20130131 Permit Pkg 03042013 o City of Yelm Permit No.: 20130131
� Community Development Department Issue Date: 3/04/2013
� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
"' Fax: (360)458-3144
Applicant:
Name: MARLIN D.D.S. KAY Phone: 360-458-5606
Address: P.O. BOX 1090
YELM WA 98597
Property Information:
Site Address: 718 YELM AVE W Owner: MARLIN KAY
Assessor Parcel No.: 21724140900 Subdivision: Lot:
Contractor Information:
Name: MARLIN D.D.S. KAY Phone:
Address:
P.O. BOX 1090
YELM WA 98597
Contractor License No.: Expires: 0/00l0000
Project Information:
Project: MECHANICAL
Description of Work:
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL BLACK HILLS, INC $ 38.25
TOTAL FEES: $ 38.25
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 f record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the State of shington.
� , �3 Date:
Signature Date
Firm ���� CV�//� L�./ c. BY�
Cit� of Y�lm
�s6 � a5a-Baoz
REC#: U()120877. 3I04/2013 1:15 P�1
OPER: CO TERM: 001
REF#: 140U6
TRAN. 33.O1100 BUILDI3� Z5CR�T5
20130131
KAY, MARLIN D,D.S•
118 YELM AVE W
MECN 36.25CR
TENqERED: 38.25 CNECK
APPI.IEq; 38.25-
CNANGE: 0,00
FROM black hills <FRI)MAR 7 2013 75:48IST. �5:47/No.7500000272 P l
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FC?RM
Project Address:��� uC.Q.I'Yl � � Parcel#: D� 1� aLI I t�1�f��}U U
Subdivision: Lot#: Plan#: Zoning:
� New Construction O Re-Model/Re-Roof i Addition o Home Occupation Sign
❑ Plumbing �echanical C� Mobile/Manufactured Home Placernent a Other
Project DescriptioNScope of Work: ��r�s�.�' v� V'/� 'Fvr,.�cG�z � t�i���
Project Value:
Building Area(sq.ft) 1 St Floor 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: GASIOTHER or ELECTRIC(Ci�c{e One)
Are there any environmentally sensitive areas located on the parcel?
lf yes,a completed environmentai checklist must accompany permit application.
ADDR SS ' tN EMAIL ''
CITY STATE Ii4� ZIP TELEPHONE
LICENSE#
ADDRESS EMAIL
CITY STATE ZIP 7ELEPHONE
TELEPHfJN E
ADDRESS EMAIL
C1TY S7ATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
TELEPHONE
ADDRESS EMAII
CITY STATE 21P FAX
CONTRACTQR'S LICENSE# EXP DATE CITY LICENSE#
QC, TELEPHONE ?(�t�- '�C�S-gS�O
ADDRESS EMAIL
CITY �� ~STATE�b�ZIP FAX
CONTRA T R'S LICENSE# EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the constructfen on,and the occupancy and the usa of the
above described property will be In accordance with the lawa,rules and regulations of tha State of Washington and tha
C' f Yelm.
Y I ►Y ` �° �
Applicant's Signature Date
Owner 1 Contractor 1 Owner's Agent!Contractor's Agent(Please circle one.)
All permits are non-transferable and wiil expi�e if wark authorized by such permit is not begun
witfiin 180 days af issuance,or if work is suspended or abandonad for a period of i80 days
]05 Yeim Auenue West (360)458-8833
Yelm,WA 98597 (360)458-8144 FAX
rvzom.ci.yelm.wa.us