20140136 Permit Pkg 03182014 �p� THFp�� City of Yelm Permit No.: 20140136
�' 9
� � Community Development Department Issue Date: 3/18/2014
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
"".°"'""Q" Fax: (360)458-3144
Applicant:
Name: JOHN/CAROL BUTNER Phone: 619-944-1121
Address: 16122 PRAIRIE CRK LP SE
YELM WA 98597
Property Information:
site Address: 16122 PRAIRIE CREEK LP SE Owner: JOHN BUTNER
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: PRATTS PLUMBING Phone: 360-357-3262
Address: PAMELA PRATT
3301 46TH AVE NE
OLYMPIA WA 98506
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE WATER HEATER WITH LIKE
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL PRATTS PLUMBING $ 29.50
TOTAL FEES: $ 29.50
Applican s Affidavit: OFFICIAL USE ONLY
I certify t at I have read and examined the information contained within the application and know the same
to be tru and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm reg lati s u m those governing zoning and land subdivision, and in addition,all covenants,
easeme s a � restriction of record. If a plying as a contractor, I further certify that I am currently Final Inspection:
registere in e a of ashin to . �
Signature Date �( �, L--� Date:
By:
Firm
Cit� af Y�lm
(36 } 456-840Z
����* REPRINT RECEIPT***�*
REC#: 001�5839 3/18/2014 10:35 AM
OPER: CO TERM: 001
REF#: 6633
TRAN: 33.0000 6UILDING I�ERMITS
20140136 29.50CR
BUTNER, JOHN/CaROL
16122 PRAIRIE CREEK LP 5E
MECH 29.50CR
TENDERED; Z9.50 CHECK
APPLI�D: 2y.50-
CHANGE: �� pp�
�o������
CITY OF YELM
. ` RESIDENTIAL BUILDING PERMIT APPLICATION FORM
ProJect Address; 1�1�� �(�lt-�-�� Parcel#: tD ! �'"I V VU I��
. �
Subdivisibn. Lot#: Zoning;
New�Eonstruction Re-Mode{!Re-Roof/Addition Home Occupation Sign
: P�umbing �Mechanica : Mobile/Manufactured Home Placement Other
Project Description/Scope of Work: "�1��-� �ti� �T w�� ��K'� � N��
Project Vaiue: �
Building Area(sq.ft) 15t Floor 2°d FlOA� Garage Deck
Basement Carport�Patio
#Bedrooms____ #Bathrooms_, Heating: GAS/OTHER or;��.ECTRiC (Circle One)
Are there any environmentally sensitive areas located on the parcef? If yes, a
completed environmentai checklist mus#accompany permit applicatfon. ,
BUILDiNG OWNE NAME: " -2 �rv �
ADDRES
CITY STATE ZIP T LEPH NE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STAT'E ZIP TELEPHONE
GENERAL CONTRACTOR -_--�—�j� TELEPH�NE �U��� 3���.�.�_-
ADDRESS,_�3L:?I ��(o'� � y�EMA1L
CITY `, • C'�-- STATE ZIP_���FAX
CONTRAC OR' LICENSE# �� XP QATE ITY LtCENSE# ��—��`�tlL�
PLUMBING CONTRACTOR �� TELEPHONE
ADbRESS EMAiL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LI�ENSE#
MECHANICALGONTRACTOR TELEPHONE �
ADDRESS EMAIL
CiTY STATE . Z(P FAX
CONTRACTOR'S LICENSE# EXP DATE�CiTY LICENSE#
Copy of mitigation agreement with Yeim Community Schools, if applicable.
i hereby certify that the above inYo%mation is correct and tfiat the conetruction on,and the occupancy and the uss of the
above described proparty wili be in accordance with the faws,rules and regulations of the State of Waehington a�d tfie
City o elm.
� ��'� _ ��� I ' "
' ant's Sig ure �
Owner ontractor!Owner's Agent!Contractor's Agent (Please cir �, � /� � �� ' „
C���+,�-� 0'L� lx�c.-�_
All permits are non-transferable and will expire tf work authorized b� y,
within 180 days af issuanCe, or if work is suspended or abandoned 1�_6 uv'„ ����w. __�__ � �-?
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1�5 I'e.hri Auenue iVest
PO Box 479
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