20140301 Permit Pkg 12222014 '�o� TH�o,� �' City of Yelm Permit ►vo.: 20140301
w ,
� r� Community Development Department Issue Date: 12/22/2014
d � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
ELM
"",""°" Fax: (360)458-3144
Applicant:
Name: MARJORIE E STOREM Phone:
Address: 1310 YELM AVE W
YELM WA 98597
Property Information:
Site,4ddress: 1310 YELM AVE SE Owner: MARJORIE STOREM
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: WASHINGTON ENERGY SERVICES Phone:
Address:
3909 196TH ST SW
LYNNWOOD WA 98036
Contractor License No.: 10807 Expires: 12/31/2015
Project Information:
Project: PLUMBING
Description of Work: REPLACE 50 GAL GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING WASHINGTON ENERGY SERVICES $ 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 Was � ton.
. �7� Date:
Signature Date .�
By:
Firm
i
Cit� af Yelm
(36 ) 458-8402
REC#: 00781402 lZl2Z%2014 12:40 PM
OPER: CO TERM: 001
REF#: 1981
TRAN: 33.�000 BUILDING PERMITS
z0i40301 27.00CR
STOREM, MARJORIE E
1310 YELM AVE SE
p� 27,OOCR
TENDERED; 27.00 CHECK
APPLIED: 27.00-
CHANGE: 0.00
�]�f,� �(f}� �
OlN►"Y� �►�-� l
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 1�10 NJ YELM AVE _ Parcel#: 21724210103
Subdivision: Lot#: Zoning;
New Construction � Re-Model/Re-Roof/Addition Home Occupation Sign
Plumbing �Mechanical Mobile/Manufactured Home Placement Other
Project �escription�scope otwork: REPLACE 50 GAL GAS WATER HEATER
Project Value:
Building Area (sq. ft) 1S` 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 OWNER NAME: MAr��oRiE E sroREnn
ADDRESS 13�o wvF�M HvE — EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE 360-458-3549
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR Washington Energy Services TELEPHONE 800-3ss-4ss3
ADDRESS ssos�sstn s�sw EMAIL
C�� Lynnwood STATE wA ZIP 98o3s FAX
CONTRACTOR'S LICENSE# WASHIES97108 EXP DATE9i�5 CITY LICENSE# 30501
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTQR 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,rules and regulations of the State of Washington and the
City of Yelm.
App icant's Signature D te �
Owner/Contractor/Owner's Agent/C`ontractor'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
� �����t���fF�{`.���
� DEC � 2 2014 '
� ;
705 Yel�n Auenue WesC ''(360)458-3835
PO Box 479 �-{360}458 3-144�'� -__;
Yelm,WA 98597 mww.ci.yelna.w¢.�is