20130287 Permit Pkg 08012013 � �o�T����,`�,' City of Yelm Permit rvo.: 20130287
,a �.
� � � Community Development Department Issue Date: 08-01-2013
Building Division (Work must be completed within 180 days)
'i �,�L� Phone: (360)458-8407
Fax: (360)458-3144
Applicant:
� Name: RICHARD GAMES
Address: 206 MOSMAN AVE SE Phone: 360-458-5974
YELM WA 98597
Property Information:
Site Address: 206 MOSMAN AVE SE Owner: RICHARD GAMES
Assessor Parcel No.: Subdivision:
Lot:
Contractor Information:
Name: RICHARD GAMES
Address: RICHARD GAMES Phone:
206 MOSMAN AVE SE
YELM WA 98597
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALL DUCTLESS HEAT PUMP, CARBON MONOXIDE ALARM
Sq. Ft. per floor: First 1000 Heat Type(Electric, Gas, Other): ELECTRIC
Second
Third
Garage
Basement
Fees:
Item Contractor
MECHANICAL RICHARD GAMES Fees
$ 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:
easem restrictions of record. If applying as a contractor, I further certify that I am currently
re ' ered in the tate of Washington. Final Inspection:
ignatur ��,�� � � _�
C'�--- Date � � �—� �� Date:
Firm
By:
' CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
� Project Address:��, /yJn�p��_?F .�� Parcel#:
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction ❑ Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement � Other
Project Description/Scope of Work:"�tqCf1 s55 �f�`�f�s/lrcx���,v5 zo t. '� � � �`��" ' " '
.� sT� .►, .
Project Value: "�r�����
Building Area (sq. ft) 1St Floor�e� 2"d Floor 3�d Floor Garage-2 car 3 car
Covered Patio Covered Porch Patio Deck
I # Bedrooms� # Bathrooms_ Heating: GAS/OTHER o ELECT (Circle One)
�
i
, Are there any environmentally sensitive areas located on the parcel? �V C1
i /fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: r
ADDRE S � -, S i £. " B�x ' ' EMAIL
CITY rN STA E�t.7�Zl TELEPHONE � � �
ARCHITECT/ENGINEER LICENSE# _--1
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
� C1�Y OF Y'ELM
�� GENERAL CONTRACTOR � TELEPHONE lbS YELM AVFNUE WtSf
ADDRESS EMAIL y�as�;-asz-aaes'
CITY STATE ZIP FAX ��:"r,,,,� io: au:y,sa��a
CONTRACTOR'S LICENSE# EXP DATE CITY LICEN: '` ° `'" �asae���eeui9ssas73e0a
Sale
PLUMBING CONTRACTOR TELEPHONE XxzxxxzXZZZZ7069
ADDRESS EMAIL ,�ISR
CITY STATE ziP Fax Entrv Method: Saiped
CONTRACTOR'S LICENSE# EXP DATE CITY LICEN� r�,tci: $ 2g,j�}
MECHANICAL CONTRACTOR TELEPHONE �8J�1/1�� Q$;30;17
ADDRESS EMAIL Inu �; 000�01 AAPr Code, 482946
CITY STATE ziP Fax p�prvd; Online
CONTRACTOR'S LICENSE# EXP DATE CITY LICEN
��istomcr �oPr
Copy of mitigation agreement with Yelm Community Schools, if appl .;,,r.„ ,�,;a
I hereby certify that the above information is correct and that the construction on,and the .,,p.. _. .,
abov described property will be in accordance with the laws,rules and regulations of the State of Washington and the
ity of . ,�
�..�...�.�� r� �-� l-->.�
c nt's Signature Date
Owne /Contractor/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 w 's suspended or abandoned for a period of 180 days
i ���.����
JUL 3�1 2013
105 Yelm Avenue West �_� (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us
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