20150148 Permit Pkg 04172015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PALISADES WEST HOMEOWNERS ASSO
Address: PO BOX 39
EAST OLYMPIA WA 98540
Property Information:
Site Address: 1f1.5R PAI ISAnFS ST SF
Assessor Parcel No.: 67110000006
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Permit No.: 20150148
Issue Date: April 17, 2015
(Work must be completed within 180 days)
Phone: 360- 790 -3683
Owner: NORTHWEST FAMILY HOMES
Subdivision: PALISADES WEST Lot:
Contractor License No.: 10734 Expires
Phone:
12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: DUCTLESS HEAT PUMP INSTALL
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
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 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% �e�itat of Washington.
Signature G' L Date ( ,
Firm vl ) 7 f
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
lY "4 5g�3�244
(360)
REG #: 00192870 4/17/2015 2:11 PM
OPER: GO TERM: 001
REF #: 34822
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150148
PALISADES WEST HOMEOWNERS ASSO
10558 PALISADES ST SE
MECH
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
MAR /24/2015/TUE 01:15 PM Sunset Air FAX No.360 456 4990 P,002/003
CITY OF YELM
fin
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: /(,L Y(2) t'' ��✓�Gt S1SEparcel #; onnr)0Q '
Subdivision: Lot #; Plan #: Zoning:
E New Construction ❑ Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
E Plumbing
XI
Mechanical D Mobile / Manufactured Home Placement ❑ Other
Project Description /Scope of Work:
�7
Project Value: �' `f n / 0
Building Area (sq. ft) 1 s1 Floor 2"° Floor 3`' Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms____, # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application./
ADDRESS U 4 Cl _ EMAIL
CITY (� /JJ�]d TATE _ZIP TELEPHONE79
x __a LICENSE #
ADDRESS EMAIL
CITY STATE TELEPHONE
MINIMUM TELEPHONE
ADDRESS EMAIL
CITY STATE P FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
TELEPHONE
ADDRESS EMAIL,
CITY S ZIP FAX
CONTRACTOR'S LICENSE # ` EXP DATE CITY LICENSE #
G�
)Jf C�fTELEPHON -)ir) yam,_
ADDRESS / EMAIL/`t%I cam. C
CITY S' ATE ZIPq FAX
CONTRACT R'S LICENSE jn EXP DATE _CITY LICENSE # �
Copy of mitigation agreement with Yelm Gommuflity schools, if applicable.
I hereby ceAn 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
f Palm_
AopfiGant'sl Signature Date
Owner I Contractor I Owner's Agent I Contractor's Agant (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 Avetue West (360) 458 -3835
Yelm, WA 96597 (360) 458 -3144 FAX
www.eiyelm.u,a.its
MAR /24 /2015 /TUE 01:15 PM Sunset Air FAX No.360 456 4990 P.001/003
SUNSET AIR, INC
PHONE (360) 456 -4956 FAX: (360) 456 -4990
5210 LACEY BLVD. LACEY, WA 98503
FAX TRANSMISSION
TO:
DATE /TIME:
COMPANY:
FAX #: Iff
FROM: ROMP MEYER — RTM@SUNSETAIR.COM
COMMENTS:
Paot
Ray.
a
ins I � Jhanr- K.
This transmission contains pages, including this cover page_ If any page is
missing, please contact me at the above number.