20130257 Permit Pkg 07082013 ��o�''"��� City of Yelm Permit ►vo.: 20130257
� � Community Development Department Issue Date: 7/08/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L 1Ni
W�6R�MG�9N Fax: (360)458-3744
Applicant:
Name: AARON GREEN Phone: 360-259-6172
Address: 10718 VAN NORHOP ST SE
YELM WA 98597
Property Information:
site Address: 10718 VAN NORHOP ST SE Owner: AARON GREEN
Assessor Parcel No.: 81580001100 Subdivision: VAN NORHOP ESTATES Lot: 11
Contractor Information:
Name: AARON GREEN Phone:
Address:
10718 VAN NORHOP ST SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: New Heat Pump
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL CHEHALIS SHEETMETAL $ 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
Yelm regulations including those governing zoning and land subdivision,and in addition, all covenants, #Sets of Prints:
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the St of Wash ton. Final Inspection:
Signature Date I` � � /� Date:
Firm By:
Cit� of Y�lm
t�h � 45s-a4o2
REC#: OQ137196 7/�8/2013 12:50 PM
pPER: CQ TERM: 001
REF#: 3178
TRAN: 3�.U000 BUILG��9.50CRTTS
20130257
GREEN, AARON
10718 WAN NORHOP ST SE
MECN 2�.50CR
TENUEREQ: 29.50 CHECK
APPLIED: 29,50-
CHANGE: �_�"___._.._.0.00
�
,
�i
�
I
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICA710N FORM
Project Address: 1 SC, �L Parcel#: R���OC�O I I O�
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction ❑ Re-Model/Re-Roof/Addition 0 Home Occupation Sign
❑ Plumbing 'l�Mechanicai ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: R2�Y0 � 1LQa �1,��1. �1�1�,� `ChQY��S'fCl."C
Projectvalue: � �, �3�J5• �
Building Area{sq.ft) 15`Floor��� 2"d Floor Garage��� Deck
Basement Carport Patio
#Bedrooms� #Bathrooms� Heating: AS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? 1�0
/f yes, a completed environmental checklist must accompany permit application.
6lJtL[71NG OWN� IVAME: 1�, �
ADDR SS �1� EMAIL
CITY STATE UJA ZIP TELEPHONE " —
A E �!G �R LIC #
...:._... :.. _
� IL
CI STQ� ZIP ELEPf� E
GE _ L CQ CTf) TE�PFIONE
RESS AIL
CITY STAT FAX
CO RACTO LICENS P DATE CITY LI SE#
PLIJ ING TRA R T PHO
� MAIL
CI ATE F
C(� TRAC�T�R'S L NSE XP D CI LICENS
MECHANICAL CONTRACTOR � TELEPHONE 3(OU) 5 - �l(o
ADDRESS 0 . Y1V�_,___, EMAIL 1�taL1SS ���.YY1P�C1101tTC01^�CCI �.�1e'�.
CITY STATE Ul h_ZIP 4$S32 FAX 3�0�),�Gr2-"l�4 S�
CONTRACTOR'S LICENSE#CkI�NP�51�.1252 EXP DATE CITY LICENSE#
ND Copy of mitigation agreement with Yelm Community�S�ools, 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 w'I be i�accordance with the laws,rules and regufations of the State of Washington and the
City of Yelm.
.� � .� I
ApplicanYs ' e Date
Owner/ ntractor w er'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 period of 180 days
105 Yelm Auer�ue West (360)455-3835
Yelm,WA 98597 (360)458-3144 FAX
www.cd.yelm.w¢.ees