20140265 Permit Pkg 10232014 �.o� TH�,,� City of Yelm Permit ►vo.: 20140265
� ,
� �� Community Development Department Issue Date: 10/23/2014
o, en (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
.`"'""°" Fax: (360)458-3744
Applicant:
Name: MARJORIE STOREM Phone: 360-458-7285
Address: 1310 YELM AVE W
YELM WA 79449
Property Information:
site Address: 115 MTN VIEW RD NW owner: MARJORIE STOREM
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: MIKE MOORE PLUMBING REPAIR Phone:
Address: MIKE&SUE MOORE
PO BOX 327
EAST OLYMPIA WA 98540
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: REPLACE HOT WATER TANK- ELECTRIC
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING MIKE MOORE PLUMBING REPAIR $ 27.00
TOTAL FEES: $ 27.00
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 Washing
;� �d ��� _ �� Date:
Signature /�2/ J�GILli Date
By:
Firm
Cit� of V�lm
(36 } 458-84Q2
REC#: OU175769 1U/23/Zp14 1p;21 pM
OPER: CO TERM: 001
REF#: 1746
TRAN: 33.0000 BUTLDING PERMITS
20140265 27.00CR
STOREM, MARJORIE
115 MTN VIEW RD NW
PL 27.00CR
1ENDEREQ: 27.00 CHECK
APPLIED: 27.00-
CHANGE: 0.00
��
CITY OF YELM C7'�
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: `�= � ��w � Parcel#:
Subdivision: Lot#: P►an#: Zoning:
!1 New Construction/ i; Re-Model/Re-Roof/Addition �� Home Occupation Sign
�Plumbing .y�Mechanical -� Mobile/Manufactured Home Placement �,, Other
Project Description/Scope of Work:��.¢rs %•���%���'� T J�— �����'
Project Value:
Building Area(sq.ft) 1S` Floor 2nd Fioor Garage _� Deck
Basement Carport Patio
#Bedrooms_ #Bathrooms_ Heating: GAS/OTHER LECTR (Circle One)
Are there any environmentally sensitive areas located on the parcel? �_
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: a
ADDRESS EMAIL _
C�N STATE ZIP TELEPHONE ""
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 O HONE ' �
ADDRESS EM L
CITYL�:ACJ�STATE ZIP FAX
CONT TOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICALCONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP F�
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 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.
; �
- /v- - ��?' - l�-
Ap s Signatu Date
wner 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
� � � x M°=����:��,-���T�D
� � (1('T � 7 �014
105 Yelm Auen.ue West (360)!458 3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us �