20140116 Permit Pkg 01312014 ',f�'p� TH�p,� City of Yelm Permit No.: 20140116
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� � Community Development Department Issue Date: 1/31/2014
m, e++ (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
"""»'"s`°" Fax: (360)458-3144
Applicant:
Name: KLIEMANN BROS. Phone: 253-537-0655
Address: 4703 116TH ST E
TACOMA WA 98446
Property Information:
site Address: g127 CARYS ST SE Owner: TRESHELL PAIMA
Assessor Parcel No.: 63520005500 Subdivision: MT SHADOW Lot: 55
Contractor Information:
Name: KLIEMANN BROS. Phone: 253-537-0655
Address:
4703 116TH ST. E
TACOMA WA 98446
Contractor License No.: KLIEM67021BT Expires: 1/27/2015
Project Information:
Project: MECHANICAL
Description of Work: GAS PIPE TO DRYER
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL KLIEMANN BROS. $ 29.50
TOTAL FEES: $ 29.50
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be tr e and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm r gu tions including those governing zoning and land subdivision,and in addition,all covenants,
easem nt res riction record. If applying as a contractor,I further certify that I am currently Final Inspection:
registe ed S te f hington.
` � Date:
Signat e Date
Firm By:
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REF#: 36E�33
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KLTEMANN ��05.
g127 CARYS �� 529 �OCR
MECH
TE.NDERED; 29•�Q CHECK
APPLIED: 29.50-.
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CHANGE:
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CITY OF YELM ZO�,�O L 1�
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: _I�Z.1 Cu.rNS S� S� Parcel#: �035.Z DD�SS O O
Subdivision: �� Lot#: '�' Plan#: � Zoning: �"
❑ New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing Vlechanical ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work: �1 aJ Q 1 /��• 'to �rNLr
Project value:� 5 50 �1�9n'���
Building Area (sq.ft) 15`Floor 2"d Floor Garage Deck
�,�A, Basement Carport Patio
#Bedrooms #Bathrooms_ Heating: GAS/OTHER or ELECTRIC(Circle One)
Are therz any environmentally sensitive areas located on the parcel? �_
/fyes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Y �• �
ADDRESS S aI.YYL�. EMAIL
CITY STATE ZIP TELEPHONE • •
ARCHITECT/ENGINEER LICENSE# ----'"
ADDRESS EMAIL %�
CITY STAT ZIP TELEPHONE
GENERAL CONTRACTOR AfiN r05 TELEPHONE • 7� �
ADDRE S�03 —lI�o EMAIL �1.r,�f�1� i L�rt�trl 0� .LDN1
CITY DL L l��- STATE ZIP FAX 2 • ' • �D
CONTRACTOR'S LICENSE# DATE_CITY LICENSE# /2��50
. .
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL /
CITY S ZIP FAX
CONTRACTOR'S L SE# EXP DATE_CITY CENSE#
MECHANICAL CONTRACTOR :���'/19�1.� TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
� Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the construction on,and the occupancy 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
City of Yelm.
.
� /-29-��
Ap licant's Sign ure Date
Owner/Contractor/Owner's Agent tractor's A en (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 work is suspended or abandoned for a period of 180 days
RFC;�'��.T��
105 Yelm Aoenue West (360 458-38 4
Yelm, WA 98597 (360 458-31�F�
www.ci.yelm.wa.us
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