20140261 Permit Pkg 10152014 �"o� �'H�p,� City of Yelm Permit ►vo.: 20140261
� ,
� � Community Development Department Issue Date: 10/15/2014
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
"".`"'""�'" Fax: (360)458-3144
Applicant:
Name: MIKE BUETTNER Phone:
Address: 16201 PRAIRIE HTS ST SE
YELM WA 98597
Property Information:
site Address: 16201 PRAIRIE HTS ST SE Owner: MIKE BUETTNER
Assessor Parcel No.: 69270002700 Subdivision: Lot:
Contractor Information:
Name: PRATTS PLUMBING Phone:
Address: PAMELA PRATT
3301 46TH AVE NE
OLYMPIA WA 98506
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS WATER HEATER WITH SAME
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL PRATTS PLUMBING $ 29.50
TOTAL FEES: $ 29.50
Applicant's Affidavit: OFFICIAL USE ONLY
I ceRify 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 tate of Washingto
� � Date:
Signature ` Date
By:
Firm
Cit� of �elm
(36 ) 458-8402
�2EC#: Op 175�769
OPER: �p ��115/2014 3:10 PM
REF#: rERM; Oal
6827
TRAN: 33,OOOU Bl�ZLp�yG pERMITS
20140261
BUEI�TNER �g��OCR
16201 PRAIF�IE HTS ST SE
MECH
2g.50CR
TENDERED;
APPLIED: 2�.50 CHECIf
29.50-
CHANGE: �`�-°------_
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CITY OF YELM
RESIDENT(AL BUILDINt3 PERMIT APPLIGATION FQRM
Project Address: ��a��/ f I'f�/�'/5��� Parcel#: ��o[ '7��D�'�0�
Subdivisian: Lot#: � Plan#: Zoning:
� New Canstruction , Re-Model /Re-Ropf/Addition � Home Occupatlon Sign
_, Plumbing � Mechanical '� MobiEe/Manufactured Home Ptaaement � Other
Project Description/Scope of Worlc; �P,�./9: _ f,�/�i3�P.i� �J9tl'•l�� /,c�i�� ��I'��
Pro�ect Value:
Building Area(sq. �#) 1�Floor 2"tl �Ioor Garage Deck_ ,
8asement Carport Patio
# Bedrooms_ #�Bathrooms_ Heating: GAS/�T�IER or ELECTRIC �Circle�ne)
Are there any environmentaliy sensitive areas iocated an the parael?
lPy�es, a completed enviranrrtentak checklist mvs#accompany permit appfication.
BIJILl�I�IG O11WT�1ER l�li0.ME:
ADDR�SS �MAIL
CITY STATE ZIP TELEPHONE
f�►RCHITECT/ENGINEE ' LICENS�#
ADDRESS ' EMAIL
CIN STATE ZIP TELEPMONE
GENE�iL�C�1`�TRAGTOR! TELEPHONE
ADDRESS � �MAf L
CITY STA7� ZIP F
CONTRAC70R'S LIC�NSE# � EXP DATE CITY LIC�,NSE#
PLUMBEI�' -�t�1'Rfi�T01� ' TELEPHONE
ADDRESS '� ' EMA1L
CITY D/ STATE ZII' FAX
CONTRA T R'S LICENS�# e EXP DATE CITY LfCENSE# bQ .�Q'�"l�,Q
....... .... ...... .. .
MECHANTCAC;`CONTRAC R T�LEPHON�
ADDRESS ' EMAiL �
CITY STAT��Zi P FAX
CONTRACTOR'S LIC�NS�# EXP DATE CITY LICENSE#
Copy of mitigatlon'agreement with Yelm Community Schoals, ff appficable.
1 he�eby certify tfiat the above(n�ormation is correct and that the Constraction on,and the occupancy and tha use of the
abave Aascrtkled propelty witl be in accorddqce with the laws,rules and reguldtlon9 of the State of Wd5hington and the
Clty of Yeim. �
r
Applicant's Signature Date
Owner/Contractor/OwnePs Agent/Contractor's Agent(Please circle one.)
All perm':ts are n,on-transferable and will expire if wflrk authorized E�y such permit is not begun
within 180 days of issuanGe, o�if woric is suspended or abandoned for a period,q,#�84-da�$._g—.-.--
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