20140203 Permit Pkg 07092014 o� tH�,, City of Yelm
Permit ►vo.: 20140203
Q�+ ��f Issue Date: 7/0912014
� +�p� Community Development Department �ork must be completed within 180 days)
d
Building Division
Phone: (360)458-8407
YEL�,�,,,, Fax: (360)458-3144
Applicant: Phone: 253-468-0390
Name: MICHAEL& NORA DOMASKIN
Address: 14447 98TH WAY SE
YELM WA 98597
Property Information:
Site Address:
14447 98TH WAY SE Owner: MIKE DOMASKIN
Assessor Parcel No.: 78640119200
Subdivision: TAHOMA TERRA Lot: 192
Contractor Information:
Phone:
Name: CUMMINGS INC
Address:
6824 19TH ST.W.#174
UNIVERSITY PLACE WA 98466
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALLING NW A/C WITH EXISTING FURNACE
Sq. Ft. per floor: Heat Type(Electric,Gas, Other):
First
Second
Third
Garage
Basement
Fees: Fees
Item Contractor $ 29.50
MECHANICAL CUMMINGS INC
TOTAL FEES: $ 29.50
OFFICIAL USE ONLY
ApplicanYs Affidavit: lication and know the same
I certify that I have read and examined the information contained within the app y #Sets of Prints:
to be true and correct.I also certify that the proposed structure is in conformity with all applicable Cit of
Yelm regulations including those governing i o�nin9 aa dont actoral furtheracertify thattl amacurrently nts, Final Inspection:
easements and restrictions of record. If app y 9
registered in the State of Washington. � Date:
. Date ( " �'
Signature By:
Firm
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(36 ) 458-8402
REC#: 00165477 7/09/2014 3:38 PM
ppE�; �p TERM: 001
REF#: 1201
TRAN: 33.OU00 BUILDI29 50CRITS
20140203
pOMASKIN, MICHAEL & NO�A
14447 98TN WAY 29 50CR
MECH
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: �.00
7�u��2-� �----
CtTY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address �U�`'�7 �l���'�`t''� 5� Parcel#: � ��P��� 1 ��^' _
Subdivision: Lot#: Plan#: Zoning:
New Construction ! ' Re-Model/Re-Roof/Addition Home Occupation Sign
' Plumbing � Mechanical ' Mobile/Manufactured Home Placement i Other
Project Description/Scope of Work: Sr+S'�a-``� '^� 1�'�`'`� �<<' ��y S�'�� �``��� ���� ��`�
�v t��wn��
Project Value: ���G'
Building Area(sq. ft) 15t Floor 2"d Floor Garage Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: AS OTHER or ELECTRIC(Circle One)
Are there any environmentally sensitive areas�ocated on the parcel? ��
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: +Y�i SC-�. ��� � �
ADDRESS �'�1�''� 7 K��' °"'``� 5 � EMAIL
CITY �L v✓� STATE L� ZIP q S4 7 TELEPHONE Z 5 3�"r"l fr`�'�'� `��'
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP__F�
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE,_CITY LICENSE#
MECHANICAL CONTRACTOR vr o� 5 Tr��- TELEPHONE zS^3°
ADDRESS G 2'L-4 <<'1}" S t t✓, � �7 EMAIL Cvw�w�i✓•�s :v�c It`J-e. cc��,.�
CITY v;���e:„fiv ���C STATE +-v v¢ ZIP �1f��u� s� FAX
CONTRACTOR'S LICENSE# ��TZ `�(-Z �?�EXP DATE2�� ITY 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.
�'.� , `7—�'— 2 G /�--/
Appl cant's Signature Date
Owner/Contractor 1 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
� (360)458-3835
105 Yelm Auenue West (360)458-3144��3F-:—,--��-�'t
Yelm,WA 98597 `"�
www.ci.yelm.wa.us .
,JUL 0'9 2014