20150168 Permit Pkg 04272015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: DAVE /DARLENE BORLAND
Address: P.O. BOX 2447
YELM WA 98597
Property Information:
Site Address: 191A2 PPAIRIF r_RFFK I P SF
Permit No.: 20150168
Issue Date: 0/00/0000
(Work must be completed within 180 days)
Phone: 360- 878 -1085
Owner: DAVE BARLAND
Assessor Parcel No.: 69240002400 Subdivision: PRAIRIE CREEK Lot: 24
Contractor Information:
Name: BRENNAN HEATING
Address:
4601 S 134TH PL
SEATTLE WA 98168
Contractor License No.: 10111
Phone:
Expires: 12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: REPLACE NATURAL GAS FURNACE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BRENNAN HEATING
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 proposed structure is in conformity with all applicable City of
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
registered in the State of Washington. 4v? I)
_ZPI O� 1 Lc. jlQ 7 2U
Signature : Date
� S
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
�lt� o45se3m44
(36 )
REC #; 00193449 00172015 10:14 AM
OPER. CO
REF #: 42230
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20150168
BORLAND, DAVE /DARLENE
16142 PRAIRIE CREEK LP SE
MECH
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE; 0.00
7VS01 lab
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 1(o 14 2 Pr , it ; c Cr e cK Lp Parcel #: (a cl 24 o 0o 2.t-} o o
Subdivision: Lot #:: Plan #: Zoning:
P, New Construction Re -Model / Re -Roof 1 Addition C Home Occupation Sign
I i Plumbing mechanical ❑ Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:_ nst a I I Le nn ri X 0M. 00S -FU r n a c e
Project value: 3 Cf 0 b Dllla�_ rix' r_;�(
7
Building Area (sq. ft) 1" Floor 2 "d Floor ��� Garage
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: av z , l
ADDRESS 5AA EMAIL
CITY' t I nn STATE WA ZIP X j8 �TELEPHONE 3 (o y
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR_ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ADDRESS
CITY
CONTRACTOR TELEPHONE
STATE ZIP
LICENSE #
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR 6rarinctri ttcatinq TELEPHONEZU1- • V-1,2> .�Lio0
ADDRESSit(pvi S 134 " PI 1— EMAIL, VA 'A I'c C)brenngnh ��f7� co
CITY 1 V r_VV l a STATE LAJt�- ZI P qOl tv 8 FAX - *Z44g . 9 R o S'
CONTRACTOR'S LICENSE #J5+_ENn1 +1Agq -I EXP DATE CITY LICENSE #
tZJ2^(tS
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.,
A plicant's Signat 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 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
APR 2 2015
Karen Bennett
From: Jaimie How Uaimie @brennanheating.com]
Sent: Tuesday, April 21, 2015 12:38 PM
To: Karen Bennett
Subject: Mechanical App
Attachments: borlandmechapp. pdf
Importance: High
Please let me know the fee due once processed and ready for pick up.
Thank you,
Jaim %e How
Permit Coordinator
Brennan Heating and Air
206.248.7900 office
877.273.6626 (toll free)
206.248.7905 fax