07-0184 Permit Pkg 050207~pF Tip City of Yelm
Community Development Department
d
Building Division
Phone: (360) 458-8407
ELM Fax: (360) 458-3144
Applicant:
Name: NW Refrigeration
Address: 6111 Esther Ave. SW City: Tumwater
Property Information:
Site Address: 15762 104th Ave. SE
Assessor Parcel No. 85840003200 Subdivision: NIA
Contractor Information:
Name: Applicant Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Lulich A/C
Description of Work: A/C Unit
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other):
Permit No: M-07-0184-YL
Issue Date: Not Issued
(Work must be started within 180 days)
Receipt No: 48400
Phone: 360-754-4030
State: WA Zip 98501
Lot:
Phone:
State: Zip:
Business License:
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Mechanical Permit 29.50 0.00 0.00 0.0000
TOTAL FEES: $29.50
Applicant's Affadavit:
No. Units Unit Desc
0.0000
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 futher certify that I am currently
registered in the State of Washington.
Signature / [__ /~~ /~ 1 Date ~~- ~ - (j "~
Firm % ~(,~. (/C f' 77
r w 'I r,.~ti.. at
CITY OF
YELM
P.O. Box 479
Yelm, WA 98597
360-458-3244
RECEIVED
TWENTY NINE DOLLARS & 50 CENTS
RECEIVED FROM DATE REC. NO.
NORTHWEST REFRIGERATION 05/02/07 48400
5201 CAPITOL BLVD
TUMWATER WA 98501 BUDGETARY
RECEIPT No. 4 8 4 0 0
AMOUNT REF. NO.
29.50 CHECK 21094
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: NW Refrigeration
Address: 6111 Esther Ave. SW
Project Information:
Project Lulich A/C
Description of Work: A/C Unit
Site Address: 15702 104th Ave. SE
City: Tumwater
Permit Fees Schedule
Permit No: M-07-0184-YL
Phone: 360-754-4030
State: WA Zip 98501
Assessor Parcel No. 85840003200
Fees:
Item Acct Code
Mechanical Permit 032 001-322-10-00
TOTAL FEES:
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
29.50 0.00 0.00 0.0000 0.0000
$29.50
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~ 5-10 X `~y~~ ~~ S~ Parcel #: ~ 5 ~ ~ 0 003 ~O n
Subdivision: Lot #: Zoning;
New Construction i Re-Model / Re-Roof /Addition i Home Occupation Sign
Plumbing ~ Mechanical ~ Mobile /Manufactured Home Placement _i Other
Project Description/Scope of Work:~~pS ~ ~~~ ~ ~ C t,~s .~
Building Area (sq. ft) 1~' Floor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms- # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
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.
- ~ ' `- ~~
A icant's ignature Date
er /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
IU5 Yelm Auere-ie West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597 www.ci;yelm.wa.ua
May-O1-07 12:36P
I ~_ ~• of THE ~ ..,: ,~.
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CITY OF YELM
PO BOX 479
Yelrn WA 98597
(360) 458-3244
APPLICATION FOR
BUSINESS LICENSE
OFFICIAL uSE ONLY
Fee RCVd
sY
Comm Dev. Dept.
8tdp Dept,
Insp. pale
Lit. Np.
Upon receipt of license application, the City of Yelm will conduct an inspection of the premises for building
and fire code conformance. Upon approval from the Yelm Building Department of said premises, the City
Clerk's Office will process a business license and billing for f35.00 and mail to applicant at address listed
below. License fee is due tyro weeks after issue date of license.
P.02
Application is hereby made for a Business License for the City of Yelm
~ ~EW BUSINESS ~ NAME CHANGE/MAILING ADDRESS CHANGE ONLY
DATE ~~ - ~ - ~~
BUSINESS NAME ~ ~ ~~
NATURE OF BUSINESS ~~ ~.C_ Sc~~ ~, ~~~~ c e
BUSINESS LOCATION ADDRESS ~0~ ~~ or ~yj 2 W~ _\ ~R1 ~~(;.~25 • `v~l
MAILING ADDRESS S,~(~\ ~lao ~~ ~~ ~~~~ ~,~(~\ ~Uct~ ~~ec ~\~_•~{~ l
ANTICIPATED OPENING DATE
DAYS & HOURS OF OPERATION
OWNER(S) Q
Birthdate Sociall Security No. ~ 1 ` `a
Address ,~~\~ ~.~S~~Q r ~Jrr S +~~U~~~ L,,j3~ [ p SU I
City State Zip
TELEPHONE~~-?i>1-9 /~~ ~loO•~.5~-~~~t1
(Business) (Home/Emergency)
CONTRACTOR'S REGISTRATION NO.
(If applipble)
THURSTON CO. HEALTH APPROVAL NO.
STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI) ~~_~3~ y~
CITY OF Yl'_L'1~J
BUSINESS LICFN,Sf= APPLICATION
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