20130176 Permit Pkg 04172013 os � City of Yelm Permit No.: 20130176
,� Community Development Department Issue Date: 4/17/2013
�
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
NPiMINOtpN Fax: (360)458-3144
Applicant:
Name: JAKE BUTLER Phone:
Address: 14630 BERRY VALLEY RD
YELM WA 98597
Property Information:
site Address: 14630 BERRY VALLEY RD Owner: JAKE BUTLER
Assessor Parcel No.: 21724240202 Subdivision: Lot:
Contractor Information:
Name: JAKE BUTLER Phone:
Address: JAKE BUTLER
14630 BERRY VALLEY RD
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
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 JAKE BUTLER $ 29.50
TOTAL FEES: $ 29.50
Applicant's 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 restr' ions of record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the St of hi ton.
Signature - Date Date:
Firm By�
�b��� ���
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
ProjectAddress:`���0�3� l� ��.tia�-,`iZ��Parcel#:
Subdivision: Lot#: Plan #: Zoning:
❑ New Construction ❑ Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Piumbing �Nechanical ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: ,,; '��StSS �cis��-- ��,�-,f,�
Project Value:
Building Area (sq. ft) 1S' Floor 2"d Floor 3�d 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:Tc� 'Z;._-��Lr
ADDRESS " , I � EMAIL
CITY ST TE(,,,�-- ZIP�;U " TELEPHONE �($`� - '2C�
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#
MECHANICAL CONTRACTOR' � TELEPHO E 5�° �
ADDRESS - EMAIL ��� �� , � ,��„�, _�..,N2.�—
CITY �l k r-t STATE �t� ZIP °i�.`�°j7 FAX
CONTRACTOR'S LICENSE# G ' -"�+EXP DATE CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if app�icable.
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 Yel .
c� $., �{—�1 - l 3
A licant's Sign ure Date
Owner/Contrac or/Owner's Agent/Contractor's Agent(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 p�r��p�e�
I �.,� �C.: I ED
APR 17 2013
,,
I05 Yelm Avenue West
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us
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REF#; MC
�RAN� 3�,Ot1C10 BUILCII.�9.50(i�IiS
2t�13�1�� IAKE
BUTLER, �
14630 �ERRY VAL��Y5�aR
MECH
TF:NDEREG: 29,5U OTHER
AF'Pl_IEQ: 29.50-
CHANuE: _��W�J��.�.OG