20150159 Permit Pkg 04132015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: MATTHEW IDZIAK
Address: 117 MOSMAN AVE SE
YELM WA 98597
Property Information:
Site Address: 117 MngRAAN AVF CF
Assessor Parcel No.: 22719331500 Subdivision:
Contractor Information:
Name: PAUL'S CUSTOM HEATING A/C INC
Address: PAUL GUIRSCH
PO BOX 4595
SPANAWAY WA 98387
Contractor License No.: 10547 Expires
Permit No.: 20150159
Issue Date: 4/13/2015
(Work must be completed within 180 days)
Phone
360- 339 -0611
Owner: MATTHEW IDZIAK
Phone:
12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: GAS TO GAS WALL FURNACE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
PAUL'S CUSTOM HEATING A/C 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 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 St f Wash'n
Signature s�/ ` Date
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
qV150 f 5 q
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: J' '7 !+ l o s m GZn AUC S Parcel
Subdivision: Lot #: Plan #: Zoning:
New Construction i Re -Model / Re -Roof /Addition i Home Occupation Sign
Plumbing
Wmechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:
Project Value:_ -7 062, 00
Building Area (sq. ft) 1" Floor 2nd Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating GA 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: R q Q Je..I i
ADDRESS j j 7 u , nI ck n 1/4✓ $L EMAIL
CITY V"_ l m STATE L4/4__ZIP�, �i,i TELEPHONE 360 – 2 15 J1 ! 7S i"7
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 #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR -Moi s ,Lut,,4a" /feA ;:!.5TELEPHONEJ: 60 ^4 /SE—I cf C79
ADDRESS I ' _ EMAIL
CITY. no u STATE ZIP -,32ZFAX 360 e-15e r
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 YO
'A � Z/ C �>i
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 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
APR 10 2015
(360) 458 -3835
(360) 4 8-3144 FAX
L =_ y —
City of Yelm
(3E ) 458 -3244
REC #: 00192038 4/13/2015 2:19 PM
OPER: CO TERM: 001
REF #: 12302
PAID BY:
TRAN: 33,0000 BUILDING PERMITS
20150159 29.50CR
IDZIAK, MATTHEW
117 MOSMAN AVE SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00