20045999 Pl Permit file 0116040
CITY OF YELM
fT'~ ~ PLUMBING PERMIT N- 5999
P.O. Hox 479 Separate application for each structure
Yelrn, Washington 98591 ~
Telephone (360) 458-3244 pate ~
~ /~ .~ %7'10 /ID.J ~ IN -- -
~'~7f i51 Acirlr6!55 / ~~
- - - - - ---- UccupancY_ ~~ --- /
Owner_~z ~f- ~ ~ ~e 1 ~/C~_ Sal A r~~ . - Address _ ~~~~C ~ Il~ ~.5~ - ~ y~
~ ~,¢ / - Phone `L ,[
Conlrar_tor_ ~t,.!-~.ic,c __ /Vj!~%- - -- - - -- - Address ~ ~ ~ N' ~/~ ~~ Phone 7 ~ T~~__
Stale. Conirs. No.7~!~S[~~ ~ Z~/L~ _ Building Permit Number- _ , ~"
ITEM
-- - FEE 61UANTIT1f FEE DESCRIPTION OF WORK
fr~ilefs U New --- --
Urinals U Addition
Lavatary__ __ _ _____ i Rem
odel
[3ath Tubs _ _ _
U AI_te__r_ation
Shower Baths _ _
-
_
K~tchen Sunk __ _ _ CO
'
Disposal Units
--- -
- NTRACTOR
S AFFIDAVIT
Dish WaShefS I hereby make.appllcailon Ior a Plumbing permit and <;erlify that our
firm is re
lsterPd as a
t
t
l
h
_ DflflkinC~. FOUntalnS _ ___ g
con
rac
or wl
h t
e State of Washington and
City or Yeim and that work shall be performed In accordance with
_ LQUndfy TU_b _ _ all Codes and Ordinances or City of Yelm.
Automatic Laundry Equip. Firm
-Catch Basin - - --
Flo_or Drains___
FIUOf $Ink Signature-
liot Water Tanks : a ~ / ~ No work shall be performed prior to receipt of validated permit.
MISC. /1' ~ U~ ~ p ~ Call (360) A5g-8407 for Inspection.
Misc.
fOR CIfY OF YELM USE ONLY
Pe rmit Fee
T OTAL ENC LOSED FEE ~,~~~ Rec'd by _ - ___ __ Date- ____ Permit ~ - __
P.O. Box 479
Yelm, WA 98597
360-458-8403
RECEIVED *~~*THIRTY TWO DOLLARS & 00 CENTS
RECEIVED FROM
SUNSET AIR
5210 LACEY BLVD SE
LACEY WA 98503
DATE REC. NO.
01/16/04 29952
SITE 1115 RHOTON CT NW
1~iISCELLANEOUS RECEIPT
JANINE
RECEIPT No. 2 9 9 5 2
AMOUNT REF NO.
32.00 CHECK 21543
5999 REPLACE GAS FURNACE/WATER HEATER
.~99~'~
PAID
CITY OF YELM JAN 1 6 2004
RESIDENTIAL BUILDING PERMIT APPLICATION FORM ~ A
Project Address: ti ~ ~ ,J ~ hc> ~" G' ~ ~ t I~l ~~~ Parcel #: r ~~ YE LIVI
Subdivision: Lot #: Zoning;
i New Construction ~_ Re-Model / Re-Roof /Addition Ci Home Occupation Sign ~.~~,~Y
^ Plumbing ~ Mechanical _I Mobile /Manufactured Home Placement ~ Other
Project Description/Scope of Work: ~r 71~ ~~ ~.i~3=~~t~rr~ ~_c e--~l.~ ~~~~.rh>°.~~t~l~
Project Value: '-17`-1 L C,~C ~
Building Area (sq. ft) 1~ Floor 2nd Floor Garage ~ Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heating: GAS/OTHE or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
ARCHITECT/ENGINEER LICENSE #
ADDRESS
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR n c ' ~ r TELEPHONE(-~') `-(~' '~QSCv
ADDRESS ~.I ~ > LAC c' _ I ~/ S -
CITY ~c't - STATE ~,c_~A ZIP ' ~ ~G'3 FAX ~G) y`-~ ~ -
CONTRACTOR' LICENSE#-5~fN5~N>i;~cMEXPDATEZC~ICITYLICENSE#~3~C~?2~55~
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certify that the above information Is correct and that the construction on, and the occupancy and the use
of the above described property wlil be In accordance wkh the laws, rules and regulations of the State of
Washington and the Cfty of Yelm.
Applicant's Signature Date
Owner /Contractor /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
R:\Communily Dcvelopment\Fortns & Procedures\Building Permits\ResBldgPermitApp.doc Page 2 of 3
3f~~ ~c~