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20110119 Permit Pkg 01122011City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360)458-3144 Applicant: Name: VELMA KELLEN Address: 10406 PARKVIEW LP SE YELM WA 98597 Property Information: Site Address: 10406 PARKVIEW LP SE Assessor Parcel No.: 67290002000 Subdivision: Contractor Information: Name: DICK'S HEATING Address: 1516 85TH ST SUMNER WA 98391 Contractor License No.: DICKSHA9185L Project Information: Project: MECHANICAL Description of Work: REPLACE GAS FURNACE Sq. Ft. per floor: First Second Third Garage Basement Fees: Item MECHANICAL Phone: Expires: 12/31 /2011 Heat Type (Electric, Gas, Other): Contractor VELMA KELLEN Permit No.: 20110119 Issue Date: 1/12/2011 (Work must be completed within 180 days) Phone: Owner: TYPE CURRENT OWNER NAME TOTAL FEES: Applicant's Affidavit: 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 registered in the State o Was ~__ Firm Date ~~~L ` Fees $ 29.50 E 29.50 OFFICIAL USE ONLY Sets of Prints: final Inspection: Date: By: _ Lot: Git~ of_Y~1~ l3~0~ 4,~8 840 ~~ 111~I2011 ~:~E~ FM RECi`+~ ~0~'TERi~: 001 ppER: CO REF11: S";.s0`~a TRt~i: ;,3.0000 BIJILUING PERi4ITS 50CR ~~ . ~011011~~ KELLEN;, VELi~A 1040f, PARi<tiaEW ~t~ FE .., . ". ~OCh t~ECH ' APRt.IED: a .50... ~ CHANGE: ~ __----___~.00 CITY OF YELM j RESIrD__ENTIAL BUILDING PERMIT APPLICA/TION FORM Project Address: ! ~~ ~U/ G'~(~[J~e~ ~~.SC Parcel #: 1/ ~ Z~ ~~0 Z~~ Subdivision: Lot #: Plan #: Zoning: New Construction Re-Model / Re-Roof /Addition Plumbing Mechanical Mobile /Manufactured He Project Description/Scop/e/of Work: ?~ ~~~ Project Value: ~ y~~~ Building Area (sq. ft) 151 Floor 2"d Floor Garage Home Occupation Sign 'lacement Other Deck 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 r(, TELEPHONE I - ~ ~ ADDRESS I(D ~~ EMAIL CITY ~/vh.~.f11 STATE ZIP ©FAX_ '? S'j ~ i- 95,~~ CONTRACTOR'S LICENSE # L 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 will be in a~6cordance with the laws, rules and regulations of the State of Washington and the ~~ ~~ Applic s Signatu Date Owner /Contractor /Owner's Agent 1 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 }'ehrr Anerrrre {Pest Y'elur, WA 911.597 wu+u+.ei ;vela:. uur. us f 360) (360) ~ ~rS~~~ .~ti, ~ LEI .~,..~~ . B Y: ------------- ------ Basement Carport Patio # Bedrooms- # Bathrooms- Heatin . GA OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on parcel? !f yes, a completed environmental checklist must accompany permit application.