20140284 Permit Pkg 11242014 �o� TH�p,� City of Yelm Permit No.: 20140284
�
� ~7� Community Development Department Issue Date: 71/24/2014
a � (Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
WP6MIMGrqry Fax: (360)458-3144
Applicant:
Name: LLC PHE Phone: 253-468-7373 BRANDON
Address: 2661 N. PEARL ST#169
TACOMA WA 98407
Property Information:
site Address: 1202 CRYSTAL CT NW Owner: PHE, LLC
Assessor Parcel No.: Subdivision: Lot:
Contractor Information:
Name: LLC PHE Phone:
Address:
2661 N. PEARL ST# 169
TACOMA WA 98407
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: PLUMBING
Description of Work: NEW ELECTRIC HOT WATER TANK
Sq. Ft. per floor: First Heat Type(Electric,Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
PLUMBING LLC PHE $ 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 t e State of Washington.
/ Date:
Signat U Date �'� �
Firm By�
Cit �f�elmo�
(36�) AM
11/2412014 10:�6
R��#: 0017886 ERM: 001
ppER; CO
REF#:
1RAN;
33.00C10 6UYLDT 27 pOCRITS
2p140284
pHE, LLC
1202 CRYSTAL �T 27w�0��
PL
TENDERED: 4U,00 CASH
APPLIED:
27.00-
GHANG�:
�'�'- 13 00
. �
CITY OF YELM
RESIDENTIAL BUILDING PERMIT PPLICATION FORM
� Project Address: �L� I J �C'L� �� / 'CP'arcel :
� ` J �.
Subdivision: `tot#: Plan#: Zoning:
, New Construction i� Re-Model/Re-Roof/Addition �� Home Occupation Sign
�,Plumbing !_� Mechanical ❑ Mobile/Manufactured Home Placement ❑ Other
Project Description/Scope of Work:�l�,/�1�'�1/,� �� �� l\
Project Value: ���� '—
Building Area(sq. ft) 15` Floor 2"d Fioor Garage� Deck
Basement Carport Patio
�
#Bedrooms� #Bathrooms_r Heating: GAS/OTHER or LECTRIC(C' cle One)
�
Are there any environmentally sensitive areas located on the parcel?
lf yes,a completed environmental checklist must accompany permit application.
BUI�DING O NER NAME: � " '
ADDRES � ' ° ( `? � G EMAIL C `�C�� �
CITY STATE�,7JY�J- ZIP TELEPHONE � �` �
ARCHITECT/ENGINEER LICENSE#
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERALCONTRACTOR TELEPHONE
ADDRESS EMAIL
` CITY STATE ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
PLUMBIN�CO TRACTOR Yf � l"Yl%'t TELEPHONE�S3 �t � ' l_
ADDRESS� C� �C - � . EMAIL
CITY 1�1,V n�ti���`�l,l� • STATE L i�-. ZIP . � FAX
CONTRACTOR'S LICENSE# TI,t;A,�('(',I?�� N'EXP DATE_CITY LICENSE#
MECHANICAL CONTRACTOR 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.
I
" r� !� � ' �( � �� �1� ��� � /�
Ap�i icant's Signature Date
qwner/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
105 Yelm Avenue West (360)458-3835
Yelm,WA 98597 (360)458-3144 FAX
www.ci.yelm.wa.us