20140232 Permit Pkg 08202014 o� ��Ep City of Yelm
Permit►vo.: 20140232
Qk, '�'7 Issue Date: 812 012 0 1 4
� � Community Development Department �ork must be completed within 180 days)
o. �
,° Building Division
Phone: (360)458-8407
ELM Fax: (360)458-3144
qpplicant:
Phone: 360-894-2585
Name: ROCKY SIMPSON
Address: P.O. BOX 2092
YELM WA 98597
Property Information:
Owner: ROCKY SIMPSON
Site Address: 302 EDWARDS ST SW
Lot: __
Assessor Parcel No.: 75300701100
Subdivision:
Contractor Information:
Name: WASHINGTON ENERGY SERVICES
Phone:
Address:
3909 196TH ST SW
LYNNWOOD WA 98036
Expires: 0/00/0000
Contractor License No.:
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 50 GALLON GAS WATER HEATER
Heat Type(Electric,Gas, Other):
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees: Fees
Item Contractor $ 29.50
MECHANICAL WASHINGTON ENERGY SERVICES $ Zg.50
TOTAL FEES:
OFFtCIAL USE ONLY
ApplicanYs Affidavit: lication and know the same
I ceRify that I have read and examined the information contained within the a yp licable Cit of
Yelm re ulat ons including thoselgove ning zon ng andtland subdivis onf an�dtin a'dd tionpall covena ts, #Sets of Prints:
g Final Inspection:
easements and restrictions of record. If applying as a contractor,I further certify that I am currently
registered in the State of Washin ton: j � � Date:_____.__._--
;j' Date �1 , �/,
Signature � ,:' BY�
�
Firm � —
Cit� of Yelm
c36 ) 4�a—a���
REC#: �01699�8 BI�O/'2014 10:39 HM
OPER: CO TE�'M: 001
REF#: 1644
TRAN; 33,OU00 BUILDTNG PERMITS
20140232 29.50CR
SIMPSON, ROCKY
3U2 EDWARpS ST SW
MECH 29,50CR
TFNUEREa; 29,50 CHECK
� APPLIED: 29,5�-
�HANGE: -_________._ �,00
����z3a
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:
302 EDWARDS ST SW Parcel#: �5300701100
Subdivision: Lot#: Zoning;
New Construction � Re-Model/Re-Roof/Addition Home Occupation Sign
Plumbing �Mechanical Mobile/Manufactured Home Placement Other
Project Description/Scope of work: REPLACE 50 GALLON GAS WATER HEATER
Project Value:
Building Area (sq. ft) 15f 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 UWNER NAME: Roc►cY a siMPSON
ADDRESS 302 EDWARDS ST SW EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE 360-252-osoo
ARCHITEC�CtENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
Washington Energy Services TELEPHONE $00-398-4663
GENERALCONTRACTOR EMAIL
ADDRESS 3909 196th St SW
C�N Lynnwood STATE wa Z�P 98036 FAX 30501
CONTRACTOR'S LICENSE# �NASHIES9710B EXP DATE9/�5 CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANIGAL CC?NTRACTC3R 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 wiil be in accordance with the laws,rules and regulations of the State of Washington and the
City of Yelm.
,� '� � � �
� � ; �
� �G Z-L�� '� /-�„ �`j Date �� v�.
ApplicanYs Signature please circle one.)
Owner/Contractor/Owner's Agent/Gontractor'S Ag�. (
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 Avenue West (360)458-3144 FAX
PO Box 479 wu�w.ci.yelm.wa.us
Yelm, WA 98597