20100210 Permit Pkg 11052010City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: AIR SOLUTIONS
Address: 8746 CULLENS ROAD
YELM WA 98597
Property Information:
Site Address: 16230 PRAIRIE CRK LP
Assessor Parcet No.:
Contractor Information:
Name: AIR SOLUTIONS
Address:
8746 CULLENS ROAD
YELM WA 98597
Subdivision:
Permit No.: 2010021 ~
Issue Date: 11/05!2010
(Work must be completed within 180 days)
Phone: 360-400-1492
Owner: FELICIA PEARSON
Lot:
Phone: 360-400-1492
Contractor License No.: AIRSOSL931 NO Expires: 9/09/2011
Project Information:
project: PLUMBING
Description of Work: WATER HEATER CHANGE OUT
5q. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
Contractor
AIR SOLUTIONS
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
TOTAL FEES:
Fees
$ 27.00
S 27.OD
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
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
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Project Address: ~ 6 23O /~%rit C/2Gk~arcel #:
Subdivision: Lot #: Plan #: Zoning:
~ New Construction i Re-Model / Re-Roof /Addition ~ Home Occupation Sign
Plumbing ~ Mechanical ~ i Mobile /Manufactured Home Placement ~ Other
Project Description/Scope of Work: ~C1{~i- 1j~d~r~ Ll1Qgw-Dt.~.~
Project Value: `,~ '7 S• O o
Building Area (sq. ft) 1S` 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.
BUILDING OWNER NAME: Q ~Q
ADDRESS rb ' k EMAIL
CITY .., STATE~Q ZIP TELEPHONE .. 2 O
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR .~ TELEPHONEe{/Ooo../~/9Z
ADDRESS_g7~1 ~ ~/i..t fl./ EMAIL
CITY Y~.•. STATE w ZIP gg5l~ FAX yoc-o?0
CONTRACTOR'S LICENSE #,¢1RSaS~ 9/oDf,XP DATE iGITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
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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 be In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
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Ap ca 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
105 Yelm Avenue 4i
Yelm, WA 98597
www.ci.yelm.wa.us
(360) 458-3835
(360) 458-3144 FAX