20140251 Permit Pkg 10032014 '"�a� ''H��,�,�" City of Yelm Permit No.: 20140251
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� � Community Development Department Issue Date: 10/03/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
EL
Fax: (360)458-3144
Applicant:
Name: JESSE MOORE Phone:
Address: 16207 PALOUSE AVE SE
YELM WA 98597
Property Information:
Site Address: 16207 PALOUSE AVE SE Owner: JESSE MOORE
Assessor Parcel No.: 32640000300 Subdivision: Lot:
Contractor Information:
Name: SUNSET AIR INC Phone:
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALLATION OF HEAT PUMP
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL SUNSETAfR INC $ 29.50
TOTAL FEES: $ 29.50
Applicant's 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 vernin zoning and land subdivision,and in addition,all covenants,
easements and restri s of cord lyin a contractor, I further certify that I am currently Final Inspection:
registered in the of shin o .
Sign Date
� Date:
Firm By�
Cit� of Yelm
(36 ) 458-8402
REC#; 001735�3 1G/03/2p14 3;33 PM
OPER: CO TERM; 001
REF#; 34505
TRAN: 33.00��0 BUILqING �ERMITS
20140251 29.50CR
MOORE, JESSE
16207 PALGUSE AUE SE
MECH 29.50CR
TENqFREp; 2g,50 GHECK
APPLIED: 29.50-
CHANGE: ��0
SEP/15/2014/�ON 02: 41 P� Sunset Air FAX No, 360 456 4990 P, 002
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C17Y OF YELM ��-1�� (
. R�SID�NTIAL BUILDING PERMiT APPLICATION FORM
ProjectAddress:��Z, �i���wu-c--G�`J � Parcel #: ��1��"1����� lJ
Subdivisian: l.ot#: ,�oning;
Q New Construction_ ❑ Re-ModeE/Re-Roof/Addition ❑ Home Occupation Sign
❑ Plumbing `�Mechanical o Mobife/Manufactured Home Placement ❑ Other
�
Project Description/Scope of Work: � f . � .l`nP Q`/�(1�� '` ` '#
Prvjecf Value:�'Z�,?� �� _ _ _ ____ _
Building Area(sq, ft) 1s`FEoor 2"d Floor Garage Deck
Basement Carport Patio
# Bedrooms_ #Bathraoms_ Heating: GAS/OTFlER pr ELECTRIC (Circfe One)
Are there any environmentally sensitive areas located on fhe parcel? If yes, a
completed environmental checklist mu5t accompany permit appEicatian.
BUILDING OWIVE N,�u1 : l�
ADDRES �'� EMAIL
CITY • STATE ZIP ' TELEPHONE —
ARCHITECTlEN I EER LfCENSE# '
ADDRESS � � EMAIL
CE7Y S7A7� ZIP TE��PHONE
G�NERAL CONTRACTOR. T'ELEPH N�
ADDRESS � I EMAlL � , r��_
CITY LP� ATE ZIP FAX
CON RAC,T R'S LICENSE# XP DATE CITY LICENSE#
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STA7E Zlf� FAX
CONTRACTOR'S LICENS�#� �XP DATE CITY LICENSE#
MECHANICAL CONTRACTOR TELEPH�N�
ADDRESS EMAIL
ClTY STATE Zf P FAX �
CONTRACTOR'S LIGENSE# EXP DATE CITY LICENSE# �
Copy of mitigation agreement with Yelm Community Schools, if applicable,
I hereby c� ify Eh the abova information is correct and that the constrvctlon on,and the occupancy and the use
of the atfore descr ed property will be in aCGOrdance with the laws,rules and regulations of the State of
Washingtan and t Cfty af Yetm.
--•- —-- -— - - � � ---
Applicant' Signature Ra e
Owner/Contractor 1 Owner's ABent 1 Contractor's Agent (please circle one.)
A!i perrntts are non�transferable and will expire if work authorized b�such permit ts not
begun within 180 days af issuance, or if work is suspended o�abandon�c�for a period of
1 SO ciays
._. _
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R:\Forms&Procedures�Building C�ermiu�2esBldgpermitApp.docPage 2 of 3 ' �6 r 1 11 2�14
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SEP/15/2014/�ON 02, 41 PM Sunset Air FAX No, 360 456 4990 P. 001
SUNSET ATR , TNC
PHONE: (350) 456-4956 FAX: (360) 456�4990
5210 LACEY BLVD. LACEY, WA 98503
F�1�C TRANSMISSTON
TO: `
DATE/TIME; �'l(�1�-/
COMPANY� �Jj���
FAX #. �(Qd �- ��gJ �� � 7
FROM: ROMY MEYER - RTMC�SUNSETAIR.COM
COMMENTS:
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missing, plense canfi4ct me a�t the above number.