit application.
~' ~ ~~ DARLENE BAKER
ADDRESS 16901 STATE ROUTE 507 SE EMAIL
CITY YELM STATE wA ZIP 98597 TELEPHONE 360-870-1604
.;; ..
LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
° wESCO TELEPHONE 800-398-4663
~'W.. ~..
ADDRESS 2600 THORNDYKE AVE W EMAIL
CITY SEATTLE STATE wA ZIP 98199 FAX
CONTRACTOR'S LICENSE # wASHIES9710B EXP DATE9i11 CITY LICENSE # 30501
~` ~ ~="~~ TELEPHONE
v
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE #
"`" TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATs=_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 accords ce with the laws, rules and regulations of the State of Washington and the
City of Yelm. ~
-__ f~ a v~
___._
Applicant's Signature ___ - - Date
Owner /Contractor / Owne Agertt7~Contractor's Agent (ease 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
~~
RBI/~E~. ~1
105 Yelm Avenue West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
16901 STATE ROUTE 507 SE parcel #: 64303200500
~,~ .,~.
~r,.
~~~
t Permit Inc.
~~~~~~
October 22, 2009
City of Yelm
Attn: Gary Carlson
105 Yelm Avenue W
PO Box 479
Yelm, WA 98597
Gary:
Please process attached mechanical permit. We act as permit expeditors for our clients
and as such would ask that you do not mail the permits to the address on the application.
Instead, please mail them to the address below:
Northwest Permit Inc.
1345 Gulf Road
Point Roberts, WA 98281
Please see attached check for payment of the permit fees.
Please be informed that we, Northwest Permit Inc. have taken over the permitting
services for Washington Energy Services. Please update your contact information with
the above contact address and below:
Contact: Naida Khan
Tel: 360-945-2787
Fax: 360-945-2091
Email: naida@nwpermit.com
If you have any questions please contact me.
Thank you.
Naida Khan
Northwest Permit Inc.
OCT 2 31Q39