20130348 Permit Pkg 12032013 �p� TH�p�� City of Yelm Permit ►vo.: 20130348
�v y
� �� Community Development Department issue Date: 12/03/2013
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
"'.`"'"`_°" Fax: (360)458-3144
Applicant:
Name: KIERSTEN SLEVIN Phone: 602-593-7930
Address: 15627 92ND WAY SE
YELM WA 98597
Property Information:
site Address: 15627 92ND WAY SE Owner: JOHN SLEVIN
Assessor Parcel No.: 55360001000 Subdivision: Lot:
Contractor Information:
Name: BLACK HILLS, INC Phone:
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS FURNACE WITH LIKE
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL BLACK HILLS, INC $ 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 contrador, I further certify that I am currently Final Inspection:
register State�i ton.
Signatur
�1"1( �� '� Y � Date 1 � 3 � Date:
Firm By�
Cit� of Y�lm
(36 } 458-8402
�**** REPRINT RECEIPT****�
REC#; 00145418 12/03/2013 4:16 PM
OPER: CO TERM: 001
REF#; 14614
TRAN: 33.0000 BUILDING PERMITS
20130348 29.50CR
SLEVIN, KIERSTEN
15627 92ND WAY SE
MECN 29,50CR
TENDERE�: 29.50 CHECK
HPPLIED; 2�.50-
CHANGE: 0,00
From:Bl2ck Hills Inc 360 705 8584 Y2/03/2013 13:54 �088 P.001/OOl
_ _ _ _ _ _ __ _ �rj��-Cp��B
C[iY OF YELM
RESIDESJTtAL BUEL�ING PERMlT APPLICAT10iV FORM
Proiect A�dress;�S t.4arF `�1 c'�h.l� �� Farcel�_ '�J�']���.�f�`�CT�
Subdivisiorl: Lc:#: PI2n�: �oninn:
� New Gonstruction _� Re-Mode!I Re-Roof!Addifion t_i Hame Occupaiion Sign
° Piumbing '!�.Mecha�3ica{ Ma6iie!Manufaetured Home Placement Other
Project GescriptioniScope af Work: ����.-'°.�_� �A-R �=�' 1"�-w 1-�
Projec�Vatue: o�'�LOOp� '
Buildina Area(sq.R) 9�`Roor 294 Ftaor Gerage Deck
�asement Carpost Fati�
#Bedrooms #Ba4hrooms_ Heating:GAS!O i HER ar EL�GTRIC(Circie�sie)
Are tnere anp environmenta{ty sensitive areas located an the�arcel?
: lfyes,a compteted enviroi�mentai checkiist must accampany peemit appliGafion.
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t�:QIVTR,4 QR S l ICENS�� EX?D/�T�� CITY!ICENSE# '' 3S •o
� Copy of mitiga*,ion agraement wrtn l�eim:.ommunitySchools,if applicabfe.
-I ltereby certify tha!the aDove infarmafion is carrect and that the const[uction on.and�the occupancy and the use.af�the �.
above described.property wiit be-ir.accordance with the laws,ruies and regulations of the State ot Wzshing:on and the �.
City ot Yelm.
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Appiicant's Signature Rate
Owner(Cornrac#oe f Ownet's Agent?eontractor's Agent�Please eircte one.)
A!F permits are nan-transferabte anti wiit expire if work authorized by such permi!is nat begun
' within 180 days of essuance,or if work es suspended nr abandoned for a period nf 98O days
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Unfiled Notes Paae 2