20140246 Permit Pkg 09092014 �oF tH�p,�� City of Yelm Permit ivo.: 20140246
� ,a �+� Community Development Department Issue Date: 9/09/2014
p� rn (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
YELM
"",""°" Fax: (360)458-3144
Applicant:
Name: MARTHA PARSONS Phone:
Address: P.O. BOX 385
YELM WA 98597
Property Information:
Site Address: 103 VAN TRUMP ST NW Owner: MARTHA PARSONS
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: WASHINGTON ENERGY SERVICES Phone:
Address:
3909 196TH ST SW
LYNNWOOD WA 98036
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 50 GALLON GAS WATER HEATER
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Th i rd
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL WASHINGTON ENERGY SERVICES $ 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 Washin to .
O Date:
Signature Date
By:
Firm �� �< O
Cit� of Y�lm
(36 ) 458-6402
REC#: 00171434 9/09/2014 2:59 PM
OPER: CO tERM: 001
REF#; 1755
TRAN: 33.0000 BUILDING PERMITS
20140246 29.50CR
PARSONS, MARTHA
1Q3 VAN TRUMP ST NW
MECH 29,50CR
TENDERED: 29.5D CHECK
APPLIED: 29,50-
CHANGE: 0.00
��D��l�
�
CITY OF YELM
RESIDENTIAL BUILDlNG PERMIT APPLICATION FORM
Project Address: 103 VAN TRUMP ST NE Parcel#: 64421700100
Subdivision: Lot#: Zoning;
New Construction � Re-Model/Re-Roof/Addition � Home Occupation Sign
Plumbing �Mechanical Mobile/Manufactured Home Placement Other
Project�escription�scope of work: REPLACE 50 GAL GAS WATER H EATER
Project Value:
Building Area (sq. ft) 1 S`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.
BUIL.DIt�1G OWNER IVAME: MARTHA M PARSONS
ADDRESS 103 VAN TRUMP ST NE EMAIL
CITY YE�^^ STATE WA ZIP 98597 TELEPHONE 360-458-7557
ARCH`ITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRAGTOR Washington Energy Services TELEPHONE $00-398-4663
ADDRESS 3909 196th St SW EMAIL
C�"� Lynnwood STATE WA ZIP 98oss FAX
CONTRACTOR'S LICENSE# WASHIES9710B EXP DATE9/�5 CITY LICENSE# 30501
P'LUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CC)h1TRACTOR TELEPHONE
ADDRESS EMAIL
C�N STATE ZIP FAX
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 will be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
• ' s�o/f�
App icant's ignature —� Date
Owner/Contractor/Owner's Agen Contractor's A lease 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
PO Box 479 (360)458-3144 FAX
Yelm,WA 98597 mww.ci.yel�n.wa.us