20130199 Permit Pkg 05212013 �o� City of Yelm Permit No.: 20130199
Community Development Department Issue Date: 5/21/2013
~ (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
w,. =o� FaX: (360)458-3144
Applicant:
Name: BRADLEY BROOKS Phone: 360-400-6788
Address: 15410 91 ST AVE SE
YELM WA 98597
Property Information:
Site Address: 15410 91 ST AVE SE Owner: BRADLEY BROOKS
Assessor Parcel No.: 41610015900 Subdivision: CHERRY MEADOWS Lot: 159
Contractor Information:
Name: PACIFIC AIR SYSTEMS Phone:
Address:
12811 PACIFIC HWY SW
LAKEWOOD WA 98499
Contractor License No.: PACIFAS093KA Expires: 9/08/2013
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 PACIF�C AIR SYSTEMS $ 29.50
TOTAL FEES: $ 29.50
ApplicanYs Affidavit:
I certify that I have read and examined the information contained within the application and know the same OFFICIAL USE ONLY
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 in the State of Washington.
Signature Date � Date:
Firm r `�1��—,�L��� �T r ' � By:
/ _ .
City of Y�lm
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�013����
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:�sa�os,SrAVese Parcel#:oa�s2i�oo2
Subdivision: Lot#: Plan#: Zoning:
New Constructi n �Re-Model/Re-Roof/Addition I Home Occupation Sign
- Plumbing �/lecharncal �' Mobile/Manufactured Home Placement - Other
Project Description/Scope of Work:Add air conditioner-American Standard-4A7A5042E1000A-3.5 Ton
Project Value:$5200
Building Area (sq.ft) 1s1 Floor 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUiLDING OWNER NAME:B�adley Brooks
ADDRESS 15410 91 st AVE SE EMAIL
CITY Ye�m STATE`�`�A ZIP 98597 TELEPHONE 3so-aoo-s�es
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECNANICAL CfJNTRACTOR Pacitic Air systems TELEPHONE 3so-sas2�a�
ADDRESS 12811 Pacific HWY SW EMAIL William@nwpermit.com
CITY�akewood STATE WA ZIP 9�99 FAX
CONTRACTOR�S LICENSE#PACIFAS093KA EXP DATE09�og�13CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby 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 State of Washington and the
City of Yelm.
�!�� n.�1'�6 05I1412013
Applicant's Signature Date
Owner/Contractor/Own r's�gent ontrac or's Agen Please 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
1'elm,WA 98597 (360)458-3144 FAX
urwu�.ci.yelm.ma.us