20140249 Permit Pkg 09112014 'Y�o� TH�P,��' City of Yelm Permit No.: 20140249
'
,� '0� Community Development Department Issue Date: September 11, 2014
d t+� (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
�/�RtlIMGipI! Fax: (360)458-3144
Applicant:
Name: RANDALL&CASSA HAY Phone:
Address: 16224 PRAIRIE CRK LP SE
YELM WA 98597
Prope�ty Information:
Site Address: 16224 PRAIRIE CREEK LP SE Owner: RANDY HAY
Assessor Parcel No.: 69240002900 Subdivision: Lot: 29
Contractor Information:
Name: FAST WATER HEATER Phone:
Address:
12601 132 ND AVE. SE
KIRKLAND WA 98034
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: NEW GAS HOT WATER HEATER
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING RANDALL&CASSA HAY $ 27.00
TOTAL FEES: $ 27.00
ApplicanYs Affidavit: OFFICIAL USE ONLY
I certify at I have read and examined the information contained within the application and know the same
to be tr e and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints:
Yelm r ulations including those governing zoning and land subdivision,and in addition, all covenants,
easem�nts res � ions of re ord. If applying as a contractor,I further certify that I am currently Final Inspection:
registered i he St e of Wa i gton.
� � Date:
Signatu�re Date
By:
Firm
Cit� of Y�lm
(36 ) 458-8402
REC#: 00171744 9/11/2014 2:20 PM
OPER: Cq TERM: 001
REF#: 17691
TRAN: 33.0(7�0 BUILQING RERMTTS
20140249 27.UOCR
HAY, RANDALL & GASSA
16224 PRAIRIE CREEK LP SE
PL 27.00CR
TENDERED: 27.00 CHECK
APPLIEq: 27.00-
CHANGE: 0.00
, 715376
CITY OF YELM ,��� �� f`� ��?�� �
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:16224 PRAIRIE CREEK LOC Parcel#: �Q ����l.'l:� �V
Subdivision: Lot#: Zoning;
❑ New Constructio,� ❑ Re-Model/Re-Roof/Addition o Home Occupation Sign
' ; Plumbing (�(7 Mechanical ❑ Mobile/Manufactured Home Placement ❑ Other
v �
Project Description/Scope of Work: Remove/Replace Gas Water
Project Value:���
Building Area(sq.ft) 1S`Floor 2°d Floor Garage Deck
Basement Carport Patio
#Bedrooms #Bathrooms_ Heating A OTHER or ELECTRIC(Circle One)
Are there any environmentaily sensitive areas located on the arcel? if yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: HAY RANDY
ADDRESS 16224 PRAIRIE CREEK LOC EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE360 556-9306
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTORFAST WATER HEATER COMPANY TELEPHONE
ADDRESS 11715 N. CRE EMAIL carolr(a�fastwaterheater.com
CITY BOT LL STATE ZIP FAX 425-636-7055
CONTRACTOR'S LICENSE# FASTWWH9486C EXP DATE�i4i��ITY LICENSE# 1048
PLUMBfNG CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MEGHANICALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY 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,ruies and regulations of the State of Washington and the
City of Yeim.
� � 9/4/14
ApplicanYs Signature Date
Owner I 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 Ye[m Auenue West (360)458-3835
PO Box 4�9 (360)458-3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us