20050272 Permit Pkg2~~~ va 7~
CITY OF
YELM
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Ye~m. V;,a 9E597
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RECE!'v'ED FROM DATE
FAST WATER HEATER COMPANY
Cll Y OF 1'FLI~1
319824 Conley
RECEIPT No. 3 8181
REC. NO. AMOUNT REF. NO.
9/ Il20U~
? 7.00
2714
F:1ST C.A, B;1ti'vER 319824 Conley 2i.U0
CITY OF YELM ,;~~
RESIDENTIAL BUILDING PERA~IT APPLICATION FORM
ProjectAddress:16136 Prairie Creek Lp Sparcel#: 69240002100 ~~~~
Subdivision: Lot #: Zoning;
New Construction _i Re-Model / Re-Roof /Addition Home Occupation Sign
i Plumbing ~ Mechanical ~ ~ Mobile /Manufactured Home Placement i Other
Project Description/Scope of Work: REmove/re lace qas water heater
Project Value: 4 4 9. 0 0
Building Area (sq. ft) 151 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.
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX _
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yeim 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.
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
/05 Yelm Avenue West (360) 458-3835
PO Rox 479 (360) 458-3144 FAX
Yeim, WA 98597 www.ci;yelm.wa.us