20140145 Permit Pkg 04282014 �.�°pF rHEp� City of Yelm Permit No.: 20140145
� , ����,�
� �� Community Development Department Issue Date: +�6�99�96A9—
p, rrs (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
`"'""°" Fax: (360)458-3144
Applicant:
Name: FUNK INSURANCE, INC Phone: 360-458-6061
Address: 10501 CREEK ST. , SUITE B
YELM WA 98597
Property Information:
site Address: 10501 CREEK ST SE 3 Owner: FUNK INSURANCE
Assessor Parcel No.: 69280000300 Subdivision: Lot:
Contractor Information:
Name: CAPITOL DUCT CLEANING Phone:
Address: JON ROSWALL
9116 FOX RIDGE �ANE SE
OLYMPIA WA 98513
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE FURNACE A/C
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL CAPITOL DUCT CLEANING $ 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 confoRnity 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 Wash ngton.
\� Date:
Signature� `'`— " Date �`I 2� ZG I�-�
l� By:
Firm C ��1�\ 6 , � � �'��� ��
�
CITY OF YELM ��� � ���
�
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address:�,(� �e r e-r�--e�'�' � '� Parcel#:
Zoning; Current Use: Proposed Use:
❑ New Construction ❑ Re-Model/ Re-Roof/Tenant Improvement
❑ Plumbing �Mechanical ❑ Fire Prevent/Suppress/Alarm ❑ Other
Project Description/Scope of Work: �v�^�4-�t `� �C —
Project Value: �� Sr� �
Building Area (sq. ft) Parking Garage 1� Fioor /202� 2"d Floor 3�d Floor
Building Height � �
Are there any environmentally sensitive areas located on the parcel? � v If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME: oK� � �e I�v� �-
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR 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#
MECHANICAL CONTRACTOR C4.. �� 6 � C on-�ro1�ELEPHONE 3 �� r3 y
ADDRESS �i t ( 4 t'a-� ��c� c �r �"�-t S � EMAIL -�Q a S u'�►'�` Ca�cc.s s«.t.-�-
CITY d f h r,� STATE �J�- ZIP 5 (3 gr � FAX 3�o 0 3s 2 � �.9 s� �
CONTRAC OR'S LICENSE# EXP DATE CITY LICENSE#
�. C!� i �z. 7C�� 3
Copy of City Mitigation documentation(TFC).
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.
�' D�,r!� ` r.c9 / �+l
A plicant's Signature Date
Owner I Contractor I Owner's Agent I Contractor's Agent/Tenant (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��a �,�j�D
�PR 1 � 2014
(360)458-3835
105 Yelm Aue W (360)458-3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us
�.._.. .:........ . � . � . � � - . . —
....-..�e^— � °' . .. _ . . . � ... _ .. . ..�.
Cit� of Yelm
(36 ) 458-8402
REC#: 00159075 4/28/2014 2.44 PM
OPER: CO TERM; 001
REF#: GI
1RAN: 33.0000 BUILUING PERMITS
20140145 29.50CR
FUNK INSURANGE, INC
10501 CREEK ST SE 3
MECH 29.50CR
TENDERED; 29,50 OTHER
APPLIED: 29.5U-
CHANGE: 0.00