20140192 Permit Pkg 06182014 �a� TH�P,��' City of Yelm Permit No.: 20140192
4� �'�,►, Community Development Department Issue Date: 6/18/2014
a � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
LM ro� Fax: (360)458-3144
Applicant:
Name: RUTH LUCAS Phone:
Address: 1017 KINGSVIEW CT NW
YELM WA 98597
Property Information:
Site Address: 1017 KINGSVIEW CT NW Owner: RUTH LUCAS
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: COMMUNITY HEATING&COOLING Phone:
Address: KAI DOUGHTY
855 TROSPER RD SW STE 108-187
TUMWATER WA 98512
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALL 50 GALLON GAS WATER HEATER
Sq. Ft. per floor: Heat Type(Electric, Gas, Other):
First
Second
Third
Garage
Basement
Fees: Fees
Item Contractor
MECHANICAL COMMUNITY HEATING&COOLING $ 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 ovenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am urrently Final Inspection:
registered i of Washington. � ' ' �
Date:
Signature Date
By:
Firm
Cit� of Y�lm
(36 ) 458-8402
REC#: Ot�163990 6/18/2014 12:56 PM
OPER: CO TERM: 001
REF#; 1237
TRAN: 33.0000 BUILDING PERMITS
20140192 29.50CR
LUCAS, RUTH
1U17 KINGSVIEW CT NW
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
2s�yc�i�lZ
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: �U 11 ,.I W �������1 C�� Parcel#: ����UD �.C� C�t`�UU
Subdivision: Lot#: Plan#: Zoning:
❑ New Construction ❑ Re-Model/Re-Roof I Addition ❑ Home Occupation Sign
' �Plumbing �IeeMa�+sa� ❑ Mo6ile/Manufactured Home Placement CI Other
Project Description/Scope of Work: q�� �/L� �
Project Value:�.,1�
Building Area(sq.ft) 1S�Floor 2"d Floor 3`d Floor Garage-2 car 3 car
Covered Patio Covered Porch Patio Deck
#Bedrooms_ #Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas�ocated on the parcel?
/f yes, a completed environmental checklist must accompany permit application. �
{
�'���� ;
ADDRESS c��,�^� EMAIL ;
� CITY STATE ZIP TELEPHONE� ' �
�,� �k .�,���" LICENSE#
'����`�"�y"' EMAIL
ADDRESS
CITY STATE ZIP TELEPHONE
����---�, -� s =°°r� �� TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
��.��'I� ` " n`'�`�h�,..-. o , � �PHONE 3(�d�23 t-127.�
ADDRESS S . � �' EM�(IL
CITY f 'h 's�r STATE ZIP F�
CONTRACTOR'S LICENSE# XP DATE_CITY LICENSE#
���°,;�������;������,,r� TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# 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 witl be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
�"�
Ap licant's Signature Dat
O ner I Contractor I 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
T 05 Yelrn Avenue West (360)458-3835
Yelnt,WA 98597 (360)458-31 �.— '
:'��.�-+. ,�°°,T'���—�?
www.ci.yelm.wa.us '
t
��� 1 �' ��01�
B�: