20150139 Permit Pkg 03162015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20150139
Issue Date: 3/16/2015
(Work must be completed within 180 days)
Applicant:
Name REGINA REEDER Phone: 360- 458 -6070
Address: P.O. BOX 1362
YELM WA 98597
Property Information:
Site Address: 207 FOURTH ST SE Owner:
Assessor Parcel No.: 64420800700 Subdivision:
REGINA REEDER
Contractor Information:
Name: SUNSET AIR INC Phone:
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: 10734 Expires: 12/31/2015
Project Information:
Project: PLUMBING
Description of Work: GAS HOT WATER REPLACEMENT
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
Contractor
SUNSET AIR INC
TOTAL FEES:
Applicant's Affidavit:
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 pro osed structure is in conformity with all applicable City of
Yelm regulations including those governi oni g and land subdivision, and in addition, all covenants,
easements and restriction§ of recor I pplyi a contr r, I further certify that I am currently
registered in the StatgpgWash' o
Date `-)
Firm
Lot:
Fees
$ 25.00
$ 25.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Ciuof Yo)m
(36 ) 458 -3244
REC #: 00189747 3/16/2015 8 :15 AM
OPER: CO TERM: 001
REF #: 34802
PAID BY:
TRAN: 33,0000 BUILDING PERMITS
20150139 25 -GOCR
REEDER, REGINA
207 FOURTH ST SE
PL 25.000R
TENDERED: 25.00 CHECK
APPLIED: 25.00 -
CHANGE: --- ________0,00
MAR /16/2015/MON 08:50 AM Sunset Air
FAX No. 360 456 4990 P.001/001
CITY OF YELM
RESIDENTIAL CBUILDING PERMIT APPLICATION FORM �1
Project Address: rit; j `�1 � ST. J, Parcel #' U LI ) � t► y � 0
Subdivision: Lot #- _ Plan M Zoning:
❑ New Construction D Re -Model / Re -Roof / Addition C Home Occupation Sign
lumbing C Mechanical C Mobi�le/ Manufactured Home Placement D Other
Project Descriptio(n/Stcooppe of Work
pU
Project Value: . 00
Building Area (sq. ft) 1" Floor 2 "" Floor P Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms— HeatingdG(�OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? jy'u
It yes, a completed environmental checklist must accompany permit application.
ADDRESS ICU —EMAIL
CITY STATE [ &2A ^ ZIP U 6K TELEPHONE L
7r'or5. -i ei:nc"r>. r9ii`rii�� I?. W M LICENSE= #
,i` »;�,�}.•�_, fir, �,k,,...�..,.�- ,_,�.:e�.,.� lt:.e' -
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
VIAL NQRr TELEPHONE
ADDRESS EMAIL
CITY L ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ADDRESS
CITY
CONTRACTOR'S LICEI`
TELEPHONE
ATE ZIP FAX
EXP DATE CITY LICENSE #,
CITY t TAT ZIP FAX ' °
CONT AC R'S LICENSE #, L+ EXP DATECITY LICENSE #_
-11.3111
Copy of mitigation agreement with Yelm Community Clools, 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
Applicant's Signature Date
Owner / 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 Yetm Avenue West 060) 458 -3835
Yednb, WA 98597 (860) 458 -5144 FAX
wruw.c1,ye1m,W a,us