20140169 Permit Pkg 05162014 �'o��'H�p,�� City of Yelm Permit ►vo.: 20140169
w ,
� �4; Community Development Department Issue Date: 5/16/2014
d en (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
+F�IMGTO�+ Fax: (360)458-3144
Applicant:
Name: LATONYA/SEAMON JONES Phone:
Address: 15222 CARTER CT SE
YELM WA 98597
Property Information:
site,4ddress: 15222 CARTER CT SE Owner: SEAMON JONES
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: AIR SOLUTIONS Phone: 360-400-1492
Address:
8746 CULLENS ROAD
YELM WA 98597
Contractor License No.: AIRSOSL931N0 Expires: 9/09/2011
Project Information:
Project: MECHANICAL
Description of Work: ADD AC
Sq. Ft. per floor: First Heat Type (Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL AIR SOLUTIONS $ 29.50
TOTAL FEES: $ 29.50
ApplicanYs Affidavit: OFFICIAL USE ONLY
I ceRify that I have read and examined the infortnation 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 restrictio s of record. If applying as a contractor, I further certify that I am currently Final Inspection:
registered in the Stat Washington.
� /� // Date:
Signature ( Date
By:
Firm
_
Cit� af Yelm
(36 ) 458-8402
REC#: 00161181 5/16/2014 11 :47 AM
OPER: CO TERM: 001
REF#; GI
TRAN: 33.0000 BUILDING F'ERMITS
20140169 29,50CR
JONES, LATONYA/SEAMON
15222 CARTER CT SE
MECH 29.50CR
TENDERED: 29.50 OTHER
APPLIED: 29.50-
CHANGE: 0.00
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r�rr.�,
.
� 201�.� ��
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
� Project Address ��.�z z 7 �Q����� Parcel#:
i Subdivision: Lot#: Plan#: Zoning:
New Construction � Re-Model/Re-Roof/Addition Home Occupation Sign
' Plumbing �iGlechanical " Mobile/Manufactured Home Placement Other
Project Description/Scope of Work: ,��c� 17"��
Project Value: ���UO�O`'
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 completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: �a�� 'f
ADDRESS ZZ Z �� EMAIL
CITY �/Q � STATE ZIP 9S'�97 TELEPHONE zS"3-���°-ZS�S3`�
ARCHITECT/ENGWEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
�r 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 o r� TELEPHONE � � -�/` �
ADDRESS �7�/� �� ���1 ��� EMAIL n;i�!'o o. ie�/ �7��f'7l
CITY �/e%� STATE�ZIP. 9�-�7 FAX
CONTRACTOR'S LICENSE#��SoS�yjU>>z EXP DATE_CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
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.
!G� S� 6 /
Applican s Si nature Date
Owner/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
� 105 Yelm Auenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us