07-0114 Permit Pkg 041405~~OF T"FP City of Yelm
Community Develop
a
Building Division
Phone: (360)458-8407
y Fax: (360) 458-3144
Applicant:
Name: Brazil's Stove 8 Hearth
Address: 125 Sussex Ave E.
Property Information:
Site Address: 815 Mountain Aire Lane NW
ment Department
City: Tenino
Assessor Parcel No. 22719210304 Subdivision
Name: Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Davis Fireplace
Description of Work: Installatio n of gas fireplace, gas piping
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other): OTHER
Fees:
Item Item Fee Base Amt Unit Fee
Mechanical Permit 20.00 _ 0.00 W 0.00
TOTAL FEES: 520.00
Applicant's Affadavit:
Permit Ivo: M-05-0114-YL
Issue Date: 04/14/2005
(Work must be started within 180 days)
Receipt No: 36164
Phone:
State: WA Zip
Lot:
Phone:
State: Zip:
Business License:
Garage 0 Basement 0
Unit Rate No. Units Unit Desc
0.0000 0.0000 ~^
OFFICIAL USE ONLY
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 # Sets of Prints:
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. ff applying as a contractor, I futher certify that I am currently
registered in the to of Washington. Final Inspection:
Signature ~~~ Date ~c Date:
W_
Firm By'
CITY OF
YELM
RO Box -}7J
Y21m, WA 9887 RECEIPT NO. 3 616 4
3E0-458-8x03
3ECElVED : * * * Tj~ENTY DOLLARS & 00 CENTS
FECEIVEC FaU'~.1 DATE REC. NO. Ah~'.OUNT REF. NO.
DEANNA DAVIS 04/14/05 36164 20.00 CHECK 3421
P.O. BOX 851
YELri WA 98597
SITE 815 MNR AIRS LANE NW
PROJECT F/P MISCELLANEOUS RECEIPT
MICHELLE ,
t•iECH PERMIT/ DEANNA DAVIS SITE 815 tiNT AIRS LANE Nti~l
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~'~ ~~ ~f //'~ .~~'" Parcel #: ~~ '
il/C~~ _
Subdivision: Lot #: Zoning; /~ ~ ~ /,LPL- /1/7-//`~L-
U New Construction U Re-Model / Re-Roof /Addition u Home Occupation Sign
u Plumbing t~(Mechanical u Mobile /Manufactured Home Placement a Other
Project Description/Scope of Work: ZN~ T~L- l_ ~ / /Q ~~~~' ~iP~~
Building Area (sq. ft) 1~' Floor ~ ~l~d Floor Garage Deck
# 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.
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
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 will tie in accordance with the laws, rules and regulations of the State of Washington and the
City 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
!~
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105 Yelrrt Auenue West (360) 458-3835
PO Box 479 (360) 458-3144 FAX
Yelm, WA .98597 www.ci.yelm.ma.ua
Copy of mitigation agreement with Yelm Community Schools, if applicable.