20130123 Permit Pkg 02142013 � City of Yelm Permit No.: 20130123
Community Development Department Issue Date: 2/14/2013
rr (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
` Fax: (360)458-3144
Applicant:
Name: ZIELINSKI CONSTRUCTION, INC. Phone: 360-253-4058
Address: 4615 HERMAN RD SE
OLYMPIA WA 98501
Property Information:
Site,4ddress: 9225 MTN VIEW RD SE Owner: MATTCAREY
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: ZIELINSKI CONSTRUCTION, INC. Phone:
Address:
4615 HERMAN RD SE
OLYMPIA WA 98501
Contractor License No.: ZIELIC1957LP Expires: 6/27/2013
Project Information:
Project: RESIDENTIAL REMODEL
Description of Work: ADD RETROFIT 2 VINYL WINDOWS ON WEST SIDE OF HOME SEND OUT SIGNED
INSPECTION CARD TO CONTRACTOR
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING ZIELINSKI CONSTRUCTION, INC. $ 38.75
TOTAL FEES: $ 38.75
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 re . I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm regul ions i uding those governing zoning and land subdivision,and in addition,all covenants,
easement and re Ictions of ord. If applying as a contractor, I further certify that I am currently Final Inspection:
registered,in he te of Washi ton.
Si nature'
[ � � ^ Date z �,3 Date:
� i /�
Firm
� �%Y/I"/ � .-f� G" � By.
Cit� of Yelm
(3E ) 458-8402
REC#: OU119666 2/141��13 10:04 AM
�PER: CO TERM: OU1
�tEF#: GI
TF�AN: 33.ClUUt� BUII.GING PERMITS
201�G123 38,�75C�
ZIELINSKI GONSTRUCTION, INC.
9225 MTN VIE�� RD SE
BLDG 38.75CR
TENDERE(): 38�75 OTHER
APPLIED: 38�75-
CHANGE: � � 0.00
s����
CITY OF YELM
RESIDENTIAL BUILDIN PERMIT APPLICATION FORM
Project Address: �4�� �� Parcel#:
Subdivisiom '— Lot#: '^ Plan#: '� Zoning: '—
� New Construction i Re-Model/Re-Roof/Addition � Home Occupation Sign
! Plumbing ' Mechanical '' Mobile/Manufactured Home Placement �Other
Project Description/ cope of Work:��l��i��/�!�'% � ✓�� ��w
� .,,fk--- u V y !�'��.3ii��P�l:�'
Project Value:
Building Area(sq. ft) 1S' Floor�'�„ 2�d Floor Garage Deck
Basement Carport Patio
�-----
#Bedrooms� #Bathrooms� Heating: ��1�R rfELECTRIC ircle One)
._-.—•
Are there any environmentally sensitive areas located on the parcel? �
lf yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME �---- �-�
ADDRESS � 2�'S •��(."% ` 'EMAIL
CITY -' STATE ZIP ' 7fELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAI�
CITY STATE ZIP TELEPHONE
GENERAL CONTRAC ORZ�'�� yG�' � FLEPHONE � � � '� r o '�'
ADDRESS ' EMAIL --�
CITY U 1' � STATE�.ti� ZIP�f�_FAX G f�- ` �"'� ^��'� !
CONTRA O S LICENSE# " P DATE_CITY LICENSE# ` / �
z -
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# 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
abo scribed property will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Y m.
t . �� � �
p ica s Sign r Date
ner/Contra tor/ wner's Agent!Contractor's Agent(Piease 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 Yelm Auenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us
� � City of Yelm Permit►vo.: 20120311
,� Community Development Department Issue Date: 11106/2012
4 (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
"•`"'"`_°" Fax: (360)458-3144
Applicant:
Name: MATT CAREY Phone: 360-894-0949
Address: 9225 MT VIEW RD SE
YELM WA 98597
Property Information:
Site Aadress: g225 MTN VIEW RD SE Owner: MATT CAREY
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: ZIELINSKI CONSTRUCTION, INC, Phone:
Address:
4615 HERMAN RD SE
OLYMPIA WA 98501
Contractor License No.: ZIELIC1957LP Expires: 6/27/2013
Project Information:
Project: RESIDENTIAL REMODEL
Description of Work: REROOF, SKIRTING, REPLACEMENT OF TWO WINDOWS
Sq. Ft.per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
BUILDING ZIELINSKI CONSTRUCTION, INC. $ 111.25
ROOF ZIELINSKI CONSTRUCTION, INC. $ 25.00
TOTAL FEES: $ 136.25
Applicant's Affidavit: OFFICIAL USE ONLY
I certi h ve read and examined the information contained within the application and know the same
to b rue an orrect.I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yel regulatio s including those governing zoning and land subdivision,and in addition, all covenants,
ea ments an restrictions of record. If applying as a contractor,I further certify that I am currently Final Inspection:
regi�stered'n t State of ingt�n. r i
I t j` ^ _ Date:
Si natur Date V
Firm � By�