20140109 Permit Pkg 01292014 �o� T�E�,� City of Yelm Permit No.: 20140109
,
� � Community Development Department Issue Date: 1/29/2014
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
"`"'"�'"°" Fax: (360)458-3144
Applicant:
Name: NANCY GAMES Phone: 400-044-5000
Address: 1107 RHOTON CT NW
YELM WA 98597
Property Information:
Site Address: 1107 RHOTON CT NW Owner: NANCY GAMES
Assessor'Parcel No.: Subdivision: Lot:
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 DUCTLESS HEAT PUMP
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
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 Washington.
Signature k � Date J� 2�-2.D� Date:
Firm � N T��6 "'�' L By�
Cit� of Y�lm
(3� ) 458—�402
REG#: U0150762 1/29/2014 10:06 AM
fJpER: CO TERMo 001
REF#: 40138
TRAN: 33.OGQ0 BIJILQTNG PE�MTTS
201401U9 29.5UCR
GAMES, NANGY
11Q7 ftHOTON CT NW
MECH 29.50CR
TENDERED: 29.5� CHECK
APPLIED: 29.50—
CHANGE: � 0.00
___
zor�- O�D�
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:l�O� �n 0��'l C,-� Parce�#� J`r�1ot�o bo 3�o
Subdivision: Lot#: Plan#: Zoning: ^
� New Construction ❑ Re-Model!Re-Roof/Additl0n ❑ Home Occupation Sign
u Plumbing �Mechanicai � Mobile/Manufactured Home Placem nt � Other
Project Desc " tion/Scope of Work: �Q S ^.�.
Project Valu� ��
Building Area(sq.ft) 1�`Floor 2nd Floor Garage Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating:GAS/OTHER or LECTRI (Circle One)
Are there any environmentally sensitive areas located on the parcel?
!f yes,a completed environmental checklist must accompany permit application.
BUILDtRIG OWNER'NAME: o r� -a-
ADDRESS SAA.. EM IL
CITY STATE ZIP TELEPHONE �.� )
ARCHITECTlENGINEER LICENSE#
ADDRESS EMAIL
C�N STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
C�n' STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
PLUMB(NG CONTRACTOR TELEPHONE
ADDRESS EMAIL
C�n' STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANtCAL CONTRACTOR TELEP NE ��v � 00
ADDRESS O S �'3 EMAIL � �, y� �m
��N STAT� ZIP �FAX � .
CONTRACTOR'S LICENSE# t t,, XP DATE CITY UCENSE#
Copy of mitigation agreement with Yelm Community ch o s, �applicable.
I hereby certify that the above InformaNOn is correct and that the eonsWCtlon on,and the occupa�cy and the use of the
above described property will be in accordance with the laws,rules and regulations of the State of Washington and the
Ci etm.
^ % aa �
A a t's Si n e Date
0 er! ontractor Owne�'s Agent/Contractor's Agent(Please circle one.)
All permits are non-transferable and will expire if work authorized by SUGh p@rmit iS ItOt b@gUlt
within 180 days of issuance,or if work is suspended or abandoned for a period of 180 days
105 Yeim Auenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAR
ra w u�.c i.y e[m.ui a.„�
RECEI�ED
JAN 21 2014
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