20130223 Permit Pkg 05312013 �o� City of Yelm Permit ►vo.: 20130223
Community Development Department Issue Date: 5/31/2013
�' (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
w,.s Mo�o� FBX: (360)458-3144
Applicant:
Name: HOME SERVICES NORTHWEST Phone: 509-846-4489
Address: PO BOX 1722
TONASKER WA 98855
Property Information:
Site Address: 15426 94TH AVE SE Owner: TYPE CURRENT OWNER
NAME
Assessor Parcel No.: 69390000700 Subdivision: Lot:
Contractor Information:
Name: HOME SERVICES NORTHWEST Phone:
Address:
PO BOX 1722
TONASKER WA 98855
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work:
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING HOME SERVICES NORTHWEST $ 27.00
TOTAL FEES: $ 27.00
ApplicanYs Affidavi�: OFFICIAL USE ONLY
I certify that I have ad d exami d th %i ormation contained within the application and know the same
to be true and corr �t. Iso rti at prop `ed structure is in conformity with all applicable City of #Sets of Prints:
Yelm regulations' Elu ' g th g ''g z ng and land subdivision,and in addition,all covenants,
easements and �tri ions of I ap ing as a contractor, I further certify that I am currently Final Inspection:
registered in th t of Wa ' ton.
Signatur V Date � '"'._S����� Date:
Firm ��lcsin�C �•f���°� i(1 1G,"�h�ta`{^ BY�
Cif� of Yelm �
f 36 ) 458 840,2
REC#: 00128842
OPER: CO TERM: OOj�/2�13 2.14 PM
R�F#: 2217
TRAN. 30,pU00
HOM� SERVICE BUSINESS L7CENSE
BUSINESS NORtHWE�r
LrrENSES &
1RAN: 33.O�pp ����aCR
2U130223 BUILDIyG p��MTTS
HDME SERVICES 27.00CR
15426 94TH NORTHW�ST
p� AVE SE
27.DOCR
TENDERED;
APPLIED: 62.U0 CHECI�
62.00-
CHANGE: �"`'-----�_
�.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 1 :S` �foZ� - ��f` ��� �� Parcel#: � ��3�� ��C����C� 7 �`�`"
Subdivision: Lot#: Pian#: Zoning:
❑ New Construction ❑ Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement o Other
Project Description/Scope of Work: �, 2. � � /
Project Value:
Building Area (sq. ft) 15t Floor 2"d Floor 3rd Floor Garage-2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR u c,..,.� 5�'��3 v.�,`��+��1TELEPHONE ,5'0 5 - �sY�- �1�/Ir5_
ADDRESS �. t�� '�:F 1 `7 Zz. EMAIL
CITY �y.+►�z-I STATE �•°* ZIP j�<!C'��` FAX
CONTRACTOR'S LICENSE# N,3w.�,�S.>>7Sx LI�EXP DATE" CITY LICENSE#
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 eement with Yelm Community Schools, if applicable.
n
I hereby c rtify th t e 'bov inf'rmation is correct and that the construction on,and the occupancy and the use of the
above d cribed r p I in accordance with the laws,rules and regulations of the State of Washington and the
City of Im.
/
f
` � •-3%- �C�/�
Applicant's Signature Date
, �lwnnr/!_nn+��r+nr/(lwnor°c_Anont/ . nt ° �gent(Please circle one.)
Home Services Northwest LLC.
Design Build Team/Bonded&Insured .,�; Ork authorized by sueh permit is not begun
Shane�Lusk � � d or abandoned for a period of 180 days
�hancluskQaol.com � '� �� ���
P O ROX.1722 Tonasket WA.98855 .'_��� �
S 322 1/2 Antwine Tonaske[ �r ��
\ti'.�.98855 � �
Cc;l:509-84G-d489
°� , -
sustainabilitv is our mission/ (360)458-3835
remodcls is our passion (360�458-3144 FAX
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