20140142 Permit Pkg 06252014 �a� THE,�,� City of Yelm Permit No.: 20140142
o �
� Community Development Department Issue Date: 3/25/2014
o. (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
w�6NINGTOti Fax: (360)458-3144
Applicant:
Name: FAST WATER HEATER Phone: 425-814-3124
Address: 12601 132 ND AVE. SE
KIRKLAND WA 98034
Property Information:
Site Address: 16201 VANCIL LP SE Owner: RAFAL STACHNIUK
Assessor Parcel No.: 69270000600 Subdivision: Lot:
Contractor Information:
Name: FAST WATER HEATER Phone: 425-814-3124
Address:
12601 132 ND AVE. SE
KIRKLAND WA 98034
Contractor License No.: FASTWWH948BC Expires: 1/04/2014
Project Information:
Project: PLUMBING
Description of Work: REMOVE/REPLACE ELECTRIC WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING FAST WATER HEATER $ 27.00
TOTAL FEES: $ 27.00
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 re latio uding those governing zoning and land subdivision,and in addition,all covenants,
easeme ts and res ictions of r ord. If ap ying as a contractor, I rther certify that I am currently Final Inspection:
register i he S te of Wa g n.
Date:
Signatur
By:
Firm
Cit� of Y�lm
(36 ) 458-84G2
REC#: 00156226 3/251��1� 4.49 PM
QPER: CQ Tk��: OCl1
R�F#: 16853
1'RAN: 33.00U0 BUIL[ll�� P�oR�j�$
20140142
FAST WATER MEA1'ER
16201 VANCIL �-P27�OOGR
PL
TENDERE.D: 27.00 CHECK
APPLIEG: 27.Q0-
CHANGE: ~ �Q�
� - .
` ` 686396
CITY OF YELM 2►��`'����Z'
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:16201 VANCIL LOOP SE Parcel#:
Subdivision: Lot#: Zoning;
� New Construction ❑ Re-Modei/Re-Roof/Addition � Home Occupation Sign
m Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement 0 Other
Project Description/Scope of Work: Remove/Replace Electric Wa„� 0
Project Value:_ �`'"l�
Building Area(sq.ft) 1S`Floor 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms #Bathrooms_ Heating:GAS/OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes,a
ccr�;p�eted enviro^menta! checkiist must accompany permit application.
BUILDING OWNER NAME: JUDSON DANI
ADDRESS 16201 VANCIL LOOP SE EMAIL.
CITY YELM STATE WA ZIP 98597 TELEPHONE360 520-1448
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
��N STATE ZIP TELEPHONE
GENERAL CONTRACTORFAST WATER HEATER COMPANY TELEPNnNF - -
ADDRESS 11715 N. CRE � �^ EMAII.�:�`�fastwaterheater.com
CITY BOT L STATE ZIP FAX 425-636-7055
CONTRACTOR'S LICENSE# FASTwWH9a86C EXP DATE (yl��jTY LICENSE# 1048
PLUMBWG CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
__ Copy of mitigation agreement with Yelm Community Schools,if applicable.
1 hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the
above described property wfll be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm. ,,
lj ��-�/`''�.s'� _, 3/20/14
Applicant'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 Auereue West �;� " ' ' . g�'w� (360)458-3835
PO Box 479 �� ��� ��w `��V����� ` -�� (360)458-3144 FAX
Yelm, WA 98597 �/ www.ci.yelm.wa.us
A p r�ved
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