20130326 Permit Pkg 09132013 'fi`�QF rH�p,g�' City of Yelm Permit ►vo.: 20130326
'
� � Community Development Department Issue Date: 9/73/2013
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
""'"`T°" Fax: (360)458-3144
Applicant:
Name: DOLARES SMITH Phone: 360-690-8787
Address: 10071 JENSEN DR SE
YELM WA 98597
Property Information:
Site,4ddress: 10071 JENSEN DR SE Owner: DOLARES SMITH
Assessor Parcel No.: 78640104400 Subdivision: TAHOMA TERRA Lot: 44
Contractor Information:
Name: SOUND HEATING &AC Phone: 253-875-3350
Address: CURTIS HOOD
5526 184TH ST. E, STE.A
PUYALLUP WA 98375
Contractor License No.: SOUNDHA066BM Expires: 8/15/2011
Project Information:
Project: MECHANICAL
Description of Work: AIR CONDITIONING ADD ON
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL SOUND HEATING&AC $ 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 restrictions of record. If applying as a contractor,I further certify that I am currently Final Inspection:
registered in the State of Washingto .
Date:
Signature � Date � /
Firm By�
Cit� of Y�lm
(36 ) 458-8402
REC#: 00138719 9/13/2013 12:43 PM
OPER: CO TERM: 001
REF#: 57506
TRAN: 33.00OG 6UTLDING PERMITS
20130326 29,50CR
SMITH, DOLARES
10071 JENSEN DR SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED; 29,50-
CHANGE: ~ 0.00
Sep, 12. 2U13 4: 31PM No, 1596 P. 2
CItY OF YE4M
RESIDENTiAL BUt�pING P�.RMlTAPPI.ICATION�ORM �I�O 3°2�
Project Address: I O� � ����� � Parcei#:,��`a e� 0�� � C3 0
Subdivision_� � ��. T � � �^-{-flt#: �oning;
�,� New Construction t1 R�Model/Ra-Roof/Additian u Nome Occupation Sign
!� I�lumbing �Mechanical u Mobile/Manufeclurad Home Piacement u Other
Proj�ct Description/Scope of Work: � � �
Project Vaiue: �
Building Area (sq.ft) 1�Floor 2rd Floor Garage ___ Deck
Basemer►t Carpo�t Patip�
#Bedrooms� #Bathrooms,�, lieatin .�1'NER or�L�CTRIC(Circle One}
Are th�re any environmentaily sensitive areas located on the parcel? If yes,a
cqmpleted environmental checklist must accompany permit application_
BUlLDING OWNER NAM�: S
ADOR�55 �1�C1 — EMAIL
CITY C�'� 5�'ATE , ZIP � � �1 TELEpH�NE (� -^ �
ARCMIT�CT/ENGINEER LIC�NS�#
ADDF2ESS EMAIL
C1TY STA�'��ZIP TELEF'HONE
GEN�RAL CbNTRACT�F2 TE�EPMON�
ADDRESS EMAIL
CiTY_ STATE ZIP„_„ ---FAX
CON7RACTOR'S LiC�NSE# EXP DATE�CiTY LICENS�#
t'LUMBIN�CONTRACTOR T�LEPHONE
qpo�2ESS EMAIL
CfTY S�'AT� zIP�FAJC
CQNTRAC70R'S(.ICENSE# EJ(P DATE�CITY LIC�NSE#� ___
MECEiANIC�L CON7RACTOR o ����P��N� � � ^ � � � .�,p�
AQDR�SS�J� tio � EMAIL �[M �A- �
CITY STAT�V�1 A�._ IF' FAX .,o Z ��I- U �
CAN RA R'S L CENS�# :XP DATE_CITY �tCENS�
Copy of mitigatfon agreement with Yelm Community Schtwl !'if��plicable. '
t hereby��MY tbp��ert bw�'�����caordanco w h the Is st rulas a d regu�ations of the Stete af W sh ngton end thee
above descrl6ed prope y
City af Ye1m.
�
Applicant' 3 gnature � �
Owner I C actar/Owner's Agent/Contractor's Asent (Piease circle one.)
Ali permits are non-transferable and wlll expira if wot'lc autho�lzed by such perrni!is nat begun
Withln 180 day�o#issuance,or i4 work is susp�nded or ebandoned for a period of 180 days
l04 YRI»L Auenus We6t � (360)458�3835
PO�ox 479 (360)45&Sl dt FAX
Yelm, WA A8597 +eiet�ur.Cl.y¢Im.mo.uB
Sep, 12. 2013 4: 31PM No, 1596 P. 1
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