20140157 Permit Pkg 05132014 "f�Q� TH�p,��' City of Yelm Permit No.: 20140157
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� �7� Community Development Department Issue Date: 5/13/2014
� en (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YEL
"".°"'"`_°" Fax: (360)458-3144
Applicant:
Name: DUSTIN OLIVEIRA Phone: 253-905-5749
Address: 15402 CALLIE AVE SE
YELM WA 98597
Property Information:
Site Address: 15402 CALLIE AVE SE Owner: DUSTIN OLIVEIRA
Assessor Parcel No.: 41610017300 Subdivision: CHERRY MEADOWS Lot: 173
Contractor Information:
Name: BRENNAN HEATING Phone:
Address:
4601 S 134TH PL
SEATTLE WA 98168
Contractor License No.: BRENNHA971R4 Expires: 12/29/2013
Project Information:
Project: MECHANICAL
Description of Work: INSTALL 3 TON AC UNIT
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL BRENNAN HEATING $ 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 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 State of Washington.
� '' _ \ �� �/ � � n�,I� Date:
Signature r[�1�� Date Gv
By:
Firm � t- �
Cit� af Y�lm
(36 ) 458-84G2
REC#: 00160664 5/13/2014 11 :12 AM
OPER: CO TERM: 001
REF#: 40604
TRAN: 33.00OU BUILDI2� 50CR���
20140157
OLIV�IRA, DUSTIN
15402 CALLIE AV29S�OCR
M�CH
TENQ�RE.I�: 29,50 CHECK
APPLIED: 29.50-
Cf�ANGE: � ���
Zo�u�c� i�'�
CITY OF YE�M
RESIDENTIAL BUILDIN PERM T APPLICATION FORM
r ss: �vc7L j I� �-'�ar�cel#: `i�t-F�� �J ����
Pr�ect Add e
Subdivision_
Lot#: Plan#: Zoning:
❑ New Construction/ � Re-Modei!Re-Roof/Addition ❑ Home Occupation Sign
❑ Piumbing �'Mechanical L� Mobiie!Manufactured Home lacement � Other
Project Des ' tioNScope of Work �.�.�"�-�� � �` �'"'
Project Val �..a
���
Building Area(sq.ft) 1g'Ftoor 2nd Floor _ Garage Deck
Basement Carport Patio —
#Bedrooms_ #Bathrooms_ Heating:GASIOTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes,a completed environmental checklist must accompany permit application.
BUILDWG UVNNER NAME: � �' �Y�"�
ADDRESS � � � EMAIL ��
C�N STATE ZIP TELEPHONE :
ARGHITECTIENG[NEER �ICENSE#
ADDRESS EMAIL
'; C�-N STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CIN STATE ZIP________F�
CONTRACTOR'S LICENSE# EXP DATE_CITf LfCENSE#___________
PLUMBING CON7RACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
LE HONE _ �
MECHANIG CONTRACTOR EMAIL' C�-� `�'� '�"���
ADDf�,FSS � �� F�_ ., t�
C�Tr _ STAT�_ �
CONTRACTOR'S LICENSE# DATE CI tICENSE#
Copy of mifigation agreement with Yelm Communi c oo 'i applicable.
1 her$by certlfy that v+°abo+re informatlon(s eorrect and that the ConsMuCtion on,and tha occupancy and the use of the
abo described property wlll be in accordance with the laws,fules a�d regulations of the State of Washington and the
Ci o elm.
�, 3t� 1 �
canYs Signature Date
ner 1 Contractor!Owne�'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 1$0 days
I05 Yelm Auenue West (360)458-3835
(360)458-3I44 Fr1X
Yelm,WA 98597
www.ci.y¢Im.wa.vs