20090216 Permit Pkg 102209City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: MARSHA GALE
Address: P.O. BOX 1344
YELM WA 98597
Property Information:
site Address: 16233 VANCIL LP SE
Assessor Parcel No.: 69270000200 Subdivision
Contractor Information:
Name: OLYMPIA FIREPLACE
Address:
506 EAST 4TH AVE
OLYMPIA WA 98501
Contractor License No.: OLYMPFS185JZ
PRAIRIE HEIGHTS Lot: 200
Permit No.: 20090216
Issue Date: 10/22/2009
(Work must be started within 180 days)
Phone: 360-458-8784
Owner: nneQCUe r_ni G
Expires: 10/31 /2010
Project Information:
Project: INSTALL GAS FIREPLACE
Description of Work: INSTALL GAS FIREPLACE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING PERMIT
Phone:
Units Fees
1 $ 27.00
TOTAL FEES: $ 27.00
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 27.00
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 in t~h/e~State of Washington.
Signature //~,~~jJ~j,( ~~Q.(~ ~ Date ~~~~~ 7/U y
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ial .Inspection:
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Received
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
OET 2 ~ 2009
Project Address:~~ z33 YCL(~L~ ~ (,oS~ (,~C~IYI Parcel #: ~09 ~ 7 ~ 0 0o ap 6
Subdivision:
~ `~I C twZ' eta *z
L' l S Lot #: LoT Z Plan #: R- )
Zoning: ~}
New Construction Re-Model / Re-Roof /Addition ~ ~ Home Occupation Sign
Plumbing Mechanical Mobile /Manufactured Home Placement Other
Project Description/Scope of Work: -~ 5ru-(( ,~eeStQ./~C~//1p ~~ ~~~~
Project value: ~3~Cx?.
Building Area (sq. ft) 1S` Floor 2"d Floor X Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heatin :GAS/OTHE or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? x(10
If yes, a completed environmental checklist must accompany permit application
ADDRESS ~ 2 S~ - EMAIL
CITY U[IY/1 STAT ZIP S TELEPHO
A HITECT/ENGINEER LICENSE #
DRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTO TELEPH E g
ADDRES ''" ~ ~ EMAI ~ ~ . ci;ry
CITY 4 STATE co . ZIP ~ r~~C i FAX~6((J•-~.'~- ~/ 5'0~
CONTRA T R'S LICENSE #K ~/f'!YI(,t`~/ - XP DATITY LICENSE #
P BING CONTRACTOR TELEPHONE
DDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DAT~EITY LICENSE #
HANICAL CONTRACTOR TELEPHONE
DDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # 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 of Yelm.
ant s Signature Date
Owner Contractor I Owner's Agent /Contractor's Agent (Please circle one.)
~„ ..,,_.,,,,:._ ___ S~t~.t..s~ ~--•-• ••• •- 'authorized by such permit is not begun
WWW.OLYMPIAFIREPLACE.COM r abandoned for a period of 180 days
FIREPLACES STOVES INSERTS
GAS • WOOD PELLET
SPAS AWNINGS SUNSCREENS
BARBE9UES & ACCESSORIES
(360) 458-3835
(360) 458-3144 FAX
PROFESSIONAL INSTALLATION WA#OLYMPFS185JZ
/3y~f
/~/~ ~1~.~~7
800-434-4328