20130279 Permit Pkg 07242013 �d'�tN�A� City of Yelm Permit ►vo.: 20130279
7
� �, Community Development Department Issue Date: 7/24/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
""`"'"`�°" Fax: (360)458-3144
Applicant:
Name: LUKE/ASHLEY RANDALL Phone: 253-640-7150
Address: 14854 99TH WAY SE
YELM WA 98597
Property Information:
site Address: 14854 99TH WAY SE Owner: LUKE RANDALL
Assessor Parcel No.: 78640016900 Subdivision: TAHOMA TERRA Lot: 169
Contractor Information:
Name: BRENNAN HEATING Phone:
Address:
4601 S 134TH PL
SEATTLE WA 98168
Contractor License No.: BRENNHA971 R4 Expires: 12/29/2013
Project Information:
Project: MECHANICAL
Description of Work: INSTALL 3 TON HEAT PUMP WITH AIR HANDLER
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL BRENNAN HEATING $ 29.50
TOTAL FEES: � 29.50
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify that I have read and examined the infoRnation 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 of record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the State of Washington.
Signature �C1J-L�,1Lc=���;,• �sj,J Date � `2� —� �3 Date:
F��, �3�.��v �1 � N ���-T�i�1 G � �-C BY�
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City af Y�1m
(360) 458-8402
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REC#: 00134114 7/24/2013 10:54 AM
OPER: CO TEFtM: 001
REF#: 24860
1'RAN: 33.0000 BUILQING PERMTTS
20130279 29.50CR
RANDALL, LUKE / ASHLEY
14654 99TH WAY SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIEQ: 29.50-
CHANGE: 0.00
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CITY OF'1'�LM
RESIDEN7IA�. UILDI�IG P�RMu APPLICATION �'ORM
7 `
Project Address:� � q �1"�` �Q �����; �(o ��� D�
Subdfvi5ion: �ot#• Plan#: Zaning:
� I New Construction � Re-Model/Re-Roaf/Addition � Home Occupation Sign
� Plumbing �Mechanical C7 Mobile/Manufacture Home Placement I � Other
Project DescriptionlScope of Woric: n�,l �, 3 ' ,.,�j � "�.�
Project Value: W � �' f
1 �
Building Area (sq.ft} 1gr Floor 2""' Floor Garage Deok
Basement Carport P�tic
#Bedrooms, #Bathrooms_ Meating: GAS/QTH�R o �LECTRI (Circle One)
Are there any environmentally sensiti�e areas located an the par�el7
lf yes, a Completed envirpnmental checklist must accompany permit appfication.
u
ADDR S W EMAIL
C�T1' 't-��'Y1 STATE�zIP TEL.EPHON - �`�.
� �� , . LfC�NSE#
ApDRESS EMAIL
Cl�i'Y STATE ZIP:�TEL.EPHON�
� . � TELEPHOIYE
ADDR�SS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY L.ICENSE#
- TELEPHONE
ADDRESS � EMAIL
GiTY STATE_,Z�p FqX
CONTRACTOR'S LiCENSE# EXP DATE CITY L,ICENS�#
ADD SS ���P dNE b
CI „� EMAIL '� � ��� . ��
STAT ZIP FAX b�o p
CON7RACTpR'S LICENS�# XP DqT IGENS�#
Copy of mitigation agreement with Yelm Community Schools, if applicable_
��►ebY cerkfiy that th�ahove Informaklon is correct and that!he eonstruetion an,and the occupancy and the use ot the
above dsscribed properry wfll he in accordsnce with the�au,,s,ru�es and regulatlona of khe St�e of Washington and the
Clty alm.
A ant's Signature �
ner!Contrdctor/Owr�er's Agent/Contractor's Agent(Please ci�Ie one�)
A��Perntits are no�natransfierable and wlll explre if wor'k authorized by such permit Is not be un
wit�in 1$0 days of issuahce,or if work is suspended or abandoned for a peri
�VED
JUL 2 2 2013
106 YeT►re AoettrEe iyiegt
Yetm,WA 986'97 ( _W...
reia»4.ci.yr.Im,toa.ua (3S0)463-3,144 FAX
BRENNAN
� . � � � � �
; www.brennanheating.com
FAX TRANSII�SSION SHEET
TO: � � Il.._
COMPANY: �
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NUN[BER OF PAGES (�NC�,UDING COVER SIi�FT): �
N�ESSAGE:
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