20120315 Permit Pkg 11132012 �QF rtN�P� City of Yelm Permit No.: 20120315
� �
� �, Community Development Department Issue Date: 11/13/2012
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
""`""'°'°" Fax: (360)458-3144
Applicant:
Name: THOMAS A MILLER Phone: 360-400-0970
Address: 15202 CARTER LP SE
YELM WA 98597
Property Information:
site Address: 15202 CARTER LP SE Owner: THOMAS MILLER
Assessor Parcel No.: 52920003800 Subdivision: Lot:
Contractor Information:
Name: PRATTS PLUMBING Phone: 360-357-3262
Address: PAMELA PRATT
3301 46TH AVE NE
OLYMPIA WA 98506
Contractor License No.: PRATTPF9900D Expires: 7/29/2010
Project Information:
Project: PLUMBING
Description of Work: REPLACE EXISTING NATURAL GAS WATER HEATER WITH SAME
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING PRATTS PLUMBING $ 27.00
TOTAL FEES: $ 27.00
ApplicanYs Affidavit: OFFICIAL USE ONLY
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 #Sets of Prints:
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 Final Inspection:
registered� State o shington.
� � Date:
Signature Date 3 ��
/ 1 ' gy.
Firm �
Cit� of Y�lm
(�6 ) ��s-��o�
REC#: U01107I� 11/13/1U12 3:46 pM
7PER: CO ItRM; �101
RFF#; 617b
�IRAN; �iJ�U0U0 �UILGINIa PERMI7S
?01203�i 5 27.O�t;R
Mll.l.Eh, TfiQMA� A
15'lCi2 CARTER l.p SE
Pl. 27.OUCR
I k�N[�kC�EI�: ;�l.OQ t;Hk:(',K
AF�'L:IED; 27000-
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CHANGE: � U,oO
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CITY O�Y��,M
. � �31DE IAL BUILDIN(3 PERMI'I'APP�.ICATiON I�ORM
� �
Pro)ect d►ddress: � Parcel#: y _ _ �Q (�
Su�dlvisl<tn: ' Lot�F: � zoning�
, � -- ,.....
�,? �t�u+i�eonst�ucf n ' ::] e�Model!Re-Roof!AddiEian (.:, Hame Occupatlnn Sign
�"��Plumbing M h�nical '-i Mablle/Manufactured Home Placement �7 Other
Pro)ect Deacnptio Sc� e'of Wo : �„�I�S��
ProJect Value: '
Bullding Rrea{sq.ft) °�FlOOr 2"d Floor C��rage � Deck
Raseme t Carport__ . patia
#B�drooms_ �Bath ms_ Heating:GAS/QTHER or ELECTRIC(Circle One)
Are there any env fonm r�t�lly se sitive areas(ocafed on the parcel? If yes, a
completed envl ment !checklE t must accompany permit appllcation. ,
�IJiI.ptNG 4WN I�NA E'
ADDRESS S �MAIL
CITY STA7� ZIP TELEPHON�
ARChfET�CT/�N 1NE� ' !.lCENS�#
ADDRESS �MAf�
CITY S?'A�'� Z!P TELEPHON� � "��
G�N�RAL CpNT CT R TELEPMONE L
ADI7R�SS EMAIL
ClTY STA7"� ZIP�FAX
CONTRACTOR'S ltC� SE# EXp DATE CITY UC�NSE#
PLUMB}NG CON F2AC OR `C-�ELEPHON� !9
ADDRESS — r �MAIL
Gt?Y STATE �II� FAX
CONTRAC�`0 "S LtCE 8�# EXP DA7E7 iTY LIC�NSE# ,a
M�CHANICAL C NT C`�OR TELEPNON�
AdDRE55
CiTY EMAE�
TATE zIP��FAX
CONTRACYdR'S !CE S�# EXP DAT�i,,,ClTY 1�ICENSE#
Copy of itiga on:agr �nt with Yslm Community Schaols, if applicable.
!hsroby certKy that •abo t�lo�inat n!s corrgct and that the Cono4ruatlon on,apq ths occupancy snd tho uee of tho
above d�sarlbad p rty w I b�In ee Irl�snc�with tha�ews,rulas and regulntlont of the StaCe of Weshington and the
Clty Of Yelrtt.
anYs Sign l 1 ( 1� 1�—.�
� D�te
Owne /Contract r! r�et's A ent�/Contractor's Agent (Please circle one.)
AI!permiCs are n n-tra sf�rabl and wlll explre If work authorized by such parmit fs not begun
wlthin 760 days o €ssu r�ce�o� f woirk Is suspended or abandoned for a perEad of 180 days
1Q5 Yelm Ave►ae�e F�'e e � � � (�8D1 438-888g
PO Box 479 ����c—�-. (860)4GB-81a4 FAX
Yclm,WA 9Xb97 IU '��f��... 1�1 e' � (j wu�w.ci,yelm.wa.��A
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