20120262 Permit Pkg 09132012City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: OLYMPIA FIREPLACE
Address: 506 EAST 4TH AVE
OLYMPIA WA 98501
Permit No.: 20120262
Issue Date: 911 312 01 2
(Work must be completed within 180 days)
Phone: 360 - 352 -4328
Property Information:
Site Address: 504 JEFFERSON AVE NW Owner:
Assessor Parcel No.: 22719232300 Subdivision:
Contractor Information:
Name: OLYMPIA FIREPLACE
Address:
RACHEL MASTERS
Phone:
506 EAST 4TH AVE
OLYMPIA WA 98501
Contractor License No.: OLYMPFS185JZ Expires: 10/31/2010
Project Information:
Project: MECHANICAL
Description of Work: INSTALL OF WOOD STOVE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
OLYMPIA FIREPLACE
TOTAL FEES:
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
registered in the State ofjn/ashington.
Finn
Lot:
Fees
$ 2950
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yell
(36) 458 -8402
REC #: 00105255 9/1312012 9'25 AM
OPER: CO TERM: 001
REF #: 9851
TRA4: 33262 0 BUILDING 50CRITS
OLYMPIA FIREPLACE
504 JEFFERSON A'E9 50CR
MECM
TENDERED: 29,50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
09/05/2012 14:54 360 - 352 -9492 OLYMPIA FIREPLACE PAGE 02/02
70( vO71��
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address. 504 5eil ve5an A�Q AnoW Parcel #: Z.7- 37-300
Subdivision: Lot # Plan #: Zoning:
:1 New Construction n Re -Model / Re -Roof / Addition , Home Occupation Sign
L Plumbing V Mechanical Mobile / Manufactured Home Placement Other
Project Description /1
Project Value#_
of Work. :1"I? W a0d2 Slo u e
Building Area (sq. ft) 1a` Floor 2 "d Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GASIOTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
H yes, a completed environmental checklist must accompany permit application.
_ r
ADDRESS o` Q a l44c 14W EMAIL
CITY IL STATE W ZIP 48547 TELEPHON
LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
OF
........ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ADDRESS TELEPHONE
EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
7:MSTA ADDRESC LICEZCONTRA
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hareby, 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 Stata of waahington and the
city of Yelm.
Applicant's Signature Date
Owner I Contractor! Owner's Agent I Contractor's Agent (Please circle one.)
All permits are nontransferable 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
nvCn pR YYea6
Yelra, WA 96W
4WW.cLye1m.ara.ua
468 -8144 FAX
09/05/2012 14:54 360 - 352 -9492 OLYMPIA FIREPLACE PAGE 01/02
OLYMPIA
F
: 50 PAP 4th Avenue
Olympia, WA 98501
Phone (360)-352-4328
Fax (360) 352 -9492
Fax Cover
Sheet
Date I Z
TO r�
From Qon
Number, of pages including cover skeet. 2
Notes �y a K