20140134 Permit Pkg 03122014 o,�oF T"��►,p�"' City of Yelm Permit No.: 20140134
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� � Community Development Department Issue Date: 3/12/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
'"•°"'""'°" Fax: (360)458-3144
Applicant:
Name: RACHEL FARMER Phone: 253-666-2729
Address: 15321 CALLIE AVE SE
YELM WA 98597
Property Information:
site Address: 15321 CALLIE AVE SE Owner: RACHEL FARMER
Assessor Parcel No.: 41610014500 Subdivision: CHERRY MEADOWS Lot: 145
Contractor Information:
Name: BLACK HILLS, INC Phone:
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091 Expires: 12/31/2014
Project Information:
Project: MECHANICAL
Description of Work: INSTALL HEAT PUMP
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 contractor, I further certify that I am currently Final Inspection:
registered in the of Washington.
Signature ' Date Q3 't� Date:
Firm By
.
�6f� of �elm
) 458 $q02
REC#: 001550�4
OPER: CO TERM: OOjz/2U14 11:06 AM
REF#; 14851
TRAN; 33.0000 BUILDING PERh1TtS
20140134
FARMER, RpCHEL 2�"50CR
MECH
r�321 CALLIE AVE SE
29.50CR
TENDEREp;
APPLIED: 29.50 CHECK
29.50-
CHA NGE: �`'-------__
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
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Project Address: �`��%� ��.�tyoC'_. ���P�' Parcel#: 1 � ��,���^`� ��'-�
Subdivision: Lot#: Plan #: Zoning:
� New Construction ^ Re-Model/Re-Roof/Addition C Home Occupation Sign
� Plumbing �Vlechanical ��� Mobile/ Manufactured Home Placement C Other
, P .p �-�°-���'��ti4.� ��� �`.�'�� `,-
Pro'ect Descri ti / cQ e of Work: � � r� 1�,I._>
��°, 1
Project Value: '�`�
Building Area (sq.ft) 1St Floor 2"d Floor 3�d Floor Garage-2 car 3 car
Covered Patio Covered Porch Patio Deck
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#Bedrooms_ #Bathrooms_ Heating: GAS/OTHER o LECT (Circle One)
� n i iv r s located on the arcel? �
Are there any environmentaily se s t e a ea p
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
I ARCHiTECTJENGJNEER LICENSE#
� ADDRESS EMAIL
� CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
MECHANICA�CO,NTRACTOR �.-�C.�CU' ' �,� TELEPHONE � f^"` ° ��
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ADDRESS � � ```'"��'� � ' EMAIL %r�tii� ''�E�'�_, h,Nl
CITY 4.�'�� ,, w.�� � � STATE � )v�s ZIP ; � FAX ° " '�� . 7
CONTRAE O 'S LICENSE#��,(if,L�il�l.��l, EXP DATE�[j,�j ITY LICENSE# " . (D �
Copy of mitigation agreement with Yelm Community Schools, if applicable.
reby certify that the above informati is correct and that the construction on,and the occupancy and the use of the
abo described property will be in ac rd�nce with the laws,rules and regulations of the State of Washington and the
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�►pplicant's Signature Date
Owner I 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 work is suspended or abandoned for a period of 180 days
I05 Yelm Avenue West (360)458-3835
Yelm, WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us
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