20040090 Permit Pkg 07072004City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Robbins Heating and Cooling
Address: P.O. Box 775
Property Information:
Site Address: 311 Cullens Road
Assessor Parcel No. 21724140502
Contractor Information:
Name: Robbins Heating 8< Cooling
Address: P.O. Box 775
Contractor License No: ROBBIHC022BG
Project Information:
Project: Easthaven Villa
Description of Work: Install Three Heat Pumps
Sq. Ft. per floor: (1st) 0
Heat Type (Electric, Gas, Other):
Fees:
Item
Mechanical Permit
TOTAL FEES:
(2nd) 0
City: Packwood
Subdivision: NIA
Contact:
City: Packwood
Expires: 08122/04235
(3rd) 0
Permit No: M-04-0090-YL
Issue Date: 07/07/2004
(Work must be started within 180 days)
Receipt No: 32252
Phone: 360-494-6100
State: WA Zip 98361
Lot: N/A
Phone: 360-494-6100
State: WA Zip:
Business License: 03-002395
Garage 0 Basement 0
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
----------- ----------- ----------- ----------- ----------- -------------
48.50 0.00 0.00 0.0000 0.0000
$48.50
Applicant's Affadavit:
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 ~ ate of Washington.. _,~
,~
Signatuoe ~' r~ ~ ~'- ~ "~ " Date ~ ~ ~ ~~ ~~
Firm
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Applicant:
Name: Robbins Heating and Cooling
Address: P.O. Box 775
Project Information:
Project: Easthaven Villa
Description of Work: Install Three Heat Pumps
Site Address: 311 Cullens Road
Fees:
Item Acct Code
--------------------------- --------------
Mechanical Permit 032
001-322-10-00
TOTAL FEES:
~/"!'
J U L 0 7 2004
CITY ®F YELM
,~~~~~
City: Packwood
Permit Fees Schedule
Permit No: M-04-0090-YL
Phone: 360-494-6100
State: WA Zip 98361
Assessor Parcel No. 21724140502
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
----------- ----------- ----------- ----------- ----------- -------------
48.50 0.00 0.00 0.0000 0.0000
$48.50
CITY OF YELM
COMM//J~EA~~CEAL Bl31LDtNG PI`RMI7 APPLICATION FOR'M'/~ l~
Project Address:.~1 ~ t~Wlt°~,3 ~ -- _ Parcel #:~ 77 T~~~. _-
Zoning; c.JPI/~ ~ ;f!C~Current Use: C~~~ odosed Use:
^ New Construction ~ Re-Model / Re-Roof /Tenant Improvement
^ Plumbing ~ Mec;hanical ^ Fire Preve~nUS~u~p~pre~ss/Alarm 0 Other
Project Description/Scope of Work: ~~ ~~ ~,`--~-~,y~~-' --
Project Value:,~~± ~~/~ ~~`~.~
Building Area (sq. ft} Parking Garage 1~` Floor~C,_2''° Floor 3f° Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
6t1;ILQING01~N_~F~fTENANT ~fAM ,: ~ ~P~ GL.
ADDRESS / ~
CITY ~ ~'-- STATE ZIP TELEPHON
-. .
ARC;HITEGY(1=1VG1N1=CR LICEN E T
ADDRESS
CITY STATE ZIP TELEPHONI=
........
;GENERf1t_GQI~tT'F~ACTOR TELEPHONI`
ADDRESS
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE €1' EXP DATE CITY LICENSE #
l?~U,M.gt.NG'CONTRA4~TOF{ TELEPHONE
ADDRESS
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHAN;ICA'~ C;C*N~RACTO,~R ' ELEPHONE ~~
ADDR S
CITY STATE ~ ZIP FAX -
CONT ACTOR'S LiCGNSE # D P DAT LICENSE # Q3-OiDo23RT
Copy of City Mttlgauon documentation (TFC}.
i hereby certify that the above intortnatlon is correct and chat the construction on, and the occupancy and the use
pf the above described property wlll be in accordance with the laws, rules and regulations of the State of
Washington and the Clty at Yelm.
Applicant's Si nature; Date
Owner /Contractor /Owner's Agent /Contractor's Agent /Tenant (Please circle one.}
All permits are non-t~~ansferable 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
~, `.l`unu~ivitu} Ur. vcanpmrntlf~gngf .~. 1': n~rdutc~iifitiJins• P^.rrni;:`(~umml:Ll.~Ncti;lu:\~~ .d•ic f'ot,~ ' Uf ~1
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08/10/04 TUE 14:48 FAQ 2S3 596 3827 LABOR & INDIISTRIES TAC ~-~-- OLY REG _ _fdj001 _
~d ~/~~ ~~ ~ s ELECTRICAL WORK PERMIT APPLICATION
y
^ ns ectl°° 214 6 419
('~ ^ Aanual Pvmit ^Alatrnt ^Caruival ~ommerdal ^Roetdential ^Rcsidential Maint Si s
~1 ^ @a TMrmostat [~ Telecom.
J b ed 1 cal con c r Owner Ia~tall,um ~~10°
Doctrical contractor name Liconse numbs
1'Ladi sLQ ~ 71 F' o~ r y n e 7 ~~
Purthu:c's mmlina.'S.,.~L~~,T~Q~ ~ L ~' O fT ~ ~
S a U ~~ 835
L~, ~ U - Smote ZIP
.-~T,e/lG'ephondaumbcr FAX number
owner'. game
Address of inryeetion
County
Power compsrry
I hereby certify that m the owner of the above named property or a ~~:
licensed electrical contractor (or the firm's authorized agent) and am ~`
making the elechicai installation or alteration in Compliance with the ~.
electrical law, G3apter 19.28 R('_W. ? .
Ot Owtld', elKtnlcal ContractUr Or
~X ~Q~
R~~~3i,~s l1~~~9.
To assist us in providinY better service to you
please fill out the application paying
particular attention to the following iu~ms:
1. Complete all appropriate blanks.
2. Provide detailed description of installation.
3. Provide detailed map to jobsitc.
4. If no home phone number is available, please
provide mescagc number.
5. Make check payable to the Dept. of Labor &
Lndttstries.
6. If you are mailing this in, please remove hard
copy to post oa the jobsitc and send the top 3
copies to the appropriate service location,
~• Signer is owner only if not wired by an
electrical contractor.
8- 1f wirccl by an electrical contractor, must be
signed by administrator or authorized desigrcx.
If you have questions, please feel free to ask uc!
Cash Check #
IPcbs ~~ _ ''a ~)~~Jl'~~
~Q~~l M1~M~~~ ~~;
~~ ~~
Please Draw Map Below from the Nearest MaPm Street or Hitzhwav
~~ ~ l
Do not remove or conceal
C ~RCV rr S
Eleeh~iCal Permit No.
Approval I
Date
Dept. of Labor ~ ~ 14
& Industries `''pprove y
FSOD-005-000(5-93)
electrical Section
a
FS00-001-000 electrical work permit application rev 5-03
INSPECTO