20120123 Permit Pkg 02102012City of Yelm
Community 0.velopment OelmNnent
eunmry Divisions
Phone: (380) 45843407
Fax: (380) 45841"
APprlcal
Name: BLACK HILLS. INC
P dtl , 100385TH AVE BE
OLYMPIA WA 9801
Property lMonnitlon
Permit No.'. 20/120123
IYL9 Dare: 24012
asl most M mmplMbwnln 180 mr9
Phone'. 380.2392770
Site Aciall. 718 YELM AVEW D.v «: BRARUNKAY
Panel Rome) No 21724140900 SuESrvbbm LW
Name'. BUCK HILLS, INC Phone: 300.239.97]0
Address
1003 BSTH AVE BE
OLYMPIA WA 98501
Cothatm Ucenae Na: BUCKH10901L Exame: 001204
Project In ma0on:
Prajad: MECHANICAL
Deemprlan or Work: REPLACE HEAT PUMP AND FURNACE
Sal FL per float. First Hear Text(Elechic, Gas, OtMp:
Second
nid
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL imsom ILLO INC S 4275
TOTAL FEES: 5 4375
AdAId mb AmWSIL OFFICIAL. USE ONLY
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Pmlact Addmss: 11(i mClm LO. Pamelx: QgArID9I0300
Subdiview. Lord Plan It Zoning:
II New Cowtructon T IdWodel l Re- Root /Addition _ Home O=Won Sign
o Plumbing st MeManlcel L Goble / Wonderland Home Placement ]Other
Prraem Descnpron /Swpeofwork : cM -�[�fn hn a�YL�l1nA �i..rr nr�
BullmngAidefil n)
1"Elcor zc Floor_ Garage_ Deck_
TELEPHONE
Basement Carport Patlo
#Bedmoms_
#6eMrooma_ Heating :GAS /OTHER w ELECtRIC(Cimm Orl
Are them any environmentally
sensitive areas located on the Larry?
Ryes, a completed enramnmantal checklist meal accompany permit implication.
CONTRACTOR'S LICENSE N
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ADDRESS
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STATE WH ZIP TELEPHONE
PLUMBING CONTRACTOR
TELEPHONE
ADDRESS
ARCHITECTIFNGiNEE4g
LICENSEIf
ADDRESS
EMAIL
CITY
STATE ZIP TELEPHONE
E %P DATE CITY LICENSE
GENERAL CONTRACTOR
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ADDRESS
EMAIL
Cltt STATE
ZIP
FAX
CONTRACTOR'S LICENSE N
ESP DATE---CITY LICENSEp
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PLUMBING CONTRACTOR
TELEPHONE
ADDRESS
EMAIL
CITY STATE
ZIP
FAX
CONTRACTOR'S LICENSE N
E %P DATE CITY LICENSE
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RCC TELEPHONE � 0- -`te40
ADDRESS I„ • -
EMAIL
CITY �� �� �p��� STATE WH ZIP or FAX
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Copyofmi6gaonagreementwt Yelm CommunlryS ools.Neppllwde.
I nmay ishroffiv met the abowlMnreremi is nwnnr and that the nmNUWm W. and the owmancy and the IWO"
sbow des ited gapnry nil) be In acamMnos wNtln Ws.rvM and rquMllma share SW of WmNrybn and tln
cUl Oyelm.
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APPllunl's SiBnalun DeN
OwnerI OontnclorI Owns /s Agent Contractors Agana (Plea" circle one.(
All "mMa are no"ranf mble and will begin if work authorized by such frermit is not begun
within 180 date of issuance, or Nwork is sus"n led or abandoned for a Period of 180 days
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