20150167 Permit Pkg 04232015Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20150167
Issue Date: 4/23/2015
(Work must be completed within 180 days)
Name: MARILYN ZIEBELL Phone
Address: 1307 CRYSTAL SPR ST NW
YELM WA 98597
Property Information:
Site Address: sm 103RD AVE NE Owner: MARILYN L ZIEBELL
Assessor Parcel No.: 22730110100 Subdivision: N/A
Contractor Information:
Name: WESCO Phone: 206 - 378 -2033
Address:
360- 458 -2014
Lot:
2800 THORNDYKE AVENUE WEST
SEATTLE WA 98199
Contractor License No.: WASHIES9710B000 Expires: 9/28/2011
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 50 GALLON GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
WESCO
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 J (ashingt9n.
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
(3 o4 8 3'244
It
23/2015 3:00 PM
REC #: 001933TE 4
RM: 001
OPER, CO
REF #: 9849
PAID BY.
IRAN: 33.0000 BUILDING 50CRIT3
20150167 MARILYN
ZIEBELL,
502 103RD AVE NE
29.50CR
MECH
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE:
�0(56/�7
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 502 103RD AVE NE Parcel #: 22730110100
Subdivision: Lot #: Zoning;
❑ New Construction V( Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing . Mechanical ❑ Mobile / Manufactured Home Placement ❑ Other
Project Description/Scope of work: REPLACE 50 GAL. GAS WATER HEATER
Project Value: $950.00
Building Area (sq. ft) 1St Floor 2nd Floor Garage Deck,
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: MARILYN L ZIEBELL
ADDRESS 502103RD AVE NE EMAIL
CITY YELM STATE WA ZIP 98597 TELEPHONE 360 -458 -2017
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR WESCO TELEPHONE 800- 398 -4663
ADDRESS 3909196th st sW EMAIL
CITY lynnwood STATE WA ZIP 98036 FAX
CONTRACTOR'S LICENSE # WASHIES9710B EXP DATE9i15 CITY LICENSE # 30501
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
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 Yelm. / /(
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
a
°1TFD
APR 2 2015
105 Yelm Avenue West (360) 458 -3835
PO Box 479 (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us