20140277 Permit Pkg 11142014 �o� TH�p,� City of Yelm Permit No.: 20140277
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� '� Community Development Department Issue Date: 11/14/2014
(Work must be completed within 180 days)
Building Division
Phone: (360)458-8407
L
e�+�rg*ON Fax: (360)458-3144
Applicant:
Name: SOUTH PUGET SOUND HABITAT FOR Phone:
Address: 415 OLYMPIA AVE NE
OLYMPIA WA 98501
Property Information:
Site Address: 412 YELM AVE E Owner: SPS HABITAT FOR AMERICA
Assessor Parcel No.: 22719340500 Subdivision: Lot:
Contractor Information:
Name: SOUTH PUGET SOUND HABITAT FOR Phone:
Address: CALEB
415 OLYMPIA AVE NE
OLYMPIA WA 98501
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALLATION OF GAS FURNACE
Sq. Ft. per floor: First Heat Type(Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
MECHANICAL SOUTH PUGET SOUND HABITAT FOR $ 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 governing zoning and land subdivision,and in addition,all covenants,
easements and reS�rictions of recslrc�-I# lying as a contra r I further certify that I am currently Final Inspection:
registered in the State of Was�iington. �
Signature;
�f� Date / �y � Date:
_ By.
Firm
Cit� af Yelm
(36 } 458-8q02
REC#; U0177959 11/14/2014 8:47 AM
OPER: CO TERM: 001
REF#:
TRAN: 33.0�00 BU.TLDING PERMITS
20140277 29,50CR
SOUTH PUGET SOUND HABITqT FpR
412 YELM AVE E
ME�H 29,5UCR
T�pN� 3Q.0000 BUSINESS LICENSE
NORTHWEST REFRIGERATION
6U5TNESS LICENSES & 35,OO�R
TENDERED: 64,50 OTHER
APPLIEp; 64.50-
CHANGE: �~ 0 00
NOV/13/2014/THU 10: 39 AM FAX No, ��l/001
o��`� � 02-
CiTY OF 1(ELM
j���,�����COMMERCIAL BUILDING PERMIT APPLICATION FORM Q
�i
Pro]ect Address:�l� Y��r �rt.c.�� Parcel#:���.��"��d
Zoning;
� � �Curren�Use-�����'C Proposed Use:
❑ New Constructio�- ❑ Re�Model/Re�Roof/Tenant Impravement
❑ Plumbing �'Mechanicai ❑ Fire PrevenUSuppress/Alarm ❑ Other
ProJect DescrlptianlScope of Work: �s-��/ � �1"N-T- ���
Project Value: ` `�
Building Area(sq.ft) Parking Garage 1g`F(oor 2n°Floor 3"0 Floor
i
Building Height ���"
Are there any environmentally sensitive areas located on the parcel? _� If yes, a
completed envirQnmental checklist must accompany permi#application.
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ADDR�SS EMAIL
CITY STATE ZIP TELEPMONE
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CITY STATE ZlP T�L�I'HON�
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ADbR�SS ---- _ _�EMAIL _
CITY STATE Z!P_— _ _____.FAX
CONTRACTOR'S L10EfVSE# EXP DATE CITY LICENSE#
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ADI]RESS EMAIL
CITY STAT� ZIP FAX
CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE#
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ADDRESS C � � ' EMAIL 6�s�„�������' ��
CITY v�, STATE G..� ZIPS'�d�FAX 2�� ?� ��3'�
CONTRACTOR'S LICENS�# '- �Xp DAT� CITY LICENSE#
Copy of Clty Mltlgatlon documantatlon(TFC). l�;, � �f/ � � .�! ' '. / ' `!
I hareby caitliy that tho abova iiNormatlon la corract and that tha constnlc�on�n�y29ff 8'4lle�ancy and tho use of 4he
abov�dascrlbad proparty wlll bo ln accordanca wlth!hs laws,rulas and rsgulaHons oi ths 3tats of Waahington and tho
Clty oi Yelm.
_L/ - __�3
App�cant's Signature , Date
Owner/Contractor!Owner's Agent/Contractor's Agent I Tenant (Please circle one.)
A!1 permits aze non-transferable and will expire it work aulharized by such permit is not begun
within 180 days of issuance,or if work is suspended or abandoned for a period of 1$0 days
� ��o
(360)458-3835
T 05 Yelm Aue W (S60)4�8-8144 FAX
�elm, VVA 98587 roww.ei.yelm.wa.us